Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES).

BACKGROUND: Breast cancer (BC) treatments and related symptoms may affect return to work (RTW). The objective of this study was to investigate the impact of BC care pathways (timing and sequence of treatments) and related symptoms on RTW. METHODS: The study population included working-age women with BC who were enrolled in the French CONSTANCES cohort from 2012 to 2018. BC treatments, antidepressant/anxiolytic and antalgic drug deliveries (used as proxies of depression and pain, respectively) and statutory sick pay (used to estimate RTW and time to RTW) were assessed monthly using data from the French national healthcare system database. BC care pathways were identified with the sequence analysis method. Cox models with time-dependent covariates were used to investigate the impact of BC care pathways and related symptoms on RTW and time to RTW, after adjusting for age and socioeconomic characteristics. RESULTS: 73.2% (231/303) of women returned to work within 2 years after BC diagnosis. Five BC care pathway patterns were identified: (i) BC surgery only, (ii) BC surgery and radiotherapy, (iii) BC surgery and chemotherapy, (iv) BC surgery and chemotherapy and radiotherapy, and (v) BC surgery and long-term alternative chemotherapy/radiotherapy. The hazards ratios of non-RTW were significantly higher for women who received BC surgery and long-term alternative chemotherapy/radiotherapy and for > 55-year-old women. Time to RTW was significantly longer in women who received chemotherapy (patterns iii to v) and in women with antidepressant/anxiolytic and antalgic drug deliveries. CONCLUSION: This study highlights the value of considering the dynamic, cumulative and temporal features of BC care pathways and related symptoms to facilitate the RTW of women with BC.

The cancer survivor-Manager dyad during the return-to-work process: An introduction with theoretical, conceptual, and methodological considerations.

OBJECTIVE: There is a need for tailored interventions aimed at promoting the sustainable return to work (RTW) of cancer survivors. As managers have a primary role in supporting cancer survivors to return to work, a better understanding of the "cancer survivor-manager" dyadic process is much needed. The aim of this paper is to introduce the cancer survivor-manager dyad in the context of RTW of cancer survivors, and to inform future studies by presenting theoretical, conceptual, and methodological considerations. CONCLUSIONS: Different theoretical, conceptual, and methodological aspects are addressed that open new perspectives concerning the cancer survivor-manager dyad. Among the theoretical and conceptual aspects, we highlight the interest of developing dyadic coping models specific to the cancer survivor-manager dyad. This would allow the conceptualization of their interpersonal dynamics and to frame interventions aimed at supporting cancer survivors and managers. In addition, we encourage to study in more detail the quality of the relationship between the cancer survivor and manager, including its impact on work-related outcomes of the cancer survivor. Methodologically, the actor-partner interdependence model could be relevant to identify any interdependence in the cancer survivor-manager dyad. We also recommend using longitudinal and prospective studies to investigate the cancer survivor-manager dyad, as these studies are well suited to identify evolutive and dynamic aspects of the cancer survivor-manager dyad. Lastly, we propose a recruitment strategy of the dyad by involving a trustworthy third party, to respect the ethical framework, and the privacy and voluntary choice of cancer survivors.

Physical activity in people diagnosed with cancer: a rapid review of recommendations and critical appraisal of international guidelines.

PURPOSE: There are numerous guidelines that recommend physical activity (PA) in people diagnosed with cancer, but the quality of these guidelines is unknown. The aim of this study was to identify existing PA guidelines for cancer survivors, describe the recommendations, and assess their methodology quality. METHODS: A rapid review of the literature was conducted in PubMed and EMBASE, supplemented by a search of the grey literature. The methodological quality of the guidelines was assessed using the AGREE II checklist. A descriptive synthesis of the recommendations from guidelines judged to be of good quality has been performed. RESULTS: A total of nine guidelines published between 2006 and 2019 were included. Of nine guidelines, five achieved a high enough AGREE II score and were judged to be of good quality for use in clinical practice. We found that the recommendations from the five guidelines converged on the prescription of supervised PA (aerobic and resistance exercise) of at least 75 min per week of high intensity or 150 min per week of moderate intensity, spread over two to five sessions per week, equating to a PA dose between 8.70 and 17.5 MET.h/week. The recommendations were applicable to address the most common side effects of cancer and its treatment, namely fatigue, lymphedema, anxiety, depressive symptoms, health-related quality of life (QoL), survival, and physical function. However, no guideline recommends PA to improve other cancer-related outcomes, such as cognitive impairment, falls, sexual function, and peripheral neuropathy frequently experienced by cancer survivors. No guideline also referred to work outcomes (i.e., work ability, return to work, etc.). CONCLUSION: Most PA guidelines for cancer survivors are of good quality. However, specific PA guidelines are needed for a given cancer site (e.g., location, stage), at a particular phase of the cancer trajectory, and for specific outcomes including return to work (RTW) in order to tailor PA to each cancer survivor.

