Breast cancer is the most commonly occurring cancer in women. Almost 70,000 cases are diagnosed every year in Germany alone. Studies show that the five-year survival rate is 88 percent. "Returning to work is important; it provides a sense of normality and meaning after a crisis caused by cancer," explains sociologist Kati Hiltrop from the Center for Health Communication and Health Services Research at University Hospital Bonn (UKB). But a breast cancer diagnosis and successful treatment are often followed by long-term difficulties such as fatigue syndrome, which means a feeling of persistent tiredness, exhaustion and listlessness. Other after-effects of chemotherapy and the fear that the cancer will return can also limit productivity.
How do breast cancer patients succeed in returning to work? "There are numerous studies on this. Our long-term study now focuses on the post-return phase from the patient's perspective," says Hiltrop. Together with the head of the research center, Prof. Dr. Nicole Ernstmann, who is also a member of the Transdisciplinary Research Area "Life and Health" at the University of Bonn, and the German Cancer Society, the sociologist investigated how a total of 184 former breast cancer patients fared after returning to work over a period of five to six years after diagnosis.
From the perspective of breast cancer patients
The study focused on how satisfied the patients were with their occupational development since diagnosis. About half experienced at least one job change during the study period. "The main finding is that we found no relationship between the number of job changes and satisfaction, but that greater involuntariness of change was associated with lower satisfaction," Hiltrop says. "The results suggest that the quality of change matters more than the quantity." About 16 percent of job changes did not happen by choice. These changes included, for example, increased workload or retirement. The results suggest that the former breast cancer patients have difficulties in meeting the job requirements in the long term after their return, resulting in changes at work.
The research team’s findings show what can contribute to satisfaction at work. "Providing a welcoming work environment and showing patients understanding and support can facilitate a satisfactory return to work," Hiltrop explains. This can help avoid involuntary job changes that are perceived as particularly drastic. The researchers conclude from the results that a satisfactory return to work and, in particular, remaining at work requires long-term support, for example because chemotherapies and aftercare have to be continued, there is a fear of a recurrence of the tumor, or fatigue symptoms have to be managed.
The current study is a follow-up study of the project "Strengthening patient competence: Breast cancer patients' information and training needs" (PIAT), which surveyed approximately 1000 breast cancer patients. The researchers interviewed the PIAT participants again 5-6 years after diagnosis. At four measurement points, surveys and interviews were used to explore the subjective assessment of health status, how often job changes occurred, and how fulfilling the job was. Socioeconomic data, such as age, number of children, and education, were also surveyed. Satisfaction with occupational development was associated with higher age, better perceived health status, and lower levels of involuntariness of job changes.
"Open communication with managers and colleagues about expectations and what can be accomplished is very important," explains Hiltrop. In addition, handling the situation more flexibly, can increase the likelihood that patients will be satisfied when they return to work.
Financial support and participating institutions
The study involved the University Hospital Bonn, the German Cancer Society, the Federal Centre for Health Education, the Institute of Medical Sociology, Health Services Research, and Rehabilitation Science at the University of Cologne, and the Carl von Ossietzky University of Oldenburg. The German Statutory Pension Insurance Scheme and the Federal Ministry of Health funded the projects.
Publication: Kati Hiltrop, Paula Heidkamp, Clara Breidenbach, Christoph Kowalski, Anna Enders, Holger Pfaff, Lena Ansmann, Franziska Geiser and Nicole Ernstmann: Involuntariness of job changes is related to less satisfaction with occupational development in long-term breast cancer survivors, Journal of Cancer Survivorship, DOI: http://dx.doi.org/10.1007/s11764-021-01035-5
Contact:
Kati Hiltrop
Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
Universitätsklinikum Bonn
Tel. 0228/28711803
E-Mail: Kati.Hiltrop@ukbonn.de