Work and Cancer Survivors (eBook)

Michael Feuerstein, Ph.D., is Professor of Public Health in the Departments of Medical and Clinical Psychology and Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland. He is also Director of the Clinical Psychology Doctoral Program at that institution. In addition, he is Clinical Professor in the Department of Psychiatry, Division of Behavioral Medicine, at Georgetown University School of Medicine, Washington, DC. Dr. Feuerstein is editor-in-chief of Journal of Occupational Rehabilitation and Journal of Cancer Survivorship, as well as editor of Handbook of Cancer Survivorship. He is a Fellow of the Academy of Behavioral Medicine Research, the American Psychological Association, and the Society of Behavioral Medicine, and a Member of the Human Factors and Ergonomics Society, the Association for Advancement of Behavioral Therapy, the International Association for the Study of Pain, and the New York Academy of Sciences.

Work and Cancer Survivors 2
Foreword 6
Preface 8
Acknowledgments 15
Contents 17
Contributors 19
Section I: Defining the Problem 22
Epidemiology 23
Introduction 23
The Scale of Cancer Survivorship 24
The Impact of Cancer on Paid Work 26
The American Pioneers 26
The Literature Reviews of Studies 27
A Thematic Review of the Literature 29
Most Cancer Survivors Are Able to Return to Work 29
The Importance of Cancer Site to Return to Work 30
The Impact of Treatment and Symptom Burden Matters 31
Educational Attainment and Occupational Status also Matter 32
The Health Status and Extent of Work Limitations Among Cancer Survivors 34
Psycho-social Factors at Work Can Help Survivors to Return to Work 37
The Role of the Medical Profession 38
And Finally, Retirement 39
Gaps in Our Knowledge 40
References 41
Economic Burden 44
Introduction 44
Cancer Morbidity and Employment: A Descriptive Overview by Cancer Status 45
Cancer Survivors: Has There Been a Shift in Morbidity Employment Experience as Taken from the Case of Breast Cancer? 69
Employment Among Cancer Survivors: Morbidity Effects 73
Work Limitations and Inability to Work 77
Employment Changes Post Diagnosis 77
Cancer and Employment Rates: The Combined Impact of Mortality and Morbidity 81
The Cost of Cancer-Related Productivity 84
The Case of Colon Cancer 84
References 89
Employers’ and Survivors’ Perspectives 91
Introduction 91
Employers’ Attitudes Regarding People with Chronic Illness and Disability 93
Productivity Concerns 95
Barriers to Hiring and Retention 96
Employer Strategies 96
Cancer Survivors’ Perspectives 99
Factors Influencing Individual Decisions to Work After a Cancer Diagnosis 99
Demographic Characteristics 100
Financial Circumstances 100
Physical Conditions 101
Individual Accomplishment 101
The Main Obstacles to Returning to Paid Work 102
Workplace Accommodations 102
Physician or Health Care Provider Input on Matters Related to Work 103
Role of Employer Attitudes and Actions 104
Cancer Survivors’ Relationship with Their Employer 104
Conclusion 105
References 106
Section II: Fundamentals of Work and Chronic Illness 108
Work Disability: It is not just the ‘‘lesion’’ 109
Introduction 109
You Say: ‘‘Disability’’? 111
Work Disability as a Specific Paradigm 111
Modeling Work Disability 113
Various Diseases and Work Disability 115
The Case of Cancer Survivors 115
Conclusion 117
References 118
The Meaning of Work 120
Introduction 120
The Meaning of Surviving Cancer 121
The Meaning of Work 123
Developmental Aspects 126
Spectrum of Severity of Work Problems 128
Disease-Specific Work Problems 130
Therapeutic Approaches 131
Directions for Future Research 132
References 132
Section III: Factors Affecting Work 135
Fatigue, Pain, and Physical Function 136
Introduction 136
Symptom Burden in Cancer Survivors 137
Cancer-Related Fatigue 138
Cancer-Related Pain 139
Physical Function 140
Work and Symptom Burden 143
Work-Related Factors 144
Cancer Survivors 144
Other Chronic Illnesses 144
Occupational Injuries 145
Conceptual Model of Physical Load, Physical Capacity, Pain and Work Disability 145
Interventions 149
Work System Interventions: Potential Application of Ergonomics 149
Conclusions 152
References 153
Cognitive Limitations 159
Introduction 159
Assessment of Cognitive Symptoms: The Role of the Neuropsychological Evaluation 160
The Impact of Cognitive Symptoms on Work 161
Management of Cognitive Symptoms: Limiting the Impact of Cognitive Impairments on Work 166
Non-Pharmacologic Strategies: Individualized, Focused Cognitive Compensatory Interventions 166
Pharmacologic Management of Cognitive Impairment 169
Future Directions 170
Refences 172
Young Survivors of Childhood Cancer 175
Introduction 175
Late Effects 175
Importance of Work for Young Survivors of Childhood Cancer 176
Unemployment in Young Survivors of Childhood Cancer: Meta-analysis 177
Method of Literature Search of the Meta-analysis 178