Effectiveness of Physical Activity Interventions on Return to Work After a Cancer Diagnosis: A Systematic Review and Meta-analysis.

Purpose The aim of this study was to assess the effectiveness of physical activity (PA) interventions on return to work (RTW) in cancer survivors, compared to usual care, and to determine the dose of PA needed to improve this outcome. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Six electronic databases including PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and Scopus were searched to identify studies, and completed by a search of grey literature and health organization websites. Two authors performed screening, selection, and data extraction independently. Study and intervention characteristics were extracted and summarized. Pooled risk ratio (RR) was estimated using a weight random-effects model with 95% confidence intervals (CIs). Results A total of 2655 records were identified, of which 8 intervention studies were included. The sample size of the included studies varied between 41 and 240, giving a total of 1087 participants aged between 18 and 75 years. Compared with usual care, PA interventions had a significant positive effect on RTW among cancer survivors with a pooled RR of 1.29 (95% CI 1.17, 1.42). We found that PA interventions (aerobic and resistance exercises) with an exercise dose between 7.6 METs.h/week and 15 METs.h/week, consisting in 50-60 min per session of moderate to vigorous physical exercise, twice a week seems relevant in improving RTW. Conclusions Our results showed, with moderate quality evidence that PA interventions are more effective than usual care in increasing the rate of RTW in cancer survivors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration Number, CRD42020203614.

Comparison of Machine Learning Methods in the Study of Cancer Survivors' Return to Work: An Example of Breast Cancer Survivors with Work-Related Factors in the CONSTANCES Cohort.

PURPOSE: Machine learning (ML) methods showed a higher accuracy in identifying individuals without cancer who were unable to return to work (RTW) compared to the classical methods (e.g. logistic regression models). We therefore aim to discuss the value of these methods in relation to RTW for cancer survivors. METHODS: Breast cancer (BC) survivors who were working at diagnosis within the CONSTANCES cohort were included in the study. RTW was assessed five years after the BC diagnosis (early retirement was considered as non-RTW). Age and occupation at diagnosis, and physical occupational job exposures assessed using the Job Exposure Matrix, JEM-CONSTANCES, were evaluated as predictors of RTW five years after BC diagnosis. The following four ML methods were used: (i) k-nearest neighbors; (ii) random forest; (iii) neural network; and (iv) elastic net. RESULTS: The training sample included 683 BC survivors (RTW: 85.7%), and the test sample 171 (RTW: 85.4%). The elastic net method had the best results despite low sensitivity (accuracy = 76.6%; sensitivity = 31.7%; specificity = 90.8%), and the random forest model was the most accurate (= 79.5%) but also the least sensitive (= 14.3%). CONCLUSION: This study takes a first step towards opening up new possibilities for identifying the occupational determinants of cancer survivors' RTW. Further work, including a larger sample size, and more predictor variables, is now needed.

Burnout among direct support workers of adults with autism spectrum disorder and intellectual disability.

