What really matters for returning to work after breast cancer? A 6-month exploratory study.

Return to work (RTW) after breast cancer (BC) may significantly impact on women recovery and quality of life. Literature hightlighed several factors associated to RTW after BC but there is still some concern about prognostic factors influencing work resumption after BC treatments. The present study aims to explore which baseline factors are associated with RTW at 6-month after BC surgery. The participants in this 6-month prospective study were 149 patients who underwent breast cancer-related surgery and accessed an Oncology Clinic for cancer therapy from March 2017 to December 2019 in Northern Italy. Participants filled in a battery of questionnaires at baseline, and they were asked whether they had returned to work at 6-month follow-up. Psychological measurements included job stress (Job Content Questionnaire), work engagement (Utrecht Work Engagement Scale), quality of life (World Health Organization Quality of Life- BREF), anxiety and depression (Hospital Anxiety and Depression Scale), resilience (Connor - Davidson Resilience Scale - 10 item) and personal expectations about RTW (ad-hoc single item). Moreover, sociodemographic, clinical, and work-related data were collected. Independent t-test and Chi-square test were used for comparisons among variables; logistic regression model was used to explore predictors of RTW. A total of 73.9 percent returned to work at6-month after surgery. In the multivariate model, chemiotherapy (B = -1.428; SE = 0.520) and baseline women's expectations about their RTW (B = -0.340; DS = 0.156) were significant predictors of RTW. These results suggest that careful individual clinical and psychological screening of risk factors at baseline can prevent from occupational disability and long sickness absence.

Patient-Factors Influencing the 2-Year Trajectory of Mental and Physical Health in Prostate Cancer Patients.

This study aimed to examine the physical and mental Quality of Life (QoL) trajectories in prostate cancer (PCa) patients participating in the Pros-IT CNR study. QoL was assessed using the Physical (PCS) and Mental Component Score (MCS) of Short-Form Health Survey upon diagnosis and two years later. Growth mixture models were applied on 1158 patients and 3 trajectories over time were identified for MCS: 75% of patients had constantly high scores, 13% had permanently low scores and 12% starting with low scores had a recovery; the predictors that differentiated the trajectories were age, comorbidities, a family history of PCa, and the bowel, urinary and sexual functional scores at diagnosis. In the physical domain, 2 trajectories were defined: 85% of patients had constantly high scores, while 15% started with low scores and had a further slight decrease. Two years after diagnosis, the psychological and physical status was moderately compromised in more than 10% of PCa patients. For mental health, the trajectory analysis suggested that following the compromised patients at diagnosis until treatment could allow identification of those more vulnerable, for which a level 2 intervention with support from a non-oncology team supervised by a clinical psychologist could be of help.

Cross-cultural differences in men on active surveillance' anxiety: a longitudinal comparison between Italian and Dutch patients from the Prostate cancer Research International Active Surveillance study.

BACKGROUND: Men diagnosed with localized prostate cancer (PCa) on active surveillance (AS) have shown to cope with anxiety caused by living with an 'untreated cancer' and different factors can influence the tolerance level for anxiety in these patients. The present study analyzes Italian (Milan) and Dutch (Rotterdam) men prospectively included in the Prostate cancer International Active Surveillance (PRIAS) trial, aiming to explore whether socio-demographic factors (i.e. age, relationship status, education, nationality) may be relevant factors in conditioning the level of anxiety at AS entry and over time. METHODS: Italian and Dutch men participating in the IRB-approved PRIAS study, after signing an informed consent, filled in the Memorial Anxiety Scale for PCa (MAX-PC) at multiple time points after diagnosis. A linear mixed model was used to assess the relationship between the level of patient's anxiety and time spent on AS, country of origin, the interaction between country and time on AS, patients' relationship status and education, on PCa anxiety during AS. RESULTS: 823 MAX-PC questionnaires were available for Italian and 307 for Dutch men, respectively. Median age at diagnosis was 64 years (IQR 60-70 years) and did not differ between countries. On average, Dutch men had a higher total MAX-PC score than Italian men. However, the level of their anxiety decreased over time. Dutch men on average had a higher score on the PCa anxiety sub-domain, which did not decrease over time. Minimal differences were observed in the sub-domains PSA anxiety and fear of recurrence. CONCLUSION: Significant differences in PCa anxiety between the Italian and Dutch cohorts were observed, the latter group of men showing higher overall levels of anxiety. These differences were not related to the socio-demographic factors we studied. Although both PRIAS-centers are dedicated AS-centers, differences in PCa-care organization (e.g. having a multidisciplinary team) may have contributed to the observed different level of anxiety at the start and during AS. Trial registration This study is registered in the Dutch Trial Registry ( www.trialregister.nl ) under NL1622 (registration date 11-03-2009), 'PRIAS: Prostate cancer Research International: Active Surveillance-guideline and study for the expectant management of localized prostate cancer with curative intent'.