Results of the Meta-analysis 178
Young Survivors of Blood Cancers 180
Young Survivors of CNS and Brain Tumors 181
Young Survivors of Bone Cancers 182
Young Survivors of Other Cancers 183
Developments Since the Meta-analysis 184
The Effect of Prognostic Factors on Employment 185
Educational Outcomes Among Survivors of Childhood Cancer and the Impact on Work 186
Interventions to Improve Employment 188
Future Research 189
What Interventions Could We Develop? 189
What Outcomes Are Important? 193
Other Issues in Future Research 194
Conclusion 195
References 196
Section IV: Primary and Secondary Prevention 201
Primary and Occupational Health Care Providers 202
Introduction 202
When to Provide Help for Problematic Return to Work 206
How to Assess Which Survivors Need Most Help? 208
What Interventions Should the Occupational Physician Carry Out? 211
Recommendation for Return to Work 212
Work Accommodations 213
Managing Fatigue and Other Disease- or Treatment-Related Symptoms 214
Involvement of Supervisors and Colleagues and Disclosure of Diagnosis 214
Occupational Cancer 214
Physician and Fitness for Work Dilemmas 215
How Well Are Occupational Physicians Doing? 216
Conclusions and Directions for the Future 217
References 218
Rehabilitation 221
Introduction 221
Cancer, Residual Symptoms and Disability 222
The Nature of Disability 224
The Nature of Rehabilitation 226
Exercise and Rehabilitation 228
Exercise and Disease Activity: Curative Rehabilitation 229
Exercise, Strength and Function: Restorative Rehabilitation 230
The Place of Exercise Training in Occupational Rehabilitation of the Cancer Survivor 230
Targeting Risk Factors for Disability in Cancer Survivors: Compensatory and Accommodative Interventions 232
Compensatory and Accommodative Interventions in the Workplace 234
Conclusions 235
References 237
Workplace Accommodations 243
Introduction 243
Reasonable Accommodations in the Workplace 244
The Accommodation Process 248
A Sample Accommodation Request Letter 249
Primary Considerations 250
Secondary Considerations 251
Accommodations for Cancer Survivors 252
Limitations Related to Ability to Communicate 254
Limitations Related to Vision 255
Limitations Related to Cognitive Abilities 255
Limitations Related to Physical Stamina 257
Limitations Related to Pain Symptoms 257
Limitations Related to Stress and Depression 257
Accommodating the Cancer Survivor: Case Examples 258
Conclusion 259
Appendix: Resources for Job Accommodation Ideas and Technical Assistance 260
References 263
Individuals with Cancer in the Workforce and Their Federal Rights 265
Introduction 265
Key Issues Facing Persons with Cancer 266
Personal and Family Experiences 266
Factors Related to Return to Work 267
Work-Related Factors 267
Disease and Treatment-Related Factors 268
Person-Related Factors 268
Federal Protections for the Employee with Cancer 269
The ADA 270
Other Federal Protections 271
Privacy and Confidentiality 272
The Story of Patricia Garrett 273
State Sovereign Immunity 273
Qualified Individual with a Disability 274
Individuals with Cancer in Other Courts 275
Best Practices and Future Initiatives 277
Model Programs and Services 278
ADA Amendments Act of 2008 and the Future 279
Recommendations and Closing Remarks 281
References 282
Section V: Global View 287
International Efforts: Perspectives, Policies, and Programs 288
Introduction 288
Factors Contributing to Return to Work 289
Developed Countries 289
Developing Countries 289
Socio-environmental Impacts on Cancer Survivors and Return to Work 293
Work Disabilities and the Role of Social Insurance 293
Cancer Survivors as Individuals with Disabilities 293
Supporting Return to Work Efforts 297
Legislation 300
Discrimination 300
Cultural Perceptions 301
Return to Work Programs to Support Cancer Survivors 304
Association of European Cancer Leagues 304
Cancerbackup (British Association of Cancer United Patients - and Their Families and Friends) 306
Danish Cancer Society 312
United Kingdom’s Breast Cancer Care (BCC) 313
Cancer Council Australia 314
Canada 315
Willow Breast Cancer Support Canada 315
Germany 316
Future Directions 317
References 320
Section VI: Future Directions 323
Future Research, Practice, and Policy 324
Some Questions that Await Answers 325
Models of Work Disability 326
Optimal Work 327
The Economic Burden 327
Employer’s and Survivor’s Perspectives 327
The Meaning of Work in Cancer Survivors 328
Fatigue, Pain, and Functional Impairment 328
Cognitive Limitations 328
Survivors of Childhood Cancer 329
Primary and Occupational Health Care 329
Work-Related Rehabilitation 329
Workplace Accommodations 330
International Activities 330
Legal, Regulatory, and Policy Matters 330
Evidence-Based Policy 331
How Is Evidence Translated into Policy? 331
An Interactive Process that Requires Patience and Persistence 334
Conclusions 334
References 335
Index 337