Table 1 Summary characteristics (study design, facilitator & barrier of return to work ) of included studies.

E. Ahn et al, 2009, Breast cancer Res treat

South Korea

  Breast cancer survivors N = 1594 & comparison group N = 415, female age 20 - 60 yrs

Cross sectional study (data from the five hospital-based breast cancer registries)

Age 40 - 49

No spouse, widow or divorced

Age <40

Low level of education

Low household income

Women lived with spouse

*Fatigue & exhaustion

Multiple co-morbidities

Advance disease stage & more extensive surgery (e.g. mastectomy)

Reduced work related abilities

Decrease wages, reduced working hours,

House hold income may be both a cause or result of unemployment

Socio-cultural factors as well as certain clinical characteristics influence the decisions of Korean women to return or not to RTW

C. Roelen et al, 2011, Breast Cancer Res Treat

Netherland

  Breast cancer patients N = 492 (2008)

Breast cancer patients N = 398 (2002),

women age <40 - >50 yrs

Longitudinal study (ArboNed register data from 2002 to 2008)

Not described

Not described

The proportion of partial RTW was stable around 70% from 2002 to 2008 but full RTW was decreased from 52% in 2002 to 43% in 2008

-Change in Dutch disability policies in 2004 may be responsible for the decrease full RTW

S. Q. Fantoni et al, 2010, J Occup Rehabil

Northern France

Cancer survivors N = 379,

age 18 - 60 yrs

Retrospective cohort study

Higher education

women with no husband,

moral support from friends and family

moral support from the colleagues

Older age (>50 years),

lower educational level,

fatigue, pain

chemo & radiotherapy, lymphoedema

psychological constrains

lack of moral support from the colleagues or employers

The self-perceived factors must be consider:

first to help support these women during their sick leave and second to initiate a work resumption support process which takes into account both the person and her environment.

A. Johnsson et al, 2007,

Acta Oncologica

Sweden

Pre-menopausal breast cancer

patients N = 270,

female age 29 - 54 yrs

Randomized trial

Not described

Advanced tumor stage

adjuvant endocrine therapy

Chemotherapy

Not able to work same extent as previously.

Age, education level, marital status, under age children has no association with RTW

J. A. Hansen et al,2008, J Occup Environ Med

U.S.A

  Breast cancer survivors N = 100,

female mean age 49.5 years (range 20 - 70)

& non-cancer comparison N = 103,

mean age 39.8 years (range 20 - 70)

Cross sectional study

Not described

**Fatigue,

work limitations

depression

Demographic, medical status, and treatment variables were not related to work limitation

K Carlsen, 2013,

Acta Oncologica

Denmark

  No of cancer survivors = 170 &

cancer free control N = 391,

age 35 - 64

  Cross sectional

Reduce work load,

support from supervisors

low income

fatigue

reduced work ability

Poor support from the colleagues and supervisors

Work ability of long-term breast cancer survivors who are disease-free and back in work is impaired in comparison with that of cancer-free women.

M. Drolet et al, 2005

CMAJ

Canada

Breast cancer survivors N = 646 &

comparison group: N = 890,

female age range 18 - 59 years

  Retrospective cohort study

Financial burden

Not belonging to a union

self-employed, white-collar job

Patients who took chemotherapy,

belonging to a union were more likely absented 4 weeks or more from their work

-

M. Drolet et al, 2005

Journal of clinical Oncology

Canada

Breast cancer survivors N = 646 &

comparison group: N = 890,

female age range 18 - 59 years

  Retrospective cohort study

High income(<$ 50,000)

Older age

low income (<$ 20,000 compared with

≥$ 50,000 )

union membership

√ Adjuvant therapy (chemo or radiotherapy) did not predict work cessation

√ Slightly more survivors were not working 3 years after diagnosis compared with non-cancer women (21% and 15% respectively)

R. R. Bouknight et al, 2006,

Journal of Clinical Oncology

USA

Cancer survivors enrolled: N = 443,

completed study 12 months patients:

N = 416, mean age 50.8 years

completed study 18 months patients:

