"I realized I had a choice": the forgiveness journey of people living with HIV.

Forgiveness, a process of relinquishment of resentment, hostility, and anger toward an offender or self, is understudied among people living with HIV. This study examined the experience and process of forgiving the person who allegedly transmitted HIV, among people living with HIV. In-depth interviews were conducted with 14 people living with HIV aged 25 or older, diagnosed at least three years before the study. Three main themes emerged: "Anger is a poison": between forgiveness and unforgiveness; "I gave up the drive to suffer": the meaning of forgiveness; and "Forgiving is like building a building": phases of the forgiveness process between forgiveness and unforgiveness. This study revealed cognitive and emotional processes and phases of forgiveness. Forgiveness-focused interventions for people living with HIV are suggested.

The impact of cancer on psychosocial function and quality of life: A cross-sectional study in 18 pan-European countries.

BACKGROUND: To improve psychosocial cancer care in Europe, more information is needed on psychosocial function and quality of life (QoL) among cancer patients in European countries. AIMS: To investigate differences in psychosocial function between cancer survivors and the general population in Europe, in relation to national economic status and personal factors. METHOD: Data were from the Survey of Health, Aging and Retirement in Europe (Wave 6). Main outcomes were psychosocial functioning: activity limitations, income adequacy, loneliness, depression, and QoL. Factors possibly associated with the main outcomes were ever having cancer, gross domestic product (GDP), and personal factors (age, gender, education, marriage status, employment status, number of children, number of chronic diseases). RESULTS: The study sample featured 6238 cancer survivors and 60,961 individuals without cancer aged 50 or older in 17 European countries and Israel. Levels of depression were higher and QoL was lower among cancer survivors compared to individuals without cancer and worse in low GDP countries, whereas differences in income adequacy and loneliness were not statistically significant. The interaction of cancer groups and country groups indicated a significant interactional effect on activity limitations, loneliness, depression, and QoL. In a multivariate regression analysis, personal factors, GDP, and being a cancer survivor predicted the main outcome variables. CONCLUSIONS: Cancer has a persistent negative effect on survivors that is related to a country's GDP. Cancer survivors in low-GDP countries are affected by the consequences of cancer intertwined with the hardships of living in a low-GDP country.

"There is a God or There is No God-It is in the Hands of God:" Fatalistic Beliefs Among Israeli People About Cancer and Their Impact on Behavioral Outcomes.

This qualitative study examined fatalistic beliefs and cancer causal attributions among people without cancer. Participants were 30 Israeli women and men aged 51-70 from diverse sociocultural backgrounds who participated in four focus groups. Three main themes emerged, referring to the variability in fatalistic beliefs of cancer occurrence and cancer outcome, the duality in attributing causality to divine providence and mere luck or chance, and the connection between distinct fatalistic beliefs and health behaviors. Data analysis enabled an expansion of the understanding of cancer fatalism as a multidimensional structure, whereby interactions between causality attribution and different fatalistic beliefs are related to prevention and screening behaviors.

Associations Between Cancer Fatalism, Causal Attributions, and Perceptions of Benefits and Barriers to Screening for Colorectal Cancer.

BACKGROUND: The aim of the study was to assess the associations between cancer causal attributions (divine providence, chance or luck, environmental or genetic factors, weak personal resilience), cancer fatalistic beliefs (cancer occurrence and outcome beliefs), and benefits of and barriers to screening for early detection of colorectal cancer. METHODS: It was a cross-sectional study of 252 individuals (46% men and 54% women) aged 50-75. Participants completed measures of cancer causal attributions, Powe's cancer fatalism questionnaire, and the benefits and barriers to colorectal cancer screening subscales of the health belief model. The study model was assessed using path analysis and mediation tests. RESULTS: Participants expressed moderate levels of occurrence and outcome of fatalistic beliefs, moderate levels of causal attributions, a high level of perception of the benefits of screening, and a moderate level of barriers to screening. The path model showed good fit measures (χ2 = 17.38, df = 14, p = .24; χ2/df = 1.24; NFI = .98; TLI = .99; CFI = .99; RMSEA = .03, 90% CI = .01, .07). Outcome fatalism mediated the relationship between each causal attribution and perceived barriers, whereas occurrence fatalism mediated only the relationship between the causal attribution of divine providence and the perceived benefits of screening. CONCLUSIONS: The results add to our understanding of the effects of causal attributions and fatalistic beliefs on perceptions of benefits and barriers to screening; hence, these factors should be the focus of change to reduce barriers to screening for early detection of cancer.

