Measures of Work-life Balance and Interventions of Reasonable Accommodations for the Return to Work of Cancer Survivors: A Scoping Review.

Background: Nearly half of patients diagnosed with cancer are in the middle of their traditional working age. The return to work after cancer entails challenges because of the cancer or treatments and associated with the workplace. The study aimed at providing more insight into the occupational outcomes encountered by workers with cancer and to provide interventions, programs, and practices to support their return to work. Methods: A scoping review was conducted using the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review guidelines. Relevant studies were systematically searched in PubMed/MEDLINE, SCOPUS and Grey literature from 01 January 2000 to 22 February 2024. Results: The literature search generated 3,017 articles; 53 studies were considered eligible for this review. Most of the studies were longitudinal and conducted in Europe. Three macroarea were identified: studies on the impact of cancer on workers in terms of sick leave, employment, return to work, etc.; studies reporting wider issues that may affect workers, such as the compatibility of treatment and work and employment; studies reporting interventions or policies aiming to promote the return to work. Conclusion: There is a lack in the literature in defining multidisciplinary interventions combining physical, psycho-behavioural, educational, and vocational components that could increase the return-to-work rates. Future studies should focus on interdisciplinary return to work efforts with multiple stakeholders with the involvement of an interdisciplinary teamwork (healthcare workers and employers) to combine these multidisciplinary interventions at the beginning of sick leave period.

The challenges of managing patients with cancer in the workplace: Needs, opportunities and perspectives of occupational physicians.

Cancer is a global major public health problem since it is a leading cause of death, accounting for nearly 10 million deaths in 2020 worldwide and the most recent epidemiological data suggested that its global impact is growing significantly. In this context, cancer survivors have to live for a long time often in a condition of disability due to the long-term consequences, both physical and psychological. These difficulties can seriously impair their working ability, limiting the employability. In this context, the occupational physician plays a key role in the implementation and enforcement of measures to support the workers affected by cancer, to address issues such as the information on health promotion, the analysis of work capacity and the management of disability at work and also promoting a timely and effective return to work and preserving their employability. Therefore, the aim of this study was to gather useful information to support the occupational physicians in the management of workers affected by cancer, through a survey on 157 Italian occupational physicians. Based on the interviewees' opinions, the most useful occupational safety and health professionals in terms of job retention and preservation of workers affected by cancer are the employers and the occupational physicians themselves, whose role is crucial in identifying and applying the most effective reasonable accommodations that should be provided to the workers affected by cancer. The provision of these accommodations take place on the occasion of mandatory health surveillance medical examination to which the worker affected by cancer is subjected when he returns to work. Results on training and information needs showed that the management of the workers affected by cancer is essentially centered on an appropriate fitness for work judgment and on the correct performance of health surveillance. However, an effective and successful management model should be based on a multidisciplinary and integrated approach that, from the earliest stages of the disease, involves the occupational physicians and employers.

An innovative approach to identify past exposure to asbestos integrating questionnaire information and administrative data.

Reconstruction of work history of subjects exposed to occupational carcinogens might be extremely challenging and provide unreliable results. This study, carried out in Italy from February to November 2014, aimed to explore the validity of an innovative approach to reconstruct the occupational history of workers who have previously been exposed to asbestos combining the administration of structured questionnaire with the use of administrative data. Subjects recruited in this study were enrolled in the cohorts of COSMOS 1 and 2 studies. Participants indicating an exposure to asbestos were contacted and a structured questionnaire was administered to them to verify the validity of the self-reported asbestos exposure. Subsequently, work histories of respondents were investigated using administrative information. The record linkage with social security archives allowed the reassembling of the complete work history of 487 participants. In detail, administrative files allow the retrieval of 98 % of workers declaring not to be exposed, versus 77 % using the questionnaire. Furthermore, the percentage of retrieved cases is not relevant for high risk sectors but it is almost double for industries with probable presence of asbestos. The combined and integrated use of structured questionnaire with administrative data proved effective in accurately identifying subjects who actually had an asbestos exposure. This innovative strategy, being cost-effective and easily adaptable to other carcinogens, could be particularly useful in selecting subjects to recruit in specific screening and control programs for the early diagnosis of occupational cancers.

Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos.

