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Return-to-Work and Breast Cancer Survivorship Care

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Abstract

Purpose of Review

This commentary addresses the current needs of breast cancer survivorship care focusing on return-to-work and management of chronic treatment effects, such as lymphedema.

Recent Findings

Current literature reported a reduced work engagement and work ability among breast cancer survivors and those who developed treatment-related lymphedema. The return-to-work experience was highly individualized and built on the interactions among the survivor, the lymphedema disease processes, their work activities, and a broad array of contextual factors. Both lymphedema and its management negatively influenced women’s physical, emotional, and interpersonal functions, which in turn had an impact on their work lives. Few interventional studies have been developed that effectively help the return-to-work process.

Summary

Multidisciplinary models of care for breast cancer survivors are needed to meet individuals’ needs. Need for supports is especially critical for survivors in underserved communities and for racial, ethnic, and cultural minority populations.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–85. https://doi.org/10.3322/caac.21565.

    Article  PubMed  Google Scholar 

  2. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25(7):1029–36. https://doi.org/10.1158/1055-9965.EPI-16-0133.

    Article  Google Scholar 

  3. Lowy DR. The Beau Biden Cancer Moonshot: National Cancer Institute. March 28, 2017.

  4. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112(11 Suppl):2577–92. https://doi.org/10.1002/cncr.23448.

    Article  PubMed  PubMed Central  Google Scholar 

  5. • Pritlove C, Safai P, Angus JE, Armstrong P, Jones JM, Parsons J. “It’s hard work”: a feminist political economy approach to reconceptualizing “work” in the cancer context. Qual Health Res. 2019;29(5):758–73. https://doi.org/10.1177/1049732318803885. This qualitative study reconceptualized the “work,” which was beyond paid employment. It helps us understand the complex situation in which cancer survivors were living, with a great number of new tasks demanding time, energy, and skills.

  6. Hudson SV, Miller SM, Hemler J, Ferrante JM, Lyle J, Oeffinger KC, et al. Adult cancer survivors discuss follow-up in primary care: ‘not what i want, but maybe what i need’. Ann Fam Med. 2012;10(5):418–27. https://doi.org/10.1370/afm.1379.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  8. American Cancer Society. Breast Cancer Facts & Figures 2019–2020. Atlanta, GA: American Cancer Society, Inc. 2019. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020. Accessed 2020.

  9. Richardson A, Addington-Hall J, Amir Z, Foster C, Stark D, Armes J, et al. Knowledge, ignorance and priorities for research in key areas of cancer survivorship: findings from a scoping review. Br J Cancer. 2011;105 Suppl 1(SUPPL. 1):S82–94. https://doi.org/10.1038/bjc.2011.425.

    Article  CAS  PubMed  Google Scholar 

  10. Mahar KK, BrintzenhofeSzoc K, Shields JJ. The impact of changes in employment status on psychosocial well-being: a study of breast cancer survivors. J Psychosoc Oncol. 2008;26(3):1–17. https://doi.org/10.1080/07347330802115400.

    Article  Google Scholar 

  11. SEER Cancer Statistics Review, 1975-2012 [database on the internet]. National Cancer Institute. 2015. Available from: http://seer.cancer.gov/csr/1975_2012. Accessed: 2015.

  12. Smith DF. The functions of work. Omega. 1975;3(4):383–93. https://doi.org/10.1016/0305-0483(75)90002-x.

    Article  Google Scholar 

  13. •• Sun Y, Shigaki CL, Armer JM. Return to work among breast cancer survivors: a literature review. Support Care Cancer. 2017;25(3):709–18. https://doi.org/10.1007/s00520-016-3446-1. This review examined 25 articles on the outcome measures and influential variables associated with return-to-work among breast cancer survivors. The review identified a consistent report of reduced work outcomes among breast cancer survivors, which were associated with a combination of numerous factors, therefore informing the need for interdisciplinary research to support survivors' occupational rehabilitation.

  14. Cheng H, Sit JWH, So WKW. The symptom burden in breast cancer survivors. Curr Breast Cancer Reports. 2016;8(1):40–6. https://doi.org/10.1007/s12609-016-0201-z.

    Article  Google Scholar 

  15. Correa DD, Ahles TA. Cognitive adverse effects of chemotherapy in breast cancer patients. Curr Opin Support Palliat Care. 2007;1(1):57–62. https://doi.org/10.1097/SPC.0b013e32813a328f.

    Article  PubMed  Google Scholar 

  16. Boykoff N, Moieni M, Subramanian SK. Confronting chemobrain: an in-depth look at survivors' reports of impact on work, social networks, and health care response. J Cancer Surviv. 2009;3(4):223–32. https://doi.org/10.1007/s11764-009-0098-x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Calvio L, Peugeot M, Bruns GL, Todd BL, Feuerstein M. Measures of cognitive function and work in occupationally active breast cancer survivors. J Occup Environ Med. 2010;52(2):219–27. https://doi.org/10.1097/JOM.0b013e3181d0bef7.

