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

From: Factors associated with return to work of breast cancer survivors: a systematic review

Study Country Participants/ Sample Study design Facilitator for employment & RTW Barrier of employment & RTW Controversial/Doubtful/ Other comments on RTW
A. Quantitative Study       
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
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
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
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
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,
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
axillary node dissection
Age, educational level, marital status, manual work were not associated with RTW
V.S. Blinder et al, 2012,
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
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,
missing work place
Physical sickness,
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,
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
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)
  1. *RTW-return to work