Returning to Work after Lymphatic Cancer Dr. Manpreet Bains

Overview  Background  Lymphatic Cancer & Return to Work (RTW)  Work Ability  Factors Impacting RTW & Work Ability  The Role of Health Professionals: An Interview Study. 2

3 Background  90,000 cancers diagnosed in working age. (Morrell & Pryce, 2005)  RTW represents a sense of ‘normality’. (Barofsky, 1989; Main et al., 2005)  40% take time off work during recovery and treatment. (Short, Vasey & Tunceli, 2005)  RTW rates vary (30-93%). Spelten et al., 2002)

Lymphatic Cancer RTW Rates 4 Author (year)DesignCancer TypeRTW Rate Buchmann et al. (2003)Cross-sectional Leukaemia and lymphoma (N = 163) 70% Edman et al. (2001)Cross-sectional Chronic leukaemia, acute leukaemia and lymphoma (N = 25) 85% Kennedy et al. (2007)Cross-sectional Breast cancer, non- Hodgkin's Lymphoma, uterus cancer, larynx (N = 29) 93% Razavi et al. (1993)Longitudinal Hodgkin’s Lymphoma, non- Hodgkin’s Lymphoma (N = 41) 54% Syrjala et al. (2004)LongitudinalLeukaemia and lymphoma (N = 315) 84%

Cancer & Work Ability “...how able is a worker to do his or her job with respect to the work demands, health and mental resources,” (Ilmarinen, Tuomi & Seitsamo, 2005, p. 3). 5

 Disease and Treatment Related Factors  Person Related Factors  Work Related Factors Factors Influencing RTW & Work Ability

 Cancer Site: Haematological, prostate, lung = worst work ability.  Lymphoma patients: 8.23 males (n = 64); 8.49 females (n = 43). (Taskila et al., 2007).  Treatment: > one treatment modality / or chemotherapy more time taken to RTW and lower work ability. (Amir et al., 2007; Taskila et al., 2007; de Boer et al., 2008).  Psychosocial & Physical Side Effects: fatigue and depression = poor quality of life. (Spelten et al., 2003; Short et al., 2005; Pasquini et al., 2006). 7 Disease and Treatment Related Factors

8 Person Related Factors  Age: 50 years RTW = 30% (Lima et al., 1997).  Gender: 20% of men and 28% of women felt that cancer had impaired their physical work ability. Mental work ability impairments experienced by 23% of men and 28% of women. (Taskila et al., 2007).  Education: Higher education status more likely to be employed after diagnosis than people with less education status and report better work ability. (Taskila-Abrandt et al., 2004).

9 Work Related Factors  Physical Demands: Manual labour jobs experience problems when returning to work. (Spelten, Sprangers and Verbeek, 2002; Main et al., 2005; Maunsell et al., 1999).  Job Type: 78% white-collar remained in job 12 months post diagnosis (blue collar workers 63%). (Mor, 1986).  Workplace Support: Lack of employer accommodations. (Maunsell et al., 1999; Main et al., 2005).

Role of Health Professionals  Do health professionals provide work-related guidance to cancer patients? (Maunsell et al., 1999; Verbeek, 2006).  Few receive work-related guidance from health professionals. (Maunsell et al., 1999; Verbeek et al., 2003; Kennedy et al., 2007).  With continuity of care more specific guidance could be provided. (Verbeek et al., 2003). 10

Aims  To explore the nature and extent to which health professionals provide work-related guidance to cancer patients.  To identify factors that may influence the type of information given. 11

Method  Design -Qualitative approach using a semi-structured interview schedule.  Participants (N = 18; 34 – 57 years) -Consultant Surgeons -Oncologists -Nurses -General Practitioners -Occupational Health Physicians -Occupational Health Advisors 12

Method II  Procedure -Interviews explored the extent and nature of work- related guidance provided -factors that impact upon this -whether any improvements could be made in the future.  Analysis -Thematic analysis (Braun & Clarke, 2006). 13