How do prostate cancer patients navigate the active surveillance journey? A 3-year longitudinal study.

OBJECTIVE: To investigate whether prostate cancer (PCa) patients' coping strategies (i.e., fighting spirit, anxious preoccupation, fatalism, helplessness/hopelessness, and avoidance) significantly change during the first 3-year follow-up period of active surveillance (AS). MATERIALS AND METHODS: Altogether, 104 patients on AS completed the Mini-Mental Adjustment to Cancer (Mini-MAC) at baseline (T0), at 10 and 12 months after diagnostic biopsy (T1 and T2, respectively) and then at 24- (T3) and 36-month (T4) follow-up. Paired samples T test was used to detect statistically significant changes over time. Changes ≥ 1 point (or ≤ - 1) were hypothesized to be clinically relevant. RESULTS: During the first 3 years on AS, men experienced decreased anxiety, avoidance thoughts/behaviors, and fight-against-cancer attitudes, and these changes were found to be statistically significant. When considering clinically significant changes between inclusion in AS (T0) and 3-year follow-up (T4), avoidance decreased in 19% of patients. CONCLUSIONS: Most patients were observed to have adopted functional coping strategies at baseline, which were maintained through the first 3 years on AS. Overall, men on AS may perceive increasing control over their cancer and comfort with the AS protocol over time and experience slight decreases in anxious preoccupation, cancer-related avoidance thoughts and behaviors, and fight-against-cancer reactions. For those men who find it difficult to cope with AS, psychological monitoring and interventions could be helpful throughout the monitoring journey.

Supporting Patients With Untreated Prostate Cancer on Active Surveillance: What Causes an Increase in Anxiety During the First 10 Months?

BACKGROUND: The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL). MATERIALS AND METHODS: A total of 236 patients participated in the PCa Research International: AS (PRIAS) protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa (MAX-PC)], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety. RESULTS: The median age was 64.4 years. Fifty-six patients (24%) reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio (OR) = 4.36], extraversion (OR = 1.9), and prostate-related symptoms (median OR = 0.46). Physical well-being was associated with a low PCa anxiety subscale (median OR = 0.15); neuroticism and functional well-being were associated with PSA anxiety (median OR = 7.05 and 0.73, respectively). Neuroticism and helplessness/hopelessness were associated with fear of progression (median OR = 18.1 and 5.8, respectively). CONCLUSION: Only a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors (i.e., anxious preoccupation, extraversion) for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being.

Emotional dissonance and exhaustion among healthcare professionals: the role of the perceived quality of care.

OBJECTIVES: The aim of this exploratory study was to analyze the association between emotional dissonance and emotional exhaustion among healthcare professionals, and the mediating role of the perceived quality of care in this relationship. MATERIAL AND METHODS: Self-report questionnaires were administered to 724 healthcare workers. The measurement model was tested and the mediation hypothesis was verified through hierarchical multiple regression analyses. Bootstrapping was used to construct confidence intervals to evaluate the mediation effects. RESULTS: Emotional dissonance was significantly related to emotional exhaustion, and the perceived quality of care was negatively related to emotional exhaustion. The perceived quality of care had a partial mediating effect on the relationship between emotional dissonance and emotional exhaustion. Emotional dissonance had a significant effect on emotional exhaustion, and the perceived quality of care was a mediating factor in this relationship among healthcare professionals. CONCLUSIONS: The management of the perceived quality of care may be helpful in the prevention of burnout and distress in the workplace. Int J Occup Med Environ Health. 2019;32(6):841-51.

Live to Work or Work to Live? An Age-Moderated Mediation Model on the Simultaneous Mechanisms Prompted by Workaholism Among Healthcare Professionals.

