Oral Presentation Cancer Survivorship Conference 2023

Return to Work of Cancer Survivors and the Impacts of Cognitive Impairments: a mixed methods study (#12)

Yook Wai J Liu 1 , Joanna E Fardell 2 , Janette L Vardy 3 4 5 6 , Haryana M Dhillon 1 7
  1. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
  2. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia
  3. Sydney Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
  4. Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia
  5. Concord Clinical School, The University of Sydney, Concord, NSW, Australia
  6. Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
  7. Psycho-Oncology Cooperative Research Group, University of Sydney, NSW, Australia

Background: Cancer survivors experience higher risk of unemployment, early retirement and poorer work outcomes compared to healthy populations. While return to work (RTW) of cancer survivors has received greater attention, previous work focused on physical challenges and fatigue. Little is known about the impact of cancer-related cognitive impairments (CRCIs) on work functionality and RTW outcomes.

 

Aim: We aimed to explore RTW experience of cancer survivors in Australia and impacts of cancer sequalae and CRCIs on RTW.

 

Methods: In mixed methods design study we recruited adults who had finished curative treatment for non-central nervous system cancers within the last 2 years to complete an online survey. A subset participated in semi-structured interviews exploring changes in work ability, arrangements and values, barriers and facilitators to RTW, and adjustments. Interviews were analyzed inductively using thematic and framework analysis. Patient-reported outcome measures were reported descriptively.

 

Results: Questionnaires were completed by 24 participants; 10 were interviewed. Participants had a median age 50 years (range 24-76), 13-24 months since initial diagnosis, and reported poorer cognitive function [mean T-score 41.9 (SD 9.2)] compared to normative US population [T-score 50, (SD 10)] on the PROMIS Cognitive Function Scale. Participants reported a mean Cognitive Change score of 2.5 (SD = 1.2), indicating worse cognitive function following cancer diagnosis and treatment.

We extracted five overarching themes: process of RTW, impacts of cancer on RTW, factors influencing RTW, active strategies, and impacts of COVID-19. We mapped themes onto existing RTW models. Our results suggest Porro et al.’s (2021) Integrative Transactional Conceptual Model captures the dynamic RTW process after cancer.

 

Conclusion: Many interrelated determinants impacted RTW decisions and outcomes. Long-term cognitive, physical, and socio-emotional consequences contributed to increased RTW burden. There is a need for greater understanding about CRCIs and ongoing limitations for survivors and greater awareness in workplaces.