Although cancer is often seen as a disease afflicting older people, each year in Australia over 40,000 cancers, or 43% of all cancers, are diagnosed in middle-aged people of working ages (45-64 years)  and the number of survivors living with cancer is increasing . Consequently, research attention has turned to assessing health-related quality of life (HRQoL) and survivorship issues after a diagnosis of cancer.
One survivorship issue that is not well quantified is work participation and workplace issues after a diagnosis of cancer. Work can define a person's self-worth, identity and social purpose, and it contributes to financial security. A cancer experience that causes major disruption in the work role can become a source of high distress in addition to expensive medical bills, and can adversely affect HRQoL [3, 4]. Inability to work may deprive an individual of stimulation, social contacts and independence, while staying in or returning to work after cancer treatment may be important for patients in maintaining a sense of normalcy and control [3, 4]. Cancer treatments are improving and current treatments can involve prolonged periods of adjuvant therapy thus previous reports on the extent of disruption to work roles, earnings and other role activities may be outdated. Lengthy treatments, ongoing medical care or the experience of a recurrence may lead to reduced career options and loss of employment. Calls have therefore been made for oncology health workers to better recognise and screen patients for work-related distress .
Studies have shown between 30-93% of workers with cancer will return to work [5, 6], with most people returning to work within 12 months of taking leave [5, 6]. Survivors of head and neck cancer and breast cancer have shown more difficulty returning to work than survivors of other cancer types [5–7]. Although many people appear to resume their employment with minimal interference [8, 9], there may also be difficult work re-entry, forced retirement, workplace discrimination and refusal of insurances . Factors that have been linked with delayed return to, or stopping work include: older age [6, 11, 12]; physically-demanding work [5, 6, 9, 12]; being female [5, 6, 11, 12]; presence of comorbidities ; being married [6, 11]; fatigue ; lower education [6, 14]; chemotherapy ; blue collar occupations ; and upper-body limitations . Amongst those who return to work, work disabilities are more common for those with a physically demanding job, advanced cancer stage and those experiencing treatment side-effects . However, many of these studies are US-based and subject to a system of employment-based health insurance and the added pressure on individuals to keep working to retain access to health care services.
Current research concentrates on breast cancer survivors so the relevance for other cancer populations is unclear. A population-based cohort study of Australian colorectal cancer survivors assessed a subset of working adults for changes in work participation . Twelve months after diagnosis, 33% of men (n = 621) and 40% of women (n = 354) were not working. Radiation therapy among men (OR = 1.90, 95%CI: 1.14- 3.17) and chemotherapy among women (OR = 1.87, 95%CI: 0.98-3.57) were associated with a higher prevalence of work cessation . The risk of ceasing work among women was smaller if they had private health insurance (OR = 0.54, 95%CI: 0.31-0.92). Quality of life scores for persons who stopped working were significantly lower than for persons who continued working, after adjusting for additional explanatory factors . However, this study was limited because there was no non-cancer comparison group and therefore was unable to determine the proportion of cases who would have ceased work irrespective of cancer.
This paper presents the protocol of a population-based observational study to examine the work experiences in adults with colorectal cancer. We aim to describe changes in work participation at two points in time within a 12-month period, identify the key predictors influencing work participation and time to work re-entry, quantify the extent of physical and cognitive limitations at work and the role of work on HRQoL. The results of the study will provide valuable information for individuals facing cancer, health professionals, supportive care services and government about the reasons for work cessation, the mechanisms people use to remain working and existing workplace support structures.