BACKGROUND: Direct support workers (DSWs) accompany adults with autism spectrum disorder (ASD) and intellectual disability (ID) in residential care homes. Such DSWs, without specialised ASD training, are exposed to chronic stress linked to supporting ASD-ID clients and must adjust by coping strategies adapted to the needs of the residents. Nevertheless, difficulties adjusting constitute a burnout risk for DSWs, characterised by high levels of emotional exhaustion, depersonalisation and loss of a sense of personal accomplishment. We aimed to describe the burnout of DSWs who support adults with ASD-ID and to identify personal variables (experience and specialised training for ASD) and transactional variables (perceived stress and coping strategies) that could predict and mediate burnout. METHOD: In total, 125 DSWs accompanying ASD-ID adults on a daily basis were included. Each participant answered four questionnaires measuring burnout, sociodemographic and professional variables, coping strategies and perceived stress. RESULTS: Five per cent of DSWs were in a state of burnout. Eighteen, six and fifty-nine per cent showed high average scores of emotional exhaustion, depersonalisation and loss of a sense of personal accomplishment, respectively. Being older, specialised training in ASD, stress perceived as a challenge and problem-focused coping strategies were associated with low levels of depersonalisation and loss of a sense of personal accomplishment. CONCLUSIONS: Understanding the burnout process of ASD-ID DSWs may require the assessment of the organisational characteristics linked to the quality of life of the DSWs and the recognition of their specific needs when facing difficulties. The necessary ASD-focused training and support depends on an appraisal that would be individualised to adult ASD-ID DSWs.

Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment.

PURPOSE: To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment. METHODS: We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20). RESULTS: Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29]. CONCLUSIONS: Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.

Development of a New Scale to Assess Students' Autodetermination At School (AAS).

The Autodetermination At School (AAS) hetero-evaluative scale was created and validated in a French teacher population with the aim of quantifying, in an ecological way, the commitment at school of elementary students. After establishing the scale's face validity, AAS was tested with an exploratory factor analysis, a confirmatory factor analysis, a convergent validity analysis, a test-retest analysis and an inter-individual analysis. The EFA highlighted three distinct factors and the CFA validated the reliability of a three-factor model for AAS with relevant fits and indices. The first dimension concerns teacher perception of academic commitment, reflecting both child performance and autonomous motivation. The second and third ones reflect teacher perception of the child's social commitment, to their peers as well as to their teacher. Consequently, AAS is a useful, reliable and robust psychometric instrument that emphases how intrinsic motivation and performance are closely linked. It also considers the importance of social child commitment at school. The inter-individual analysis revealed trends of grade, gender and school environment effects.

Supporting the return to work of breast cancer survivors: perspectives from Canadian employer representatives.

PUR POSE: A significant proportion of women with breast cancer want to RTW (return to work) after treatment. Employers play a key role in facilitating RTW for these employees who face distinct challenges. However, the portrait of these challenges remains to be documented from the perspective of employer representatives. The purpose of this article is to describe the perceptions of Canadian employer representatives regarding the management of the RTW of BCSs (breast cancer survivors). METHODS: Thirteen qualitative interviews were conducted with representatives from businesses of various sizes (< 100 employees, 100-500 employees, > 500 employees). Transcribed data were subjected to iterative data analysis. RESULTS: Three major themes emerged to describe employer representatives' perceptions of managing RTW of BCS. These are (1) providing tailored support; (2) remaining 'human' while managing RTW; and (3) facing the challenges of RTW management after breast cancer. The first two themes were perceived as facilitating RTW. The challenges identified concern uncertainty, communication with the employee, maintaining a supernumerary work position, balancing employee and organizational interests, reconciling with colleagues' complaints, and collaboration among stakeholders. CONCLUSIONS: Employers can adopt a humanistic management style by offering flexibility and increased accommodation for BCS who RTW. They can also be more sensitive to this diagnosis, leading some to seek more information from those around them who have experienced it. Employers require increased awareness about diagnosis and side effects, be more confident to communicate, and improved collaboration between stakeholders to facilitate the RTW of BCS. IMPLICATIONS FOR CANCER SURVIVORS: Employers who focus on the individual needs of cancer survivors during RTW can facilitate creative and personalized solutions for a sustainable RTW and help survivors recover their lives after cancer.

Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience.