Perceived loss of resources and adherence to guidelines during the COVID-19 pandemic in Israel.

Following the outbreak of the global COVID-19 pandemic, governments around the world issued guidelines designed to prevent contagion. This longitudinal study explored variables associated with citizens' adherence to these guidelines. Questionnaires were administered to a panel of Israeli citizens three times: in June (Time 1, n = 896), July (Time 2, n = 712) and August (Time 3, n = 662) 2020. The relationships of perceived loss of resources (e.g. stable employment) at Time 1 with adherence to guidelines at Time 2 and Time 3 were moderated by assumptions about controllability: The relationships were stronger for people who believed that appropriate behavior would lead to positive outcomes and prevent negative outcomes. The results indicate that messages about the pandemic should be accompanied by encouraging messages regarding the ability to control.

The Role of Affect as a Mediator between Coping Resources and Heart Rate Variability among Older Adults.

BACKGROUND: Heart rate variability (HRV) has been suggested as an indicator of capacity to adapt effectively to physiological or environmental challenges and of physical and psychological health in old age. AIMS: The study assessed levels of high-frequency HRV (HF-HRV) among older adults in relation to positive and negative affect and the mediating role of positive and negative affect in the association between coping resources (perceived social support and sense of mastery) and HF-HRV. METHOD: Participants were 187 men and women in three assisted-living residences who were independent in activities of daily living (93.4% participation rate). The participants completed sense of mastery, multidimensional scale of perceived social support, and positive and negative affect questionnaires. HF-HRV was derived from electrocardiography data measured by a Holter monitoring device for 15 minutes. RESULTS: The empirical model showed good fit indices indicating that higher HF-HRV was associated with lower negative affect, and negative affect mediated the association between perceived social support and HF-HRV. In addition, perceived social support and sense of mastery were associated with higher positive affect and lower negative affect. CONCLUSIONS: Although this was a cross-sectional study, it suggests that HF-HRV may be a link between affect and health in old age. It also suggests the importance of identification and intervention with older adults and their support systems to reduce negative affect.

Development and validation of the Fatalistic Causal Attributions of Cancer Questionnaire: A three-phase study.

OBJECTIVES: Tools have been developed to assess the existence and intensity of fatalistic beliefs. Causal attributions of cancer, referring to the foundation for fatalistic views of cancer as being predetermined or reflecting an unavoidable death, are lacking. The aim was to develop and validate the Fatalistic Causal Attributions of Cancer Questionnaire, a measurement tool for studying the causal attributions of cancer. METHODS: Three-phase study. Phase I: Item extraction and development based on focus groups (N = 30) and assessment of content validity. Phase II: Assessment of quality of items and construct validity (exploratory factor analysis, confirmatory factor analysis, and convergent validity) of data from 252 participants (aged 50-75). Phase III: Confirmatory factor analysis and assessment of the discriminant validity and reliability of the questionnaire with 127 online respondents (aged 20-70). RESULTS: In Phase I, an initial questionnaire was constructed. In Phase II, four factors were identified: Belief in divine providence, belief in personal resilience as a protective factor, belief in chance or luck, and belief in inevitable environmental or genetic factors. The factorial structure of an 18-item version that emerged in the confirmatory factor analysis had good fit indexes and reliability measures. In Phase III, the 18-item questionnaire and its factorial structure and reliability were confirmed. CONCLUSION: The findings show acceptable psychometric properties for the questionnaire. We suggest that this questionnaire should be used with an existing questionnaire that assesses the intensity of fatalistic perceptions for a more comprehensive assessment of fatalism in research and in promoting adherence to screening.

A multidisciplinary working model for promoting return to work of cancer survivors.