    Article  PubMed  Google Scholar 

  18. Henry NL, Griggs JJ. Complexities of adjuvant endocrine therapy in young premenopausal women. Oncology (Williston Park, NY). 2009;23(6):482 7.

    Google Scholar 

  19. Howard-Anderson J, Ganz PA, Bower JE, Stanton AL. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(5):386–405. https://doi.org/10.1093/jnci/djr541.

    Article  PubMed  Google Scholar 

  20. Lavigne JE, Griggs JJ, Tu XM, Lerner DJ. Hot flashes, fatigue, treatment exposures and work productivity in breast cancer survivors. J Cancer Surviv. 2008;2(4):296–302. https://doi.org/10.1007/s11764-008-0072-z.

    Article  PubMed  Google Scholar 

  21. Gupta P, Sturdee Dw Fau - Palin SL, Palin Sl Fau - Majumder K, Majumder K Fau - Fear R, Fear R Fau - Marshall T, Marshall T Fau - Paterson I et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. 2006(1369–7137 (Print)).

  22. Mortimer J, Behrendt CE. Severe menopausal symptoms are widespread among survivors of breast cancer treatment regardless of time since diagnosis. J Palliat Med. 2013;16(9):1130–4. https://doi.org/10.1089/jpm.2012.0585.

    Article  PubMed  Google Scholar 

  23. Assis MR, Marx AG, Magna LA, Ferrigno IS. Late morbidity in upper limb function and quality of life in women after breast cancer surgery. Braz J Phys Ther. 2013;17(3):236–43. https://doi.org/10.1590/s1413-35552012005000088.

    Article  PubMed  Google Scholar 

  24. Devoogdt N, Van Kampen M, Christiaens MR, Troosters T, Piot W, Beets N, et al. Short- and long-term recovery of upper limb function after axillary lymph node dissection. Eur J Cancer Care (Engl). 2011;20(1):77–86. https://doi.org/10.1111/j.1365-2354.2009.01141.x.

    Article  CAS  Google Scholar 

  25. Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B. Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes. 2010;8:92. https://doi.org/10.1186/1477-7525-8-92.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM & R. 2014;6(2):170–83. https://doi.org/10.1016/j.pmrj.2013.08.605.

    Article  Google Scholar 

  27. •• Vignes S, Fau-Prudhomot P, Simon L, Sanchez-Brechot ML, Arrault M, Locher F. Impact of breast cancer-related lymphedema on working women. Support Care Cancer. 2020;28(1):79–85. https://doi.org/10.1007/s00520-019-04804-2This cross-sectional study investigated the impact of lymphedema on the upper extremity functioning, interpersonal functioning, and work performance. The analysis demonstrated that lymphedema affected survivors' careers, led to impairment of arm functions, and altered the relationship with co-workers. Inadequate workplace adaption was made for survivors.

    Article  PubMed  Google Scholar 

  28. • Zomkowski K, Cruz de Souza B, Pinheiro da Silva F, Moreira GM, de Souza Cunha N, Sperandio FF. Physical symptoms and working performance in female breast cancer survivors: a systematic review. Disabil Rehabil. 2018;40(13):1485–93. https://doi.org/10.1080/09638288.2017.1300950This review synthesized the evidence about physical symptoms and their relations with work activities. The findings identified that physical limitations were mostly related to post-treatment symptoms of upper limbs and led to diminished work performance, thereby suggesting the need for modifying work conditions.

    Article  PubMed  Google Scholar 

  29. Hayes SC, Battistutta D, Parker AW, Hirst C, Newman B. Assessing task “burden” of daily activities requiring upper body function among women following breast cancer treatment. Support Care Cancer. 2005;13(4):255–65. https://doi.org/10.1007/s00520-004-0729-8.

    Article  PubMed  Google Scholar 

  30. O'Toole JA, Ferguson CM, Swaroop MN, Horick N, Skolny MN, Brunelle CL, et al. The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living. Breast Cancer Res Treat. 2015;150(2):381–8. https://doi.org/10.1007/s10549-015-3325-3.

    Article  PubMed  Google Scholar 

  31. Lee D, Hwang JH, Chu I, Chang HJ, Shim YH, Kim JH. Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema. Support Care Cancer. 2015;23(8):2297–304. https://doi.org/10.1007/s00520-014-2584-6.

    Article  PubMed  Google Scholar 

  32. Shigaki CL, Madsen R, Wanchai A, Stewart BR, Armer JM. Upper extremity lymphedema: presence and effect on functioning five years after breast cancer treatment. Rehabil Psychol. 2013;58(4):342–9. https://doi.org/10.1037/a0034657.