N = 407, mean age 50.9 years

  Prospective longitudinal study, assessment was done at 12 & 18 months of cancer diagnosis

Younger age

good health,

early tumor stage

workplace accommodation

older age, black race, low health status

advanced tumor stage

heavy lifting work,

perceived employer discrimination

Chemotherapy had no effect on return to work

A. Johnsson et al, 2011,

Work

Sweden

Cancer survivors : N = 102,

female age 35 - 63 years

Cohort study, assessment was done at 6 weeks, 6 & 10 months after surgery

Higher life satisfaction with life as a whole

(satisfaction with vocational situation, somatic health and psychological health)

Low satisfaction with vocational situation

irradiation to breast/ chest wall, and regional nodes

Chemotherapy**

axillary node dissection

Age, educational level, marital status, manual work were not associated with RTW

V.S. Blinder et al, 2012,

Cancer

USA

Low income Latinas and Non-Latina white breast cancer survivors: N = 290,

Latina survivors: N = 179, age 32-65 years &

Non-Latina Whites survivors: N = 111, age 26-85 years

Longitudinal study, assessment was done at 6, 18, & 36 months of cancer diagnosis

  More no of children at home to help with

daily tasks,

social support

**Low income

Manual work,

chemotherapy & higher comorbidity

Neither low-income Latinas nor non-Latina Whites approached the 80% rate of RTW seen in rich white cancer survivors

R. M. Villaverde et al, 2008

Occupational Medicine

Spain

Cancer survivors: N = 96,

mean age 47 years (range 22 - 65 years)

Cohort study

Self-employed

helpful co-workers and employers

Fatigue

lymphodema, comorbidity,

advanced stage disease

None reported job discrimination

E.Hedayati et al, 2012

Scand J Caring Sci

Sweden

Cancer survivors: N = 44,

women age 40 - 64 years

Cohort study

Other adjuvant therapy except for chemotherapy

*chemotherapy

advanced disease stage, lymph node involvement,

positive Her2 status

Cognitive function do not predict RTW

B. Hauglann et al, 2012,

J Cancer Surviv

Norway

Breast cancer case: N = 1548 and

cancer free controls : N = 1548,

age <50 -≥50 years

Cohort (National register based controlled cohort study)

Not described

Reduced income,

reduce work ability

early disability pension

At the end of the observation period, employment rates were higher in non-disabled patients than in non-disabled controls (82% vs.77%, p = 0.008)

E. Maunsell et al, 2004,

journal of the National Cancer Institute

Canada

Breast cancer survivors: N = 646

comparison group: N = 890,

age 18-59 years

  Cohort study (population-based retrospective cohort study)

Not belonging to a union,

No health insurance coverage among the labour force participants

Own decision to stop working

new cancer events

job is too difficult

√ Older age did not negetively affect the work situation

√ discrimination at work was rare.

√ After 3years, slightly more survivors (21%) than women in the comparison group (15%) were unemployed (RR adjusted

= 1.29; 95% CI 1.05-1.59)

F. Balak et al, 2008,

J occup Rehabil

Netherland

Patients with early stage breast cancer: N = 72,

mean age 49.2 years (18-65 years)

cohort study

Patients who did not receive adjuvant therapy

Fatigue,

chemotherapy & multimodal treatment

√ Age of women is not related to RTW

√ The time taken to RTW after early stage breast cancer was principally determined by the type of treatment.

S. Lillehorn et al,2012,

Scandinavian Journal of Caring Sciences

Sweden

Breast cancer survivors: N = 56,

mean age 49 years (range 31-60 years)

longitudinal study, repeatedly interviewed over a period of 18-24 months

Willingness/ self-motivation,

normalcy,

missing work place

Physical sickness,

chemotherapy,

fatigue, exhaustion,

discouraging work environment

Potential interactive relationships between biomedical and psychosocial circumstances affecting the return to work process.