BACKGROUND: Despite wide recognition of the necessity of an integrative maintenance and return to work (RTW) program for cancer survivors, no such program has been described in the literature. AIMS: To examine a working model of an integrative multidisciplinary health care approach for promoting RTW, using the Delphi method. METHODS: A working model for promoting cancer survivors' RTW by oncology health professionals was subjected to two rounds of evaluation by an expert panel in accordance with the Delphi research method. Twenty-six international experts in oncology (social workers, nurses, psychologists, physicians, and cancer patients) participated in the first round and 16 participated in the second round. RESULTS: The mean score of the working model's applicability was 6.07 (SD = 1.07, range = 1-7). The model outlines in detail an integrative approach for promotion of RTW according to two axes: the oncology health professionals' role and the timeline axis featuring four stages of oncology treatment and follow-up. CONCLUSIONS: Our proposed model addresses the need for an integrated program that may increase the rate of RTW and improve the quality of life of cancer survivors. The model should be subjected to further evaluation, especially its adaptability to different health systems in different countries.

Post-treatment Psychological Distress Among Colorectal Cancer Survivors: Relation to Emotion Regulation Patterns and Personal Resources.

BACKGROUND: Post-treatment psychological distress among colorectal cancer (CRC) survivors is common, but changes over time. However, data on the effects of emotional factors on changes in psychological distress over time remain limited. The study sought to describe the patterns of change in psychological distress among CRC survivors in the short-term after treatment completion and to identify predictors of the change in psychological distress experienced by CRC survivors. METHODS: A total of 153 CRC survivors, stages II-III at diagnosis, who were 4-24 months post-diagnosis (participation rate 89.5%) completed the Emotion Regulation Questionnaire, Acceptance and Action Questionnaire, Resilience Scale-14, Self-Compassion Scale-Short Form, and Brief Symptom Inventory-18 (psychological distress scale) at Time 1 (T1). Psychological distress was assessed again at Time 2 (T2), 6 months later. RESULTS: Two patterns of change in post-treatment psychological distress among CRC survivors were identified: One group of patients experienced higher psychological distress at T1, which decreased at T2. A second group experienced lower psychological distress at T1, which increased at T2. Self-compassion and personal resilience predicted higher psychological distress at T2. Lower suppression and self-compassion and higher personal resilience increased the likelihood of being in the increased psychological distress group. CONCLUSIONS: Psychological distress evaluation of CRC survivors at different time-points post-treatment is warranted. In addition, awareness is needed that self-compassion may be individually related to psychological distress among participants.

Emotion Regulation Patterns among Colorectal Cancer Survivors: Clustering and Associations with Personal Coping Resources.

Different patterns of emotion regulation have been proposed for dealing with the intense emotions elicited while coping with cancer. The relationships between these different emotion regulation patterns have not yet been studied. This study examined the usage levels of different emotion regulation patterns (repression, suppression, experiential avoidance and cognitive reappraisal), the intercorrelations and clustering of these patterns and their associations with personal coping resources (personal resilience and self-compassion) in a sample of colorectal cancer survivors. This was a cross-sectional study in which 153 colorectal cancer survivors, stages II-III, (47% female, 53% male), aged 26-87, completed the Marlowe-Crowne Social Desirability Scale, the State-Trait Anxiety Inventory-6, the Emotion Regulation Questionnaire, the Acceptance and Action Questionnaire, the Resilience Scale-14 and the Self-Compassion Scale-Short Form. The four emotion regulation patterns were found to be distinct from each other (i.e., low to moderate correlations). Cognitive reappraisal was negatively related to suppression and experiential avoidance and positively associated with self-compassion. Two-step cluster analysis revealed three distinct clusters: Cluster 1-the suppression-avoidance dominant cluster; Cluster 2-the cognitive reappraisal dominant cluster; and Cluster 3-the repression dominant cluster. Repression, suppression, experiential avoidance and cognitive reappraisal were found to differ from each other but able to be organized into distinct clusters of survivors. Healthcare professionals should be aware of these different emotion regulation patterns and the need to identify the patterns used by each survivor.

Providing regular grandchild care: Grandparents' psychological and physical health.

OBJECTIVES: To examine the associations between intensity of providing regular grandchild care and positive affect (PA) and negative affect (NA), heart rate variability (HRV) and somatic symptoms. METHODS: This was a cross-sectional study involving 104 individuals (aged 59-82) who provide at least 5 h a week of regular care for their grandchildren. The study model was assessed using structural equation modeling. RESULTS: Intensity of regular care (mean hours per week: M = 14.8, SD = 11.2) was associated with higher PA and lower NA. Higher perceived role overload, higher NA and lower PA were associated with lower HRV and somatic symptoms. The fit indices indicated a good model fit. CONCLUSIONS: The results suggest that healthcare professionals should be aware of the positive and negative implications of caring for grandchildren on their older patients, including the increased risk of future morbidity, as indicated by lower HRV.