    Article  PubMed  Google Scholar 

  33. Harrington S, Michener LA, Kendig T, Miale S, George SZ. Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review. Arch Phys Med Rehabil. 2014;95(1):153–62. https://doi.org/10.1016/j.apmr.2013.07.022.

    Article  PubMed  Google Scholar 

  34. Zuther JE, Norton S. Complete Decongestive Therapy. Lymphedema management: the comprehensive guide for practitioners. Stuttgart: Georg Thieme Verlag; 2013. p. 127.

    Google Scholar 

  35. Boyages J, Kalfa S, Xu Y, Koelmeyer L, Mackie H, Viveros H, et al. Worse and worse off: the impact of lymphedema on work and career after breast cancer. Springerplus. 2016;5(1):657. https://doi.org/10.1186/s40064-016-2300-8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Peugniez C, Fantoni S, Leroyer A, Skrzypczak J, Duprey M, Bonneterre J. Return to work after treatment for breast cancer: single center experience in a cohort of 273 patients. Bull Cancer. 2011;98(7):E69–79. https://doi.org/10.1684/bdc.2011.1401.

    Article  PubMed  Google Scholar 

  37. Quinlan E, Thomas-MacLean R, Hack T, Kwan W, Miedema B, Tatemichi S, et al. The impact of breast cancer among Canadian women: disability and productivity. Work. 2009;34(3):285–96. https://doi.org/10.3233/WOR-2009-0926.

    Article  PubMed  Google Scholar 

  38. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, et al. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psycho-oncology. 2010;19(3):299–305. https://doi.org/10.1002/pon.1573.

    Article  PubMed  Google Scholar 

  39. Dawes DJ, Meterissian S, Goldberg M, Mayo NE. Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med. 2008;40(8):651–8. https://doi.org/10.2340/16501977-0232.

    Article  PubMed  Google Scholar 

  40. Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, et al. Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors. Lymphology. 2010;43(1):1–13.

    CAS  PubMed  Google Scholar 

  41. Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A. Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology. 2006;39(4):185–92.

    CAS  PubMed  Google Scholar 

  42. Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2):167–78. https://doi.org/10.1007/s11764-010-0118-x.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Taghian NR, Miller CL, Jammallo LS, O'Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol. 2014;92(3):227–34. https://doi.org/10.1016/j.critrevonc.2014.06.004.

    Article  PubMed  Google Scholar 

  44. Deng J, Fu MR, Armer JM, Cormier JN, Radina ME, Thiadens SR, et al. Factors associated with reported infection and lymphedema symptoms among individuals with extremity lymphedema. Rehabil Nursing. 2015;40(5):310–9. https://doi.org/10.1002/rnj.171.

    Article  Google Scholar 

  45. Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27(12):2007–14. https://doi.org/10.1200/JCO.2008.18.3517.

    Article  PubMed  Google Scholar 

  46. Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol. 2009;27(3):390–7. https://doi.org/10.1200/JCO.2008.17.9291.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ridner SH. Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer. 2005;13(11):904–11. https://doi.org/10.1007/s00520-005-0810-y.

    Article  PubMed  Google Scholar 

  48. Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52(6):370–9. https://doi.org/10.1097/00006199-200311000-00004.

    Article  PubMed  Google Scholar 

  49. Fu MR, Rosedale M. Breast cancer survivors' experiences of lymphedema-related symptoms. J Pain Symptom Manag. 2009;38(6):849–59. https://doi.org/10.1016/j.jpainsymman.2009.04.030.

    Article  Google Scholar 

  50. Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42. https://doi.org/10.1200/JCO.2007.14.4899.

    Article  PubMed  Google Scholar 

  51. Tsauo JY, Hung HC, Tsai HJ, Huang CS. Can ICF model for patients with breast-cancer-related lymphedema predict quality of life? Support Care Cancer. 2011;19(5):599–604. https://doi.org/10.1007/s00520-010-0857-2.

    Article  PubMed  Google Scholar 

  52. Hayes SC, Rye S, Battistutta D, Newman B. Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body function and lymphedema. Lymphology. 2010;43(4):178–87.

    CAS  PubMed  Google Scholar 

  53. Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9(5):e96748. https://doi.org/10.1371/journal.pone.0096748.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Lee SH, Min YS, Park HY, Jung TD. Health-related quality of life in breast cancer patients with lymphedema who survived more than one year after surgery. J Breast Cancer. 2012;15(4):449–53. https://doi.org/10.4048/jbc.2012.15.4.449.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Babu BV, Swain BK, Rath K. Impact of chronic lymphatic filariasis on quantity and quality of productive work among weavers in an endemic village from India. Tropical Med Int Health. 2006;11(5):712–7. https://doi.org/10.1111/j.1365-3156.2006.01617.x.