OBJECTIVES: Smoking is the main risk factor for lung cancer, but environmental and occupational exposure to carcinogens also increase lung cancer risk. We assessed whether extending low-dose computed tomography (LDCT) screening to persons with occupational exposure to asbestos may be an effective way reducing lung cancer mortality. MATERIALS AND METHODS: We conducted a nested case-control study within the COSMOS screening program, assessing past asbestos exposure with a questionnaire. LDCT scans of asbestos-exposed participants were reviewed to assess the presence of pulmonary, interstitial and pleural alterations in comparison to matched unexposed controls. We also performed an exhaustive review, with meta-analysis, of the literature on LDCT screening in asbestos-exposed persons. RESULTS: Exposure to asbestos, initially self-reported by 9.8% of COSMOS participants, was confirmed in 216 of 544 assessable cases, corresponding to 2.6% of the screened population. LDCT of asbestos-exposed persons had significantly more pleural plaques, diaphragmatic pleural thickening and pleural calcifications, but similar frequency of parenchymal and interstitial alterations to unexposed persons. From 16 papers, including this study, overall lung cancer detection rates at baseline were 0.81% (95% CI 0.50-1.19) in asbestos-exposed persons, 0.94% (95% CI 0.47-1.53) in asbestos-exposed smokers (12 studies), and 0.11% (95% CI 0.00-0.43) in asbestos-exposed non-smokers (9 studies). CONCLUSION: Persons occupationally exposed to asbestos should be monitored to gather more information about risks. Although LDCT screening is effective in the early detection lung cancer in asbestos-exposed smokers, our data suggest that screening of asbestos-exposed persons with no additional risk factors for cancer does is not viable due to the low detection rate.

[Preliminary results of a cognitive survey among the members of the Italian Medical Radiation Protection Society(AIRM): from characterization of the professional activity to identification of training needs]. / Risultati preliminari di un'indagine conoscitiva tra i soci dell'Associazione italiana radioprotezione medica (AIRM): dalla caratterizzazione dell'attività professionale all'individuazione del fabbisogno formativo.

OBJECTIVES: For several decades, the Italian Association of Medical Radioprotection (AIRM) is engaged in the promotion of scientific, technical, and methodological knowledge in the field of medical radioprotection. METHODS: Starting from the results of the previous study conducted in 2013, AIRM has carried out a new survey among its members. This survey was carried out through a self-administered questionnaire to be completed online on a platform set up on the association's website. RESULTS: The preliminary data collected by the survey provide both the personal/professional description of the AIRM members and an in-depth analysis regarding the need for training updates in the field of radioprotection. CONCLUSIONS: The results obtained will be used by the AIRM to support its commitment, now over a decade, in the offer of current and effective radioprotection update programs.

Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs.

BACKGROUND: Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed. OBJECTIVES: The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model. METHODS: We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole. RESULTS: We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production. CONCLUSIONS: This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.

Indoor formaldehyde and acetaldehyde levels in the province of Bari, South Italy, and estimated health risk.

Indoor and outdoor formaldehyde and acetaldehyde levels were assessed to characterize pollution in dwellings in the city and the Province of Bari, also taking into account seasonal variability, and to investigate health effects of aldehyde exposure on the general population. In 2007, passive environmental monitoring was performed, for 24 hours, in the kitchen of 59 dwellings, as well as outdoors for 27 of them. A questionnaire probing personal and home characteristics was administered to all 182 subjects habitually resident in the homes. During the period January-June 2008, formaldehyde and acetaldehyde levels were monitored monthly in 20 of the investigated dwellings inhabited only by non smokers. Indoor formaldehyde and acetaldehyde concentrations were significantly higher (16.0 +/- 8.0 and 10.7 +/- 8.8 microg m(-3)) than outdoor concentrations (4.4 +/- 1.7 and 3.4 +/- 2.0 microg m(-3)), showing a correlation between indoor levels of the two aldehydes (r = 0.41; p = 0.001). In dwellings inhabited only by non smokers, formaldehyde concentrations were higher in the presence of furniture bought new or restored less than one year before (p = 0.03). Formaldehyde and acetaldehyde levels were significantly higher in winter months than in spring-summer months (F = 2.86, p = 0.02; F = 5.39, p < 0.001) and seemed to be influenced by the time that kitchen windows were kept open. As regards the effects on human health, a low prevalence of allergic disease and no association between any irritant or allergic complaints and indoor levels of the two aldehydes was observed. In conclusion, the results showed low indoor and outdoor concentrations of formaldehyde and acetaldehyde, not generally posing a risk for human health.