Health Behaviors of Cancer Survivors According to the Employment Status and Occupation: A Cross-Sectional Study.

This study aimed to identify differences in health behaviors according to the employment status and occupation of cancer survivors, as well as to identify risk factors. Using data from the Korea National and Health Nutrition Examination Survey (2008-2018), 1023 cancer survivors aged 19-60 years were classified based on their employment status and occupation, and their health behaviors were comparatively assessed. To investigate the impact of occupational status on the health behaviors of cancer survivors, we performed multivariate adjusted logistic regression analysis. Five hundred fifty-six (54.3%) cancer survivors were engaged in economic activities. After adjusting for various factors, white- and blue-collar workers exhibited an increased risk of obesity. The blue-collar group had a 1.45 times higher risk of non-practice with cancer screening, while the white-collar group had a 0.50 times lower risk of non-practice with health screening. The results provide evidence of the need to support cancer survivors in practicing healthy behaviors according to their employment status and occupation. As cancer survivors' economic activities increase, it is necessary to help them manage their health by predicting any possible health-behavior failures.

Exploring Fear of Cancer Recurrence (FCR) in cancer survivors from a medical social work perspective: A qualitative study of medical social workers in South Korea.

BACKGROUND: Fear of Cancer Recurrence (FCR) in cancer survivors has been insufficiently addressed despite its imperativeness in cancer journey. Although several studies have investigated healthcare professionals' experience with FCR in cancer survivors, a medical social work perspective has rarely been reflected. This study aimed to explore Korean medical social workers' experience with intervening FCR in cancer survivors. METHODS: Snowball sampling recruited 12 experienced medical social workers intervening with cancer survivors at tertiary or university cancer hospitals in South Korea. Individual and focus-group interviews (FGI) were conducted with the medical social workers. The interviews were recorded, transcribed, and analyzed by using an inductive qualitative content analysis. RESULTS: Content analysis of the interviews extracted the following major themes regarding FCR in cancer survivors. First, when and how FCR among cancer survivors emerged at the early stage of medical social work interventions was identified. Second, how medical social workers dealt with FCR in cancer survivors was illustrated. Third, the responses of cancer survivors to medical social work interventions for FCR were assessed. Finally, the internal and external issues underlying the medical social work interventions for FCR among cancer survivors were revealed and discussed. CONCLUSION: Based on the results, this study suggested the implications on dealing with FCR in cancer survivors in the realm of medial social work profession. Furthermore, it expanded the discussion about FCR in cancer survivors from cancer hospitals to community.

Effects of a Post-Traumatic Growth Program on Young Korean Breast Cancer Survivors.

Background: This study aimed to enhance post-traumatic growth in young breast cancer patients by providing them with self-disclosure and social support resources, to reduce intrusive rumination and increase deliberate rumination. This study was conducted at a university-based cancer center in Seoul, South Korea. The study included a four-week group-based psychoeducational program, which supported the post-traumatic personal growth of breast cancer patients. The primary outcome was increased post-traumatic growth, and the secondary outcomes were rumination, distress, and traumatic perception. Methods: The study included 38 young breast cancer patients, with a mean age of 42.21 years and mean time since diagnosis of 13.84 months. Results: Results of the study revealed statistically significant improvements in total post-traumatic growth and all subdomains, after the intervention (p < 0.001) and one month later (p < 0.001), as compared to the baseline. A significant improvement was also observed in deliberate rumination after the intervention (p = 0.038). Furthermore, the patients had a statistically significant decrease in anxiety, after the intervention (p = 0.035) and one month later (p = 0.005), as compared to the baseline. Conclusions: Overall, the program encourages activities that promote post-traumatic growth, enabling young breast cancer patients to return to their normal lives. Specifically, the growth allows patients to return to work and maintain a healthy body and mind. The results of this study indicate that this program can be used as an effective psychological intervention for young breast cancer patients.

Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients' Returning to Work (START): A Multi-center, Randomized Controlled Trial.

PURPOSE: We developed a comprehensive return to work (RTW) intervention covering physical, psycho-social and practical issues for patients newly diagnosed and evaluated its efficacy in terms of RTW. Materials and Methods: A multi-center randomized controlled trial was done to evaluate the efficacy of the intervention conducted at two university-based cancer centers in Korea. The intervention program comprised educational material at diagnosis, a face-to-face educational session at completion of active treatment, and three individualized telephone counseling sessions. The control group received other education at enrollment. RESULTS: At 1-month post-intervention (T2), the intervention group was more likely to be working compared to the control group after controlling working status at diagnosis (65.4% vs. 55.9%, p=0.037). Among patients who did not work at baseline, the intervention group was 1.99-times more likely to be working at T2. The mean of knowledge score was higher in the intervention group compared to the control group (7.4 vs. 6.8, p=0.029). At the 1-year follow-up, the intervention group was 65% (95% confidence interval, 0.78 to 3.48) more likely to have higher odds for having work. CONCLUSION: The intervention improved work-related knowledge and was effective in facilitating cancer patients' RTW.

