Challenges of the return to work for breast cancer survivors

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Scientific interpretation

For some people, the return to work after an absence due to illness can mean recovering their social network, improving their self-esteem, regaining a certain financial security or boosting their personal well-being. But the return does not always happen smoothly and can sometimes be complex. This is often the case for women who are breast cancer survivors. Some of them have to deal with side effects or delayed effects of treatment, such as pain, fatigue or trouble concentrating. Other difficulties can sometimes be related to stigmatization and lack of support from supervisors and colleagues. Some survivors may even be laid off.

During a pilot study, Bilodeau and colleagues (2018) focused on the challenges and consequences related to the return to work for breast cancer survivors. This study aimed to better understand the different contexts around the return to work, in order to better guide the development and implementation of an intervention adapted for a primary care setting. To do this, the researchers used an integrated knowledge translation approach, assisted by the experience of the different stakeholders involved.

The pilot study had two main objectives:

  1. Explore the opinions of different stakeholders on the role that primary care can play in supporting breast cancer survivors in the return-to-work process.
  2. Identify the barriers and facilitators that are noticed when implementing this new intervention in a primary care setting.

Conseillère experte

Karine BILODEAU, R.N., PhD., Faculty of Nursing, Université de Montréal

Auteurs

Étienne FOUQUET, research assistant, Université de Sherbrooke

MARIE-ÉLISE LABRECQUE, research professional, Université de Sherbrooke

This initiative was made possible through a collaboration with the Université de Sherbrooke.

WHAT DO WE MEAN BY:

Settings

In this study, settings go beyond physical spaces. They can include different roles, different types of interactions and different levels of relationships, as well as a combination of characteristics and various circumstances. The features of a setting can influence the implementation of an intervention, acting as either an obstacle or a facilitator. In addition to a physical location, such as a health care centre or workplace, settings also include health care workers, work colleagues, the employer, etc.

Primary care

This is community care, family medicine practices, and local community services centres.

An integrated knowledge translation approach

This approach is aimed at developing knowledge and having users adopt it. It incorporates available research data and stakeholder knowledge (breast cancer survivors, health care professionals, psychologists, oncologists, employers) to identify barriers and facilitators, as well as interventions for prioritizing. This involves seven steps:

This involves seven steps:

  1. Identifying the problem and selecting knowledge;
  2. Adapting knowledge to the local context;
  3. Evaluating factors that present obstacles or contribute to the use of knowledge;
  4. Selecting, adapting and implementing interventions that eliminate barriers to the use of knowledge;
  5. Monitoring the use of knowledge;
  6. Evaluating results;
  7. Creating mechanisms for maintaining the use of knowledge.

Complete reference

Bilodeau, K., Tremblay, D., et Durand, M. J. (2018). Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development. Journal of multidisciplinary healthcare, 11(1), 75-83.

Method

Country: Québec, Canada

Recruitment of participants: Participants had to represent oncology care (hospital), community-based care and services (family medicine unit, not-for-profit organization for people who have cancer) and employers.

Number of participants: 6

Method used: Semi-structured interviews

This study is the first of three steps in a development and implementation process for an intervention supporting the return to work after breast cancer.

The following steps are exploring the return-to-work process for breast cancer survivors and creating the intervention in collaboration with different stakeholders (for example, breast cancer survivors, health care professionals).

WHAT DO THE STUDY’S RESULTS SHOW?

The results of the study suggest that women survivors would benefit from having access to interventions offered by health care professionals as soon as active cancer treatments end. The intent is to mitigate the impact of side effects and facilitate occupational reintegration. However, this return-to-work process presents a set of barriers and facilitators for the intervention, which are presented in the following table:

Facilitators

Barriers

Organizational context (care and services)

Previous history of collaboration between hospital and primary care setting

  • Task division regarding follow-up breast cancer care
  • Lack of informational continuity between the hospital and primary care
  • Low financial resources
  • Disagreement over return-to-work recommendations
  • Professionals working in silos

Individual health care professionals’ context

Unanimous recognition of the need for return-to-work interventions in a primary care setting

  • Lack of knowledge of the issues related to the return to work
  • Conflicts between professionals

Social context

Good relationships and trust between professionals from different settings

Real needs of breast cancer survivors

  • Limited knowledge on the issues related to the return to work
  • Vision of cancer care centred on the hospital
  • Lack of workplace accommodation

Economic and legal context

Not mentioned

  • Budget constraints in health care

WHAT CAN ORGANIZATIONS DO?

Although there are several settings related to the return to work for breast cancer survivors, the organizational context is the one where impacts are felt more deeply. A gap was reported between the survivor’s ability to carry out the required tasks and the employer’s expectations in terms of desired productivity.

It was also noted that some survivors had to request another sick leave due to symptoms of depression or burnout. These consequences are not trivial, considering their socioeconomic impact. For these reasons, prevention may be necessary. Here are some actions you can take.

What you need to remember…

Examples

Managers are not always aware of the issues around the return to work

  • Some symptoms are known as “delayed,” meaning they arise after the return to work: fatigue, trouble concentrating and chronic pain.
  • Fully effective functioning at work is progressive. A return to work is not necessarily synonymous with full abilities. These will return gradually.

Links between hospital care and primary care are tenuous

  • A return to work after breast cancer is a process that is often hazy and not well documented. It is therefore important to identify clearly who is the primary contact (the person who can respond to questions most appropriately) for managers and survivors.

Legal aspects can be an issue for managers

 

  • It is important to know the legal aspects around the return to work, to avoid missteps.
  • It is also important to be aware of the organization’s rules, found in its internal policies regarding the return to work.

Preparation by survivors for the return to work is often insufficient

 

  • Survivors do not always have access to information on the return-to-work process
  • Resources for survivors should be enhanced and made more accessible to encourage their reintegration.

COMMENTS FROM OUR EXPERT

Although the services of occupational physicians are not available in Québec, there is an international consensus on the need to increase services for cancer survivors. From this perspective, and despite the small number of participants, the study succeeded in providing good recommendations for a local context, which will enable the researchers to pursue the project’s next steps.

TO CITE THIS GLOBAL-WATCH SCIENTIFIC INTERPRETATION

Bilodeau, K., Fouquet, E., Labrecque, M.-E. (2019). Challenges of the return to work for breast cancer survivors. Global-Watch Scientific Interpretation available at www.global-watch.com

TO CITE THE ORIGINAL ARTICLE BY THE AUTHORS OF THE STUDY

Bilodeau, K., Tremblay, D., et Durand, M. J. (2018). Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development. Journal of multidisciplinary healthcare, 11(1), 75-83.

Eric Bondo
Author: Eric Bondo

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