OBJECTIVES: Emotional profile is involved in the experience of chronic pain related to endometriosis. Following the Örebro Model of Behavioral Emotion Regulation of Pain, the aim of this study was to understand the processes involved in the psychological adaptation to pain experienced during menstruations in women either diagnosed or not diagnosed with endometriosis. METHODS: The study was conducted on a sample of 545 women, either diagnosed with endometriosis or not, during their menstruations. Functional repercussions and intensity of pain, catastrophic thinking, difficulties in emotional regulation and emotional distress were assessed through an online questionnaire. Structural equation modeling (SEM) was carried out. RESULTS: Women diagnosed with endometriosis experience more suffering than women who have not had such a diagnosis. The model we adapted from Örebro's model fits the data well. A differential effect is observed regarding the retroactive effect of depression on pain. Although emotional distress increases functional repercussions among women both with and without the diagnosis, growing pain intensity only occurs among those without. CONCLUSIONS: A woman presenting pain during menstruation faces emotional regulation issues that make her more vulnerable to the development of emotional distress. Pain impacts emotional distress, but emotional distress does not impact pain among women for whom the origin of the pain was known (i.e., a diagnosis of endometriosis). Having a diagnosis allows women to externalize the origin of their pain, attributing it to the disease and not to their psychological state.

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective.

Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient's choice of professional project; (iii) respecting the temporality of the patient's choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.

A questionable version of the Post-Traumatic growth inventory-Short form in women diagnosed with breast cancer.

OBJECTIVES: Because the full version of the Post-Traumatic Growth Inventory was considered too long, a short English version (10 items/five factors) was initially proposed in the literature (PTGI-SF). Thereafter another short Italian version (10 items/five factors) and a unidimensional English version (11 items) were proposed. This study aimed at evaluating which of these three versions of the PTGI-SF could be best adapted to women diagnosed with breast cancer. DESIGN: Cross-sectional and psychometrics study. METHODS: A total of 239 breast cancer patients or survivors were included in the study. To assess all items related to the different PTGI-SF candidate versions; the full-length PTGI has been used to measure PTG. A set of psychometric analyses, including a confirmatory factor analysis, composite reliability and construct validity has been performed. RESULTS: The English unidimensional version did not fit the data (SB-Chi2  = 184.47, df = 42, p < .001; SB-RMSEA = .119; SB-CFI = .814; SB-TLI = .757; SRMR = .083). Both the English (SB-Chi2  = 61.40, df = 25, p < .001; SB-RMSEA = .078; SB-CFI = .948; SB-TLI = .907; SRMR = .048) and Italian (SB-Chi2  = 26.52, df = 25, p > .05; SB-RMSEA = .016; SB-CFI = .998; SB-TLI = .996; SRMR = .026) versions (10 items/five factors, respectively) showed satisfactory psychometric results. CONCLUSION: Further investigations are thus required to identify which of these two versions of the PTGI-SF is the most appropriate for women diagnosed with breast cancer.

Return to work of breast cancer survivors: toward an integrative and transactional conceptual model.

PURPOSE: To propose a conceptual framework of the return to work (RTW) of breast cancer survivors (BCS) according to the transactional perspective. METHODS: The Technique for Research of Information by Animation of a Group of Experts was implemented. For each determinant in an initial list established from the literature, experts selected for the consensus exercise were firstly asked to indicate their agreement level individually, via an online questionnaire. Determinants obtaining an agreement level of 80% or over during this first phase were retained. Determinants obtaining an agreement level below 80%, and additional determinants proposed by the experts, were then discussed collectively. After discussion, experts voted via a new online questionnaire to retain (or not) each determinant. Determinants obtaining an agreement level of 80% or over after this second phase were retained. Based on the determinants selected, a conceptual model was developed following the transactional approach. RESULTS: Eleven experts participated in the study. Forty of the 51 determinants listed initially from the literature achieved an agreement level over 80%, and 20 were added after the individual consultation phase. Twenty-two of the 31 determinants discussed collectively were retained. In total, 62 determinants were selected to construct the conceptual model. CONCLUSIONS: This integrative, operational, and transactional conceptual model of the RTW of BCS, constructed following an expert consensus, will help to design more efficient patient-centered intervention studies. IMPLICATIONS FOR CANCER SURVIVORS: Identification of the 62 determinants associated with the RTW of BCS will help design tools that are easily used by all stakeholders involved in the RTW process.

[Occupational exposome: An organisational model]. / Un modèle organisationnel de l'exposome professionnel.