Changes in working status after cancer diagnosis and socio-demographic, clinical, work-related, and psychological factors associated with it.

BACKGROUND: While many studies investigated changes in working status in cancer survivors, most studies have been performed in survivors of breast cancer and few studies evaluated factors associated with changes in the working status of cancer survivors comprehensively. We aimed to evaluate the changes in the working status of cancer survivors after diagnosis and socio-demographic, clinical, work-related and psychological factors associated with it. METHODS: We conducted a cross-sectional survey of adult patients with cancer who were working at the time of diagnosis. A trained interviewer inquired about participants' current working status, including leave of absence, discontinuing, continuing, and changing work. Sociodemographic, clinical, work-related and psychological factors were measured. Multinomial logistic regression was used to identify factors associated with changes in the working status. RESULTS: Among the 730 patients, 29%, 18% and 6% were currently on a discontinued working, leave of absence and had changed jobs, respectively. Patients who discontinued working after cancer diagnosis were more likely to be female, have ≥ $3,000 of monthly family income, not be the principal wage earners for their families and be blue-collar workers. In clinical characteristics, advanced-stage cancer and experienced cancer recurrence was associated with leave of absence and discontinued working. In work-related and psychological factors, stress due to insufficient job control (relative risk ratio [RRR] = 2.26), interpersonal conflict (RRR = 1.86), job insecurity (RRR = 2.63), organizational system (RRR = 3.49), and lack of reward (RRR = 11.76), and less meaning to work were more likely to discontinue working after a cancer diagnosis. CONCLUSION: Occupational health care professionals and other stakeholders need to openly communicate with patients with cancer about potential barriers during the return-to-work trajectory.

Impact of objective financial burden and subjective financial distress on spiritual well-being and quality of life among working-age cancer survivors.

PURPOSE: To assess objective financial burden (OFB) and subjective financial distress (SFD) amikong working-age cancer survivors and evaluate their association with spiritual well-being and health-related quality of life (HRQoL). METHODS: This is a multicenter cross-sectional survey of cancer survivors working at diagnosis between 2017 and 2018. OFB was defined as patients with high medical payments for individuals/households, debt due to cancer care costs, or bankruptcy. SFD was measured using a questionnaire. Fear of cancer recurrence (FCR), spiritual well-being, and HRQoL were also assessed. RESULTS: Among 727 participants, 31% reported that they experienced financial toxicity, and 12% and 26% had OFB and SFD, respectively. The No-OFB-SFD, OFB-No-SFD, and OFB-SFD groups were 4.90, 1.82, and 7.81 times more likely to experience uncertainty than the No-OFB-No-SFD group. Furthermore, the No-OFB-SFD, OFB-No-SFD, and OFB-SFD groups were 1.92, 1.35, and 2.53 times more likely to report lost purpose of life, respectively. Overall QoL and health status in the No-OFB-No-SFD, No-OFB-SFD, OFB-No-SFD, and OFB-SFD groups were 63.1, 42.9, 57.0, and 41.2, respectively. Survivors who had SFD regardless of OFB had lower HRQoL and functioning, and higher symptoms than those of the survivors without SFD. CONCLUSION: Financial toxicity was associated with FCR, uncertainty, loss of purpose, and loss of hope among working-age cancer survivors, even in a universal care setting. It is associated with FCR, uncertainty, loss of purpose, and loss of hope. It is necessary to inform survivors of the financial implications of cancer care to allow them to prepare financially as needed.

Association between cancer stigma and job loss among cancer survivors.

OBJECTIVE: Previous qualitative studies found cancer stigma was associated with work discrimination and job loss among cancer patients. This study aims to quantify the association between cancer stigma and job loss among cancer survivors. METHODS: For this study, we used the data from a face-to-face cross sectional survey conducted at two cancer hospitals in Seoul and Hwasun in South Korea from October 2017 to March 2018. Cancer stigma was assessed using a validated questionnaire which consists of 12 items in three domains: (a) impossibility of recovery; (b) stereotypes; and (c) discrimination. Multivariable logistic regression was performed to evaluate the association between cancer stigma and job loss adjusting age, sex, marital status, education, job type, residence area, cancer site, stage, comorbidity, time since diagnosis, and self-efficacy. RESULTS: Among 433 cancer survivors, 24.0% lost their jobs after cancer, and 20.7% experienced discrimination at work. Of total, 21.7% of the survivors agreed that it was difficult to treat cancer regardless of highly developed medical science. Survivors with stigma on impossibility of recovery and stereotypes were 3.10 (95% confidence interval [CI]: [1.76, 5.44]) and 2.10 (95% CI: [1.20, 3.67]) times more likely to lose a job than survivors without cancer stigma. Survivors with discrimination experience at work had 1.98 (95% CI: [1.05, 3.74]) times higher risk of losing a job than survivors without it. CONCLUSIONS: Survivors with cancer stigma were more likely to lose their jobs than survivors without cancer stigma. Considering its social and economic impact on job loss, comprehensive interventions for working cancer survivors as well as public campaigns against cancer stigma would be necessary.