The "aging population" implies an increased proportion of older professionals and a growing demand for healthcare services. Healthcare professionals are often highly committed to their work which can be reflected in high levels of workaholism, being a double-edged sword that can prompt both positive and negative mechanisms, differently affecting younger and older healthcare workers. The present study aims to gain insights into the relationships between healthcare professionals' age, workaholism and job satisfaction, by estimating the sequential mediating roles of workload perceptions and emotional exhaustion. We used original survey data, including information on 750 healthcare professionals. Overall, the negative relationship between workaholism and job satisfaction was shown to be sequentially (and partially) mediated by workload perceptions and emotional exhaustion. Multi-Group SEM analyses revealed differences across three age groups (under 35; between 35 and 50; over 50). Only in the two younger age groups, we found a direct and positive relationship between workaholism and job satisfaction. In all age groups, we found the negative relationship between workaholism and job satisfaction to be sequentially (and partially) mediated by workload perceptions and emotional exhaustion. The indirect effects were relatively stronger in the younger age group. Workaholism can prompt both a "gain spiral" and "a loss spiral" among healthcare professionals. The first reflects workaholism to function as a job resource fostering job satisfaction (only for the two younger age groups). The second reflects workaholism to function as a job demand reducing job satisfaction. This mechanism was shown to be stronger with an increasing age.

Making Active Surveillance a path towards health promotion: A qualitative study on prostate cancer patients' perceptions of health promotion during Active Surveillance.

OBJECTIVE: Health promotion is a key aspect for health outcomes of prostate cancer (PCa) patients. However, it has been poorly explored among patients following monitoring programmes, for example Active Surveillance (AS). This study aimed to explore PCa patients' perceptions of health promotion during AS. METHODS: An explorative qualitative research design was adopted. Four focus groups were used to collected data from 24 men enrolled in the Prostate Cancer Research International: AS (PRIAS) protocol. A thematic analysis with an inductive approach was performed. RESULTS: Participants described promoting health during AS as challenged by mental, age-related, informational and organisational issues. It was reported as an effort to stay in the present with a positive outlook, despite the worries for the future ("the mental theme"). It was perceived as impacted by being older and having to manage physical and mental struggles related to age ("the life-course theme"). It depended, in their accounts, on obtaining reliable information and personalised education ("the educational theme"). Finally, it was related on taking responsibility on the care process ("the organisational theme"). CONCLUSION: This study suggested ways of promoting health during AS that can help healthcare professionals and organisations building a "health-promoting AS," able to improve overall health outcomes.

Caring for Critically Ill Patients: Clinicians' Empathy Promotes Job Satisfaction and Does Not Predict Moral Distress.

BACKGROUND: Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job. METHODS: Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables. RESULTS: Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (ß = 0.193; p < 0.05). None of the variables included in the model predicted moral distress. CONCLUSION: Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.

Value congruence and depressive symptoms among critical care clinicians: The mediating role of moral distress.

Clinicians working in intensive care units are often exposed to several job stressors that can negatively affect their mental health. Literature has acknowledged the role of value congruence and job control in determining clinicians' psychological well-being and depressive symptoms. However, potential mediators of this association have been scarcely examined. This study aimed to test the mediating role of moral distress in the relationship between value congruence and job control, on the one hand, and depression, on the other hand. A cross-sectional study involving physicians, nurses, and residents working in 7 intensive care units in the north of Italy was conducted. Clinicians were administered in the Italian Moral Distress Scale-Revised, the value and control subscales of the Areas of Worklife Scale, and the Beck Depression Inventory II. Structural equation modeling was used to test the mediation model. Analysis on 170 questionnaires (response rate 72%) found no relations between job control and moral distress. A total indirect effect of value congruence on depression through moral distress (ß = -.12; p = .02) was found. Moral distress contributes to the development of depressive symptoms among critical care clinicians who perceive a value incongruence with their organization and therefore should be addressed.

Keep Up the Good Work! Age-Moderated Mediation Model on Intention to Retire.

