Return to work, work productivity loss and activity impairment in Chinese breast cancer survivors 12-month post-surgery: a longitudinal study.

Introduction: Existing evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants. Methods: This observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress. Results: A 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes. Discussion: Using a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW.

Return to Work and Work Productivity During the First Year After Cancer Treatment.

Objectives: Working-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment. Methods: Of 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors. Results: At baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment. Conclusion: Cancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

The impact of congenital heart disease on the psychological well-being and quality of life of Hong Kong Chinese adolescents: A cross-sectional study.

AIMS AND OBJECTIVES: To examine the psychological well-being and quality of life of Hong Kong Chinese adolescents with congenital heart disease. BACKGROUND: Congenital heart disease (CHD) in adolescents is associated with having negative psychological impact and impairment to quality of life. A literature review revealed that most studies on the impact of CHD on the psychological well-being and quality of life of adolescents to date have been conducted in Western populations. METHOD: A cross-sectional design was employed. Adolescents aged 12-18 with CHD attending an outpatient clinic in an acute public hospital were invited to participate. Another similar age group of healthy Chinese adolescents was also invited to participate for comparison purposes. Subjects were asked to respond to the Chinese version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, Center for Epidemiologic Studies Depression Scale for Children, Rosenberg Self-Esteem Scale and a demographic sheet. A STROBE checklist was completed. RESULTS: Adolescents with CHD exhibited more depressive symptoms, lower self-esteem and poorer quality of life than their healthy counterparts. Disease severity might affect the self-esteem, depressive symptoms and quality of life of adolescents with CHD. Disease severity, depressive symptoms, self-esteem level and types of treatment received were associated with the quality of life of adolescents with CHD. CONCLUSIONS: Hong Kong Chinese adolescents suffering from CHD experience negative impacts on their psychological well-being and quality of life. In this group, disease severity may affect psychological well-being and quality of life. Specifically, quality of life of adolescents with CHD was associated with disease severity, depressive symptoms, self-esteem level and the type of treatment received. RELEVANCE TO CLINICAL PRACTICE: The findings contribute to clinical care guidelines and serve as a reference in developing nursing intervention to adolescents with CHD so as to uphold quality of care. CLINICAL TRIAL REGISTRATION: NCT03255850 (Clinical trial.gov).