    Article  CAS  Google Scholar 

  56. Bifulco G, De Rosa N, Tornesello ML, Piccoli R, Bertrando A, Lavitola G, et al. Quality of life, lifestyle behavior and employment experience: a comparison between young and midlife survivors of gynecology early stage cancers. Gynecol Oncol. 2012;124(3):444–51. https://doi.org/10.1016/j.ygyno.2011.11.033.

    Article  CAS  PubMed  Google Scholar 

  57. Boyages J, Kalfa S, Xu Y, Koelmeyer L, Mackie H, Viveros H, et al. Worse and worse off: the impact of lymphedema on work and career after breast cancer. SpringerPlus. 2016;5(1):1–8. https://doi.org/10.1186/s40064-016-2300-8.

    Article  Google Scholar 

  58. Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, et al. Lymphoedema: an underestimated health problem. QJM. 2003;96(10):731–8. https://doi.org/10.1093/qjmed/hcg126.

    Article  CAS  PubMed  Google Scholar 

  59. •• Sun Y, Shigaki CL, Armer JM. The influence of breast cancer related lymphedema on women's return-to-work. Womens Health (Lond). 2020;16(Special Topic – Cancer Survivorship among Women):1745506520905720. https://doi.org/10.1177/1745506520905720This study was among the first to explore the ways that lymphedema influenced breast cancer survivors’ work experience. The findings showed that both lymphedema and its treatment had physical, emotional, and interpersonal influences on survivors’ work, with environmental and personal factors together shaping the experience. The rich qualitative evidence supports a deeper understanding of the return-to-work phenomenon.

    Article  Google Scholar 

  60. • Sun Y, Armer JM. A nurse's twenty-four-year journey with breast cancer-related lymphedema. Work. 2019;63(1):21–31. https://doi.org/10.3233/WOR-192904This case study illustrated that returning to work with BCRL represents a complicated phenomenon at the intersection of the individual, the lymphedema disease processes, the work activities required, and an array of contextual factors.

    Article  PubMed  Google Scholar 

  61. Sisler J, Chaput G, Sussman J, Ozokwelu E. Follow-up after treatment for breast cancer: practical guide to survivorship care for family physicians. Can Fam Physician. 2016;62(10):805–11.

    PubMed  PubMed Central  Google Scholar 

  62. Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. Models of cancer survivorship care: overview and summary of current evidence. J Oncol Pract. 2015;11(1):e19–27. https://doi.org/10.1200/JOP.2014.001403.

    Article  PubMed  Google Scholar 

  63. Campagna M, Loscerbo R, Pilia I, Meloni F. Return to work of breast cancer survivors: perspectives and challenges for occupational physicians. Cancers (Basel). 2020;12(2). https://doi.org/10.3390/cancers12020355.

  64. Tiedtke C, de Rijk A, Donceel P, Christiaens MR, de Casterle BD. Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for RTW after breast cancer treatment. BMC Public Health. 2012;12:538. https://doi.org/10.1186/1471-2458-12-538.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ahn E, Cho J, Shin DW, Park BW, Ahn SH, Noh DY, et al. Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them. Breast Cancer Res Treat. 2009;116(3):609–16. https://doi.org/10.1007/s10549-008-0209-9.

    Article  PubMed  Google Scholar 

  66. Tiedtke C, Dierckx de Casterle B, Donceel P, de Rijk A. Workplace support after breast cancer treatment: recognition of vulnerability. Disabil Rehabil. 2015;37(19):1770–6. https://doi.org/10.3109/09638288.2014.982830.

    Article  PubMed  Google Scholar 

  67. Tiedtke C, de Rijk A, Dierckx de Casterle B, Christiaens MR, Donceel P. Experiences and concerns about 'returning to work' for women breast cancer survivors: a literature review. Psycho-oncology. 2010;19(7):677–83. https://doi.org/10.1002/pon.1633.

    Article  PubMed  Google Scholar 

  68. Fu MR, Ridner SH, Hu SH, Stewart BR, Cormier JN, Armer JM. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psycho-oncology. 2013;22(7):1466–84. https://doi.org/10.1002/pon.3201.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Nursing, University of Missouri–St. Louis, One University Boulevard, St. Louis, MO, 63121-4400, USA

    Yuanlu Sun

  2. Behavioral Health Service Line, Truman VA, Columbia, MO, USA

    Cheryl L. Shigaki

  3. Sinclair School of Nursing, University of Missouri, Columbia, MO, USA

    Jane M. Armer

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  1. Yuanlu Sun
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Sun, Y., Shigaki, C.L. & Armer, J.M. Return-to-Work and Breast Cancer Survivorship Care. Curr Breast Cancer Rep 12, 202–207 (2020). https://doi.org/10.1007/s12609-020-00371-2

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