This article describes the concept of occupational exposome in highlighting the value of the concept in understanding the complexity of workplace exposures and their determinants. An organizational approach to the occupational exposome is proposed. The organizational approach is intended, from an interdisciplinary perspective, to broaden the levels of analysis of the exposures (whether they are) of the individual to the work situation (individual or collective), the work situation in the workshop or in the service, the company and the socio-economic environment of the company, the socio-economic environment of the company to the Society as a whole. The organizational approach of the occupational exposome helps to broaden the spectrum of health risk assessment and to promote a comprehensive and integrated approach to the prevention of arduousness at work and occupational wear and tear.

Title: Un modèle organisationnel de l'exposome professionnel. Abstract: Dans cette revue, nous décrivons le concept d'exposome professionnel, en soulignant son intérêt pour appréhender la complexité des expositions en milieu de travail et saisir l'ensemble de leurs déterminants. Une approche organisationnelle de cet exposome est par ailleurs proposée. Elle vise, en lui donnant une perspective interdisciplinaire, à élargir les niveaux d'analyse des expositions, quelles qu'elles soient, de l'individu à la situation de travail, individuelle ou collective, de la situation de travail à l'atelier ou au service dans l'entreprise1 et son environnement socio-économique, et, enfin, de l'environnement socio-économique de l'entreprise à l'ensemble de la Société. Cette approche organisationnelle de l'exposome professionnel contribue également à élargir le spectre de l'évaluation des risques sanitaires et à promouvoir une approche globale et intégrée de la prévention de la pénibilité au travail et de l'usure professionnelle.

[French translation and adaptation of the "Return to Work Self-Efficacy' Scale - 11 items" in patients diagnosed with a cancer]. / Traduction et adaptation française du « Return to Work Self-Efficacy' scale ­ 11 items ¼ chez des patients diagnostiqués d'un cancer.

INTRODUCTION: The self-efficacy to return to work is a major psychological factor of the return to work of patients diagnosed with a cancer. However, french investigations in this field do not take this dimension into account due to the lack of a suitable tool for its assessment. The objective of this study was to provide a french translation and adaptation of the "Return to Work Self-Efficacy' scale - 11 items" (RTWSE-11), validated in dutch language in its original version. METHODS: After translation-back translation steps, completed by experts' consensus meetings, interviews were conducted with thirteen patients diagnosed with cancer in order to evaluate the degree of clarity, simplicity and ambiguity or the various elements of the french version of the RTW-SE-11. RESULTS: The main modifications inherent to the french adaptation of the questionnaire concerned the modalities of the Likert scale and the inversion of three negative items into positive items. DISCUSSION: The french translation and adaptation of the RTWSE-11 was particularly faithful to the semantic, idiomatic, functional, experiential, conceptual and operational aspects of the original version. Future work can therefore focus on the psychometrics evaluations of the questionnaire. However, this tool can already be used in clinical practice to establish an initial assessment of the ability of patients diagnosed with cancer to return to work.

Fatigue in cancer patients: Development and validation of a short form of the Multidimensional Fatigue Inventory (MFI-10).

PURPOSE: The MFI was developed in 1995 to assess fatigue as a multidimensional concept. This questionnaire has been widely translated and used; however, its multidimensional structure has not been consistent across studies. In addition there is a need for short questionnaires in the clinical context. Therefore, we aim to develop a MFI-short version which is easy-to-use for the patient, quick for the clinician, with solid psychometric properties. METHODS: We examined three MFI-20 validated versions and tested their structure, by leading a CFA on 422 cancer patients to evaluate their psychometric qualities (Study 1). Then, we conducted both EFA and CFA by deleting all reversed items. We assumed that 10 items were sufficient to conserve a good explanation of the data and a multidimensional structure (Study 2). RESULTS: Study 1 revealed that there is no consensus about the structure of the three MFI versions tested and CFA showed inadequate fit (RMSEA > .10; CFI < .9). Those three versions showed an inadequate fit with regard to expected fit indices. In study 2, the multidimensional structure was confirmed with only ten items. The best model gave a three-factor solution with a χ2 = 67.130, a RMSEA = .072 (95% CI [.048-.096]) and a CFI equal to .97. CONCLUSIONS: The MFI short-form maintains good psychometric quality. This new questionnaire is adapted to cancer populations, and may be useful for clinicians to screen their patients' fatigue. Further validations of this MFI-short form are warranted to confirm its psychometric properties in other populations.