Introducing the concept sense of place: A mediator between place of care and emotional distress of patients with cancer at the end of life.

BACKGROUND: A sense of place (SOP) is defined as the emotional bonds, values, meaning, and symbols attached to a place. AIM: To assess SOP of patients with cancer during end-of-life care at home (home-hospice service) versus at a hospital in relation to place of care, social support, and emotional distress. METHODS: Participants were 150, stage IV, cancer patients with a life expectancy of less than 6 months, as defined by oncological staff, who were not receiving any life-prolonging care. Seventy-five patients received care at home (home-hospice), and the other 75 received care at the oncology department at the hospital, by palliative unit staff. Participants completed the Brief Symptom Inventory anxiety and depression subscales, questionnaires on perceived support and both questionnaires on home SOP and hospital SOP. RESULTS: Mean scores of emotional distress were similar for patients in home-hospice and at the hospital. Home SOP among individuals receiving care at home was high, and hospital SOP was high among hospitalized individuals. The structural equation model had good fit indexes, showing that each of the SOP variables mediated the association between place of care and emotional distress. Perceived support was associated with lower distress only in the hospital setting. CONCLUSIONS: The SOP concept is relevant to understanding emotional distress in relation to place of care at end of life. Strengthening SOP in relation to place of care should be considered. As newly introduced concept regarding place of care at the EoL, SOP warrants further research.

Heparanase-The Message Comes in Different Flavors.

Two decades following the cloning of the heparanase gene, the significance of this enzyme for tumor growth and metastasis cannot be ignored. Compelling pre-clinical and clinical evidence tie heparanase with all steps of tumor formation namely, initiation, growth, metastasis, and chemo resistance, thus confirming and significantly expanding earlier observations that coupled heparanase activity with the metastatic capacity of tumor cells. This collective effort has turned heparanase from an obscure enzyme to a valid target for the development of anti-cancer drugs, and led basic researchers and biotech companies to develop heparanase inhibitors as anti-cancer therapeutics, some of which are currently examined clinically. As expected, the intense research effort devoted to understanding the biology of heparanase significantly expanded the functional repertoire of this enzyme, but some principle questions are still left unanswered or are controversial. For example, many publications describe increased heparanase levels in human tumors, but the mechanism underlying heparanase induction is not sufficiently understood. Moreover, heparanase is hardly found to be increased in many studies utilizing methodologies (i.e., gene arrays) that compare tumors vs (adjacent) normal tissue. The finding that heparanase exert also enzymatic activity-independent function significantly expands the mode by which heparanase can function outside, but also inside the cell. Signaling aspects, and a role of heparanase in modulating autophagy are possibly as important as its enzymatic aspect, but these properties are not targeted by heparanase inhibitors, possibly compromising their efficacy. This Book chapter review heparanase function in oncology, suggesting a somewhat different interpretation of the results.

Long-term outcome of total knee arthroplasty in patients with morbid obesity.

INTRODUCTION: Patients with morbid obesity and advanced painful knee osteoarthritis are considered as poor candidates for total knee replacement. Our aims were to evaluate the outcomes of TKR surgery and the risks for post-operative complications in patients with morbid obesity (BMI > 40 kg/m2) as compared with obese patients (30 < BMI ≤ 40 kg/m2) and non-obese patients, BMI < 30 kg/m2); to evaluate if there are differences between morbid-obese patients (BMI 40-49.99 kg/m2) and extreme morbid obese patients (BMI > 50 kg/m2); and to present some surgical tips which can improve the TKR outcomes in morbid obese patients. MATERIALS AND METHODS: There were successive 333 patients, of them 39 patients (11.7%) were lost for follow-up. So, this series included 292 patients - 82 with bilateral TKR- and 374 TKR. The mean age was 64.3 years old (48-83 years) and the mean follow-up 10.8 years (4-17 years). The KSS and FKSS scores were calculated at the end of the follow-up period and compared to the pre-operative evaluation. Radiographic assessment at the end of follow-up included evaluation of implant position, alignment, and presence of radiolucent lines around the implants and was compared with the immediate post-operative radiographs. Statistical analysis was performed using SPSS v 22.0. RESULTS: Our findings showed marked improvement following TKR of non-obese, obese, and morbid obese patients, regarding the KSS and FKSS. Significant change was observed between the non-obese and obese patients as compared to morbid obese patients. There were no significant differences between morbid obese patients with BMI > 40 versus those with BMI > 50. There was a slight increased risk of early complications following TKR in morbid obese patients such as skin necrosis and infection around the surgical incision. CONCLUSIONS: Marked improvement was observed in the three groups of patients after TKR, although non-obese and obese groups had better mean scores of KSS and FKSS than morbid obese patients. No significant differences were found within the morbid obese patients themselves. Therefore, we believe that morbid obese patients are appropriate candidates and can enjoy the benefits of total knee arthroplasty done with careful use of some surgical tips presented in our study.