M.J. Hassett et al, 2009,

cancer

USA

Cancer survivors with employed health insurance: N = 3233,

age 44-63 years

cohort(population of employed insured women) study

**health insurance

Chemotherapy

Radiation therapy did not influence employment

A. Johnsson et al, 2009,

Acta Oncologica

Sweden

Survivors with early stage breast

cancer: N = 102,

age 35 - 63 years

Prospective Cohort (early stage breast cancer) study

Good self-rated health,

Being born in Sweden,

high satisfaction with life,

low demand in work situation

High demand job

chemotherapy

axillary lymph node dissection

Age, educational level, living with underage children, marital status, manual work were not associated with RTW

B. Qualitative Study

C. Tiedtke et al, 2012,

BMC Public Health

Belgium

Breast cancer participants: N = 22,

mean age 46 years (range 40 - 55 years)

Qualitative study

For financial independence,

Self-motivation, Normalcy,

Good social environment

Anxiety, frustration,

Assuming employer will not eagerly welcome,

employers negative attitude,

Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job;(ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and(iv) they have doubts about being accepted in the workplace after returning

F. L. Tan et al, 2012, Asian Pacific J Cancer Prev

Malaysia

Cancer survivors N = 40,

female age 18 - 60 yrs

Qualitative study

Social Support (More for Malay)

regards for financial independence (more among Chinese)

support from the employers

Over protective family,

tiredness, fatigue, pain

depression, worrying, frustrations

high physical job demand,

fear of potential environment hazards

Health professionals and especially occupational therapist should be consulted to assist the increasing survivors by providing occupational rehabilitation to enhance RTW among employed survivors

V.S. Blinder et al, 2012,

J Community Health

U.S.A

Cancer participants N = 23,among them

African American = 3

African-Caribbean = 5

Chinese = 5

Filipina = 4

Latina = 3

Non-Latina white = 3;

female age range 29 - 63 years

Qualitative study

Normalcy & Acceptance to maintain a normal environment at work,

family history of breast cancer

social support from friends, family and colleagues

Appearance and privacy

lower support from the employers

Financial strain prevent African-American to take more time off from their work

African-Caribbean get support from their friends & family

Acceptance of cancer is common in Chinese

Latina group has more fear of death,

Non-Latina white has more family history of cancer which helps them to accept it.

C. Tiedtke et al, 2012,

J Occup Rehabil

Belgium

Flemish stakeholders cancer survivors N = 26

Qualitative study

Improve legislation

Varying stakeholder perspective,

Belgian legislation which emphasis the patients or disability role

Motivated stakeholders can positively affect RTW

A. Johnsson et al, 2010,

Eur J Cancer Care

Sweden

Cancer survivors: N = 16,

female age range 44 - 58 years

Qualitative study

Strong wish to stay in the labour market

support from the workplace

Change in outlook,

Poor social support,

Psychological ill health,

Diminish work capacity, unclear work roles,

Support from the workplace is of great importance for a successful RTW

S.J. Tamminga et al, 2012,

Scand J work Environ Health

Netherland

Breast cancer survivors: N = 12,

age 28 - 51 years

Qualitative study

Importance of work

support from the supervisors

social support

Temperment, feeling guilty

treatment itself, having another co-morbidity

slow or insufficient recovery over time

physical workload, stressful job

lack of support from colleagues, employers and/ or occupational physician

During initial RTW, physical & psychological side effect hampered work resumption. In the post RTW stage, work environment is the important factor.

M. Nilsson et al, 2011,

Eur J Oncol Nurs

Sweden

Breast cancer survivors: N = 23,

mean age 53 years (range 37 - 62 years)

Qualitative study

Support from the friends and family

Support from the workplace, healthcare personnel

flexibility in the implementation of sick rules

Lack of support from the colleagues and employer

Disrespectful attitude of social insurance officers

* Three factors were identified which could be barrier or facilitators for RTW-

i. The Adjustment to be arranged according to the survivor's requirements

ii. Information (sickness insurance or side effects of treatment, benefit of being employment) sharing to the survivors

iii. Attitudes (perceived and appraised) to the survivors by their surrounding people (Family, colleagues)