Risk factors for return to work in workers who experienced cancer: a systematic review with meta-analysis

The number of people who have experienced cancer is increasing, and by 2040 cases are expected to rise by 40%, with a high prevalence among working-age individuals. Many people who experienced cancer (pwEC) face reduced work ability due to health, personal, and occupational factors. Therefore, this study aims to identify the main factors that hinder RTW among pwEC.

A systematic literature search was conducted via PubMed, CINAHL, and the Cochrane Library, covering studies published between January 2012 and June 2024. Inclusion criteria focused on studies analysing RTW and Time to RTW in relation to sociodemographic, clinical, and occupational factors. Meta-analysis grouped studies by design, exposure, and effect measures. Fixed or random effects models were applied based on heterogeneity. Risk of bias was assessed using NOS and RoB2 tools. Certainty of evidence was assessed using GRADE tool and STROBE checklist.

Among 2,151 screened articles, 43 met the inclusion criteria. Chemotherapy (OR = 0.56, 95% CI: 0.52-0.60) and radiotherapy were associated with a reduced likelihood of RTW. Women were more likely than men to RTW. Manual labour was linked to a lower likelihood of re-employment than white-collar jobs (OR = 0.84, 95% CI: 0.78-0.89). In terms of timing, male sex and chemotherapy delayed the process, whereas radiotherapy accelerated it (HR = 1.03, 95% CI: 1.00-1.06).

Identifying barriers to RTW after cancer is essential for improving quality of life and social reintegration in people who have experienced cancer. These findings highlight the complexity of RTW and the need for a personalized approach. However, the evidence is limited by heterogeneity and differences in study design.

The protocol was registered in PROSPERO (registration number: CRD42022384364).