Stability and change of postchemotherapy symptoms in relation to optimism and subjective stress: A prospective study of breast cancer survivors.

OBJECTIVES: Inconsistent findings were reported about the course of postchemotherapy symptoms; specifically, the effect of changes in optimism and perception of subjective stress on the evolution of symptoms remains understudied. This prospective study aimed (a) to examine the course of postchemotherapy symptoms of emotional distress, fatigue, and cognitive difficulties among breast cancer survivors and (2) to assess the effect of changes in optimism and subjective stress on the trajectory of these symptoms. METHODS: Ninety-eight breast cancer survivors, diagnosed at stages I to III, aged 30 to 74, recruited consecutively (response rate 84.7%) completed fatigue, emotional distress, self-reported cognitive difficulties, optimism, and subjective stress questionnaires at three points in time: upon enrollment (1-6 months after completing treatment, Time 1) posttreatment, 6 months (Time 2), and 12 months (Time 3). A linear mixed-effects model was used to analyze the data. RESULTS: Emotional distress decreased between time-points, level of cognitive difficulties remained stable, and a marginal decrease in fatigue was evident. Optimism or subjective stress predicted changes in each of the symptoms (P<.01), except for the effect of optimism on cognitive difficulties (P=.06). The interactions between time and optimism and between time and subjective stress were only significant regarding their effect on emotional distress (P<.05), showing that the strongest effect of these variables was at Time 2. CONCLUSION: The course of postchemotherapy symptoms shows patterns of stability and change over a 1-year period. Optimism and subjective perceptions of stress were shown to affect the decrease of symptoms. Therefore, these two factors should be specifically targeted in psycho-social interventions.

Factors associated with routine screening for the early detection of breast cancer in cultural-ethnic and faith-based communities.

OBJECTIVES: Studies have shown a lower adherence to health behaviors among women in cultural-ethnic minorities and faith-based communities, especially lower screening attendance for the early detection of breast cancer. This study compares factors related to cancer screening adherence in two distinct cultural-ethnic minorities in Israel: Arab women as a cultural-ethnic minority and Jewish ultra-Orthodox women as a cultural-ethnic faith-based minority. DESIGN: During the year 2014, a total of 398 Jewish ultra-Orthodox women and 401 Arab women between the ages of 40-60, were randomly selected using population-based registries. These women answered questionnaires regarding adherence to mammography and clinical breast examination (CBE), health beliefs and cultural barriers. RESULTS: Arab women adhered more than ultra-Orthodox women to mammography (p < .001) and CBE exams (p < .01). Religious beliefs, exposure barriers and perceived risk were higher among the ultra-Orthodox women, while social barriers, accessibility barriers and perceived severity were higher among the Arab women (p < .01). Adjusting for background factors, higher adherence to CBE and mammography were associated with lower levels of religious beliefs (AOR = 0.90, 95% CI = 0.69-1.17 AOR = 0.62, 95% CI = 0.39-0.82, respectively), perceiving a higher risk of cancer (AOR = 1.93, 95% CI = 1.23-3.04 and AOR = 3.22, 95% CI = 1.53-6.61), and having more fears related to cancer-related losses (AOR = 1.51, 95% CI = 1.19-3.00 and AOR = 1.24, 95% CI = 0.63-1.22). In addition, perceiving greater advantages of CBE was associated with higher adherence to CBE (AOR = 1.82, 95% CI = 1.45-2.29), while not receiving a physician's recommendation was associated with lower adherence to mammography (AOR = 1.82, 95% CI = 1.45-2.29). CONCLUSION: This study addressed a lacuna in screening behaviors of women from cultural-ethnic and faith-based communities. In order to increase adherence, health care professionals and policymakers should direct their attention to the specific nature of each community.

