What can integrative oncology contribute to rehabilitation and employment for cancer survivors?
Unemployment is associated with cancer survivorship and seems largely related to disability, according to a new meta-analysis of cancer studies that are mostly from the United States and Europe.
Overall, cancer survivors were 1.37 times more likely to be unemployed than healthy control participants (33.8% vs 15.2%) in the analysis, which appears in the February 18 issue ofJAMA.
Unemployment for cancer survivors is likely to worsen, said lead author Angela de Boer, PhD, from the Coronel Institute of Occupational Health at the Academic Medical Center, in Amsterdam, the Netherlands.
"Cancer survivors are even more at risk of becoming unemployed in the present economic climate with the rising unemployment rate," she said, explaining that the higher the national/local unemployment rate, the higher the unemployment rate of survivors, relative to controls, in various studies.
However, Dr. de Boer believes that clinicians are uniquely positioned to help. "Research also shows that patients have difficulties with when and how to return to work, and that they highly appreciate their doctors' advice here," she said in an interview with Medscape Oncology.
The not-so-bright situation is ripe for innovation, suggest Dr. de Boer and her colleagues.
"Employment outcomes can be improved with innovations in treatment and with clinical and supportive services aimed at better management of symptoms, rehabilitation, and accommodation for disabilities," they write.
With almost half of cancer patients younger than 65 years, many patients are at an age where employment is needed for a variety of reasons, note the authors. In the United States, part of the need for work is the need for health insurance. As reported by Medscape Oncology, health insurance for unemployed Americans with cancer can be very difficult and expensive to obtain.
Some Cancers Worse Than Others for Unemployment
In the meta-analysis of 16 studies from the United States, 15 from Europe, and 5 from other countries, there was a total of 20,366 cancer survivors and 157,603 healthy control participants.
Analysis by diagnosis showed an increased risk for unemployment among survivors of breast cancer (pooled risk ratio, 1.28; 95% confidence interval [CI], 1.11–1.49]), gastrointestinal cancers (pooled risk ratio, 1.44; 95% CI, 1.02–2.05), and cancers of the female reproductive organs (pooled risk ratio, 1.28; 95% CI, 1.17–1.40).
Compared with healthy control participants, higher risks for unemployment were not shown among survivors of hematologic cancer, prostate cancer, or testicular cancer.
"We think that the higher disability rate for certain cancers is probably the result of the more extensive and rigorous treatment for those cancers, compared with the treatment for testis cancer, for instance," said Dr. de Boer.
The highest relative risk for unemployment was identified among survivors of nervous system cancer (1.78) and nasopharyngeal cancer (2.47), but these involved single studies only and therefore were not highlighted.
Disability Drives Unemployment
In the meta-analysis, 7 of 36 studies reported on the relation between disability and unemployment.
Subgroup meta-analysis showed that cancer patients were 2.84 times more likely than control participants to be disabled and unable to work or to receive disability benefits. "Therefore, the mechanism behind the higher unemployment rate among cancer survivors is likely to be a higher disability rate," write the authors.
Furthermore, in a subset of 5 studies that included data on reasons for unemployment among participants, the new analysis showed that cancer survivors were more likely than healthy controls to report that the reasons for unemployment were physical limitations, including cancer-related symptoms.
What Can Be Done?
Workplaces can help cancer survivors get back to work by being accommodating of the employee's circumstances and providing paid sick leave during treatment, suggest the authors.
Clinicians and other professionals could also help, but usually shy away from the topic of work, suggested Dr. de Boer.
"We know that most oncologists don't take up any employment issues with the patient," she said, citing previous research at her institution.
However, the hospital at the Academic Medical Center will soon start a novel intervention aimed at supporting cancer patients in their return-to-work process, said Dr. de Boer. The intervention will be executed by the medical staff in cooperation with the employer and an occupational physician.
"The development and evaluation of such interventions is urgently needed because they could mitigate the economic impact of surviving cancer and improve the quality of life for survivors," write the study authors.
JAMA. 2009;301:753-762.
