Nonmedical Interventions to Enhance Return to Work for People With Cancer

What effects do nonmedical interventions have on the ability of people with cancer to return to work?

Physical interventions (physical training, such as walking; resistance exercises, such as strength training and yoga; or training of bodily functions, such as vocal training) improve the ability of people with cancer to return to work (number needed to treat [NNT] to have one more person return to work = 7; 95% CI, 4–20).¹ Multidisciplinary training (any combination of psychoeducational, vocational, and physical interventions) also improves the ability of people with cancer to return to work (NNT = 7; 95% CI, 5–14). However, neither of these types of interventions improves quality of life (QOL). Psychoeducational interventions (eg, counseling and coping skills taught by any qualified professional) alone appear to have no effect on ability to return to work or QOL. (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Cancer diagnoses among working-age adults younger than 65 years are increasing due to early screening.¹ With improved detection and treatments, the 5-year life expectancy is 67%. However, individuals who survive cancer are 1.4 times more likely to be unemployed than those who have never had cancer. Returning to work can improve QOL, give patients a sense of purpose, and enable them to financially support themselves and their families. The authors of this Cochrane review sought to evaluate nonmedical interventions that can enhance the ability of people with a cancer diagnosis to return to work.

This Cochrane review included 15 randomized controlled trials (RCTs) and cluster randomized trials with 1,477 patients.¹ Participants were 18 years and older, diagnosed with any type of cancer, and employed at the time of diagnosis. All included RCTs were conducted in high-income countries. Interventions were compared with usual care or no interventions. The primary outcome was the rate at which patients returned to work or the duration of sick leave at 12 months of follow-up. The secondary outcome was QOL. Breast cancer, for which there is a 5-year survival rate of 90%,2 and prostate cancer, for which there is a 5-year survival rate of 96%,² were the most represented cancers in this review.

The four different types of interventions discussed were psychoeducational, vocational, physical, and multidisciplinary.¹ Physical interventions included any type of physical training (eg, walking), physical exercises (eg, arm resistance training), or training of bodily functions (eg, vocal training). Interventions lasted up to 16 weeks and were sometimes managed by a physical therapist. All six multidisciplinary intervention studies involved vocational interventions, such as counseling, in combination with patient education, patient counseling, physical exercises, or a combination of those. The interventions were provided by a variety of medical professionals, including a nurse, case manager, medical social worker, or multidisciplinary team. These interventions were initiated in hospital or ambulatory settings.

Moderate-quality evidence showed that physical interventions, including walking, yoga, or physical exercise, increased the rate of return to work in cancer survivors compared with no interventions (risk ratio [RR] = 1.23; 95% CI, 1.08–1.39; four RCTs; 434 participants; NNT = 7; 95% CI, 4–20). The studies were consistent in that all demonstrated benefit from the intervention. One RCT reported on QOL and showed no benefit.