Changes after cancer diagnosis and return to work: experience of Korean cancer patients.

BACKGROUND: Cancer patients' return to work is a growing aspect of survivorship care, yet limited studies have been conducted in Korea to understand the work-related experience of cancer patients. The purpose of this study was to understand the unmet needs of cancer patients and identify the necessary factors to develop a vocational intervention program based on cancer patients' work-related experience after cancer diagnosis. METHODS: Semi-structured individual in-depth interviews were conducted with 50 cancer patients who were working at the time of diagnosis at a university hospital in Seoul, South Korea from July to September of 2017. Interview data were analyzed using qualitative content analysis. RESULTS: 'The changes patients experienced after cancer diagnosis' were categorized into Personal and socio-environmental changes. 'Personal changes' were changes within the patient that were further divided into 'physical', 'psychological' and 'spiritual' changes while 'socio-environmental changes' were changes in either 'attitude' and 'relationship' of other people cancer patients encountered. In addition to these post-diagnosis changes, the following 4 major factors related to return-to-work were identified to affect patients' experience: 'fear of cancer recurrence', 'financial status', 'informational support', and 'job-related work environment'. CONCLUSION: Cancer patients' working status was determined by personal and socio-environmental changes after the cancer diagnosis which as well as psychological distress and practical issues such as fear of cancer recurrence, financial burden, and work environment. Educational materials and intervention programs informing patients on these changes and factors may facilitate their return-to-work after diagnosis.

A return-to-work intervention protocol directed at cancer patients (self-assessment, tailored information & lifestyle management for returning to work among cancer patients, START): A multi-center, randomized controlled trial.

PURPOSE: This study describes the protocol for the design and evaluation of a self-assessment based educational program supporting cancer patients' return-to-work (RTW), prior to its complete and ongoing implementation. METHODS: We designed a multi-center, randomized controlled trial with three follow-up points. The study population (N = 239) includes recently diagnosed cancer patients who plan to receive active treatment at two university hospitals in Korea. A pre-test is conducted at the point of enrollment for both groups. The intervention group receives a leaflet clarifying misconceptions about RTW and is shown a video clip of patient interviews concerning RTW. The control group receives a booklet about cancer and nutrition, and is not provided with further intervention. After active treatment, the intervention group receives a one-time, face-to-face education session with an oncology nurse. Following the education session, both groups receive three follow-up phone calls. The first follow-up call occurs at the end of intervention and at the end of active treatment for intervention and control groups, respectively. The next two follow-up calls will be conducted one month and a year following the post-test. The primary outcome is whether the patient has RTW or has plans to RTW, and the secondary outcome is knowledge of RTW. RESULTS: As of April 2020, 239 patients have been enrolled in the trial. Statistical analyses will be conducted upon trial completion in December 2020. DISCUSSION: We hypothesize that the provision of RTW education near diagnosis will not only enhance patients' intentions to RTW, but also effectively encourage them to RTW.

[A Study on the Knowledge Structure of Cancer Survivors based on Social Network Analysis].

PURPOSE: The purpose of this study was to identify the knowledge structure of cancer survivors. METHODS: For data, 1099 articles were collected, with 365 keywords as a Noun phrase extracted from the articles and standardized for analyzing. Co-occurrence matrix were generated via a cosine similarity measure, and then the network analysis and visualization using PFNet and NodeXL were applied to visualize intellectual interchanges among keywords. RESULTS: According to the result of the content analysis and the cluster analysis of author keywords from cancer survivors articles, keywords such as 'quality of life', 'breast neoplasms', 'cancer survivors', 'neoplasms', 'exercise' had a high degree centrality. The 9 most important research topics concerning cancer survivors were 'cancer-related symptoms and nursing', 'cancer treatment-related issues', 'late effects', 'psychosocial issues', 'healthy living managements', 'social supports', 'palliative cares', 'research methodology', and 'research participants'. CONCLUSION: Through this study, the knowledge structure of cancer survivors was identified. The 9 topics identified in this study can provide useful research direction for the development of nursing in cancer survivor research areas. The Network analysis used in this study will be useful for identifying the knowledge structure and identifying general views and current cancer survivor research trends.