Non-medical interventions to enhance return to work for people with cancer
- Study type
- Meta-analysis
- Study name
- Cochrane CD007569
- Design
- Cochrane systematic review and meta-analysis of randomised trials (update of the 2015 review); search to 18 August 2021
- Sample size
- 15 randomised trials with 1477 patients with cancer (19 comparisons because some trials had several treatment groups)
- Source
- Cochrane Database of Systematic Reviews · 2024
In plain words
Many people find it hard to go back to work after a cancer diagnosis. This review looked at 15 studies and found that exercise programmes (such as walking or yoga) and combined programmes (a mix of job advice, education, counselling and exercise) probably increase the chance of returning to work. Education and psychological counselling on their own probably make little difference. These programmes did not show a marked difference in quality of life. Talk to your doctor or care team about whether a programme is right for you.
Key results
Treatment arms and regimens
Patient education and counselling versus usual care. Dose details in the full text of the paper.
Vocational intervention versus usual care. Dose details in the full text of the paper.
Programmes including walking, yoga or physical exercise versus usual care. Dose details in the full text of the paper.
A combination of vocational counselling, patient education, patient counselling and physical exercise versus usual care. Dose details in the full text of the paper.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
People with cancer in randomised and cluster-randomised trials that assessed the effectiveness of psycho-educational, vocational, physical or multidisciplinary interventions to enhance return to work. All trials were conducted in high-income countries, and most targeted patients with breast cancer (9 trials) or prostate cancer (2 trials). This update added 8 new trials and removed 7 trials of medical interventions that had been included in previous versions of the review.
Endpoints
Primary endpoint: return to work (RTW), measured as the RTW rate or the duration of sick leave at 12-month follow-up. Secondary endpoint: quality of life (QoL).
Safety and side effects
No safety or adverse event data are reported in the abstract. Regarding risk of bias: 9 trials were judged at low risk and 6 trials at high risk of bias, and the most common type of bias was lack of blinding (9 of 15 trials).
Clinical significance and place in guidelines
Based on this review, when planning support for return to work in patients with cancer, physical interventions and especially multidisciplinary interventions (a combination of vocational counselling, education, counselling and exercise) are the more promising options; the evidence for both is of moderate certainty. Psycho-educational interventions alone probably have little effect on return to work, and the evidence for vocational interventions alone is very uncertain. All studies were conducted in high-income countries and mostly concerned breast cancer, so generalisation to other cancers and health systems should be made with caution. The place of these interventions in clinical guidelines should be checked separately.
Limitations
All trials were conducted in high-income countries and most focused on breast cancer (9 trials) or prostate cancer (2 trials). Six trials were at high risk of bias, and the most common problem was lack of blinding (9 of 15 trials). The evidence on quality of life was of low certainty throughout, and the evidence on vocational interventions rested on only one small trial (34 participants) and is very uncertain. The authors emphasise the need for future research on multidisciplinary interventions with physical, psycho-educational and vocational components, preferably tailored to patients' needs.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.