The long-term effects of early-life trauma on psychological, physical and physiological health among the elderly: the study of Holocaust survivors.

Objectives: To study post-traumatic stress symptoms and post-traumatic growth and heart rate variability among elderly Holocaust survivors and a matched comparison group and the mediational effect of post-traumatic stress symptoms and post-traumatic growth on the association between Holocaust experience and heart rate variability. Method: 159 Holocaust survivors and 87 matched participants without Holocaust experience answered post-traumatic stress symptoms and post-traumatic growth questionnaires. Heart rate variability time and frequency parameters were measured for a subsample of N = 133. Results: Holocaust survivors reported higher levels of post-traumatic stress symptoms and post-traumatic growth. Most heart rate variability measures were similar in the two groups, except for better heart rate variability measured by the ratio of low frequency/high frequency among Holocaust survivors. Structural equation modeling showed that belonging to the Holocaust survivor group was associated with higher post-traumatic stress symptoms and higher post-traumatic growth, as well as better heart rate variability scores (standard deviation of normal to normal R-R intervals, high frequency and the ratio of low frequency/high frequency) through the mediation of post-traumatic stress symptoms and post-traumatic growth. Conclusions: The study emphasized the duality of the association between post-traumatic stress symptoms and post-traumatic growth and their integrated effect on heart rate variability.

Return to Work of Cancer Survivors: Predicting Healthcare Professionals' Assumed Role Responsibility.

Purpose Returning to work is highly beneficial for many cancer survivors. While research has documented the significance of healthcare professionals in the process of return to work (RTW), very little is known about those professionals' views regarding their responsibility for RTW. The purpose of the present study was to identify factors that predict the extent to which healthcare professionals view involvement in the RTW of cancer survivors as part of their role. Methods In a cross-sectional design, questionnaires measuring attitudes regarding personal role responsibility for RTW, team role responsibility for RTW and benefits of RTW were administered to 157 healthcare professionals who care for working-age cancer survivors: oncologists, occupational physicians, family physicians, oncology nurses, oncology social workers, and psychologists. Results Both belief in the benefits of RTW, and the view that RTW is the team responsibility of healthcare professionals working with cancer survivors, are positively related to viewing RTW as part of the responsibilities of one's personal professional role. Moderation analysis indicated that perception of team responsibility for RTW moderates the effect of the perceived benefits of RTW, such that the perception of benefits is significantly associated with personal role responsibility only when there is a low level of perceived team responsibility. Conclusions Issues related to RTW should be routinely included in basic and advanced training of healthcare professionals involved in the treatment of working-age cancer survivors, to increase awareness of this aspect of cancer survivors' well-being and position RTW as part of healthcare professionals' role responsibilities.

The Experience of Fatigue in Breast Cancer Patients 1-12 Month Post-Chemotherapy: A Qualitative Study.

The study explored the experience of fatigue, its effects and ways of coping with fatigue and the role of family and social support among breast cancer patients. In-depth, semi-structured interviews were conducted with 13 breast cancer patients stages I-III, aged 34-67, who were up to one year after the termination of chemotherapy. Two main themes emerged: "Being imprisoned in the body of an 80-year-old," focuses the fatigue experienced by younger and older women, during and post treatment, including the different patterns of fatigue and the various means of coping with fatigue; The "Family's bear-hug" exemplifies the role of the environment in coping with the experience of fatigue and the complexities entailed in receiving support from family and friends. The study provides a comprehensive picture of fatigue in its various contexts during and post-treatment and its impact on family relations and quality of life among younger and older breast cancer patients.

Health care professionals' perspective on return to work in cancer survivors.

OBJECTIVE: Health care professionals play a significant role in cancer survivors' decisions regarding return to work (RTW). While there is ample research about cancer survivors' views on RTW, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the RTW context, as well as their views about their own role in the process. METHODS: In-depth interviews (N = 26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers, and psychologists specializing in oncology. RESULTS: An analysis of the interviews revealed 2 prominent perceptual dimensions among professionals: the cancer survivor's motivation to RTW and understanding illness-related implications upon returning to work. The 2 dimensions imply the following 4 groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist," the "enthusiast," the "switcher," and the "worrier." The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions. CONCLUSIONS: The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding RTW.