In European nations, the aging of the workforce is a major issue which is increasingly addressed both in national and organizational policies in order to sustain older workers' employability and to encourage longer working lives. Particularly older workers' employability can be viewed an important issue as this has the potential to motivate them for their work and change their intention to retire. Based on lifespan development theories and Van der Heijden's 'employability enhancement model', this paper develops and tests an age-moderated mediation model (which refers to the processes that we want to test in this model), linking older workers' (55 years old and over) perceptions of job support for learning (job-related factor) and perceptions of negative age stereotypes on productivity (organizational factor), on the one hand, and their intention to retire, on the other hand, via their participation in employability enhancing activities, being the mediator in our model. A total of 2,082 workers aged 55 years and above were included in the analyses. Results revealed that the two proposed relationships between the predictors and intention to retire were mediated by participation in employability enhancing activities, reflecting two mechanisms through which work context affects intention to retire (namely 'a gain spiral and a loss spiral'). Multi-Group SEM analyses, distinguishing between two age groups (55-60 and 61-65 years old), revealed different paths for the two distinguished groups of older workers. Employability mediated the relationship between perceptions of job support for learning and intention to retire in both age groups, whereas it only mediated the relationship between perceptions of negative age stereotypes and intention to retire in the 55-60 group. From our empirical study, we may conclude that employability is an important factor in the light of older workers' intention to retire. In order to motivate this category of workers to participate in employability enhancing activities and to work longer, negative age stereotypes need to be combated. In addition, creating job support for learning over the lifespan is also an important HR practice to be implemented in nowadays' working life.

Eleven-year management of prostate cancer patients on active surveillance: what have we learned?

PURPOSE: To evaluate the outcomes of active surveillance (AS) on patients with low-risk prostate cancer (PCa) and to identify predictors of disease reclassification. METHODS: In 2005, we defined an institutional AS protocol (Sorveglianza Attiva Istituto Nazionale Tumori [SAINT]), and we joined the Prostate Cancer Research International: Active Surveillance (PRIAS) study in 2007. Eligibility criteria included clinical stage ≤T2a, initial prostate-specific antigen (PSA) <10 ng/mL, and Gleason Pattern Score (GPS) ≤3 + 3 (both protocols); ≤25% positive cores with a maximum core length containing cancer ≤50% (SAINT); and ≤2 positive cores and PSA density <0.2 ng/mL/cm3 (PRIAS). Switching to active treatment was advised for a worsening of GPS, increased positive cores, or PSA doubling time <3 years. Active treatment-free survival (ATFS) was assessed using the Kaplan-Meier method. Factors associated with ATFS were evaluated with a multivariate Cox proportional hazards model. RESULTS: A total of 818 patients were included: 200 in SAINT, 530 in PRIAS, and 88 in personalized AS monitoring. Active treatment-free survival was 50% after a median follow-up of 60 months. A total of 404/818 patients (49.4%) discontinued AS: 274 for biopsy-related reclassification, 121/404 (30%) for off-protocol reasons, 9/404 (2.2%) because of anxiety. Biopsy reclassification was associated with PSA density (hazard ratio [HR] 1.8), maximum percentage of core involvement (HR 1.5), positive cores at diagnostic biopsy (HR 1.6), older age (HR 1.5), and prostate volume (HR 0.6) (all p<0.01). Patients from SAINT were significantly more likely to discontinue AS than were the patients from PRIAS (HR 1.65, p<0.0001). CONCLUSIONS: Five years after diagnosis, 50% of patients with early PCa were spared from active treatment. Wide inclusion criteria are associated with lower ATFS. However, at preliminary analysis, this does not seem to affect the probability of unfavorable pathology.

[Subjective and objective indicators of job stress and burnout in a residential home for the elderly]. / Indicatori soggettivi e oggettivi di rischio stress e burnout in una residenza sanitaria assistenziale.

INTRODUCTION: Elderly care workers have a higher risk than other professionals of developing burnout. Despite literature has highlighted the methodological advantage resulting from an integration of subjective and objective measures of stressors, only few studies have investigated job stress and burnout in the Italian elderly care context using this kind of assessment. The aims of this study were: (a) to investigate the level of stress and burnout and their organizational sources in a sample of eldercare workers by means of subjective and objective tools, and b) to compare the stress and burnout levels between health care staff and nursing aides employed in a residential home for the, elderly. METHODS: The sample of the study included the totality of the elderly workers employed in a residential home for the elderly (N=49; response rate: 100%). The Maslach Burnout Inventory-GS and the Areas of Worklife Scale were used for the subjective assessment of burnout and organizational riskfactors. A check list of objective indicators was used for the objective assessment of job stress. RESULTS: Results from the self-report questionnaires showed high levels of exhaustion and a perception of high workload and unfairness for, the total sample. Objective parameters ofjob stress risk were biomechanical overload, dealing with suffering people and the risk of work-related violence. Nursing aides had greater risk of burnout and reported a greater number of objective sources of stress, compared to health care workers. CONCLUSIONS: This exploratory study supports the use of both subjective and objective method for the assessment of job stress risk as the most comprehensive approach for the implementation of preventive and corrective interventions.