14 Results Key ThemesSub-themes The Nature of Current PracticeInitiating the Discussion about Work How Information is Delivered Factors Impacting the Provision of Work-Related Guidance Diagnosis and Prognosis Treatment and Symptoms Nature of Employment Barriers to Providing Work-Related Support Lack of Knowledge Insufficient Evidence Base Patients’ Perceptions and Attitudes Time Constraints The Need for a Multifaceted ApproachA Two-Stage Approach Role of the Patient Employer

 Patient contact varied according to health professional’s field, therefore not all provided work- related guidance: “It’s not part of normal practice. Patient asks time to resumption to normal activity, I don’t remember specifically talking to a patient about resuming work. It doesn’t really cross our minds.” Consultant Surgeon. The Nature of Current Practice I

The Nature of Current Practice II  Discussion often initiated by patients and discussed at various time points over pathway: “ Patients often want to know about work quite early so probably once they’ve come to terms with their diagnosis, a week or two after they’ve been told and before starting their treatments.” Consultant Oncologist.

Factors Impacting Provision of Work-Related Guidance  All participants took treatment and symptoms into account: “I’m taking it from after surgery, so that’ll be the usual post- operative recovery that we tell them, which is that basically the recovery time is six weeks...generally we say take the first six weeks and see how you are, to recover from the surgery.” Specialist Nurse. 17

Factors Impacting Provision of Work-Related Guidance II  Views about working during treatment differed: “ We help them plan their work around their treatment. We tell them how much time they will probably need to off work and give them a realistic view about how soon they will be able to go back.” Consultant Surgeon. “It depends on the symptoms really and I think the patient himself is the best judge on whether they are able to work or go off sick.” Specialist Nurse. 18

Barriers to Providing Work-Related Support I  Time constraints and patient perceptions.  Lack of knowledge about the impact of cancer on work ability was commonly reported issue: “ We haven’t got that much information to give patients, we’re just going from what we’ve advised other patients in the past.” Specialist Nurse. 19

Barriers to Providing Work-Related Support II  Insufficient evidence base to draw on when advising patients on when to RTW: “The evidence base for the return to work with the diagnosis of cancer is virtually non-existent.” Occupational Health Physician. “I’m not given any real guidance; there are no guidelines to me to say, this is what you should or shouldn’t say. I generally have my spiel after my experience of looking after patients.” Consultant Oncologist. 20

The Need for a Multi-Faceted Approach I  Majority acknowledged that a level of consistency was required at a national level.  Unclear who should provide work-related guidance to patients: “It’s probably a multidisciplinary approach…I think we need a certain amount of information and advice…We are not all of us, trained as occupational health physicians.” Consultant Surgeon. “There should be ‘the information’ that’s available, and it should come to the patient from different sources...Compartmentalising information could be dangerous. We all need to know about it and discuss it with patients at any given interaction.” Consultant Oncologist. 21

The Need for a Multi-Faceted Approach II  A two-stage approach was proposed by most: 1.Generic guidance provided initially e.g. At diagnosis 2.Tailor guidance over time according to the patient’s treatment plan, treatment effects, his / her work, prognosis and RTW intentions: “They need guidance right at the beginning so they’ve got realistic expectations as to how long they’re going to be off; then again, when they’re getting towards the end of their episode, to discuss return to work.” Occupational Health Advisor. “I think verbally, but also back up with written support, written information as well...like I said before, they feel they are getting too much...it doesn’t have to be a huge leaflet, just pointers probably, just so that they know what they can and can’t do.” Specialist Nurse. 22

Conclusions  Health Professionals did attempt to provide work- related advice.  Barriers prevent better information provision.  There is a gap in the provision of work-related advice and guidance for individuals affected by cancer.  Absence of work-related discussion may impact patients negatively.  Future research needs to address current gaps to help inform intervention development for patients. 23

24 Thank you for listening Any Questions?