Productivity in Survivors of Cancer

Productivity Assessment and Resources

The National Comprehensive Cancer Network (NCCN) guideline on survivorship acknowledges that cancer and its treatment can affect employment and a patient’s return to work, including their ability to perform all of their tasks.⁷

Although the NCCN notes that some interventions, including use of a multidisciplinary approach that includes vocational counseling, may improve return-to-work rates; however, employment status and/or employer concerns about the worker’s ability to fully function at their job is not addressed in the NCCN’s survivorship assessment template.

The American Society of Clinical Oncology (ASCO) also provides survivorship care planning templates and a website with more in-depth assessment aids for providers and patients.⁸ Work/school is indicated as a potential topic of concern among survivors.

Cancer + Careers is an organization that advocates for cancer survivors in the workplace, providing information and tools for providers and patients about working during and/or after treatment for cancer.⁹  A checklist for providers suggests asking questions to facilitate a conversation with patients about their type of employment, the culture at their site of work, and any potential issues or concerns they may have about their workplace due to their health. Cancer + Careers suggests some recommendations for patients to help them cope with the effects of cancer or its treatment while at work, including tips to fight fatigue, nausea, gastrointestinal issues, mucositis, and techniques to harness to maintain a positive attitude. The website also provides a link to the National Coalition for Cancer Survivorship (NCCS) publication about employment rights as a cancer survivor, which describes the legal rights of patients and employers.¹⁰

Conclusions

Productivity is a concern for many patients who continue to work during their cancer treatment and for survivors who choose to return to work. Impairments may be a result of ongoing fatigue or physical or cognitive deficiencies. Clinicians can provide additional recommendations about how to cope at work and/or refer patients to a vocational counselor.

References

1. Kamal KM, Covvey JR, Dashputre A, et al. A systematic review of the effect of cancer treatment on work productivity of patients and caregivers. J Manag Care Spec Pharm. 2017;23(2):136-162.
2. de Moor JS, Alfano CM, Kent EE, et al. Recommendations for research and practice to improve work outcomes among cancer survivors. J Natl Cancer Inst. 2018;110(10):1041-1047.
3. Ekwueme DU, Yabroff KR, Guy GP Jr, et al. Medical costs and productivity losses of cancer survivors—United States, 2008-2011. MMWR Morb Mortal Wkly Rep. 2014;63(23):505-510.
4. Zheng Z, Yabroff KR, Guy GP Jr, et al. Annual medical expenditure and productivity loss among colorectal, female breast, and prostate cancer survivors in the United States. J Natl Cancer Inst. 2016;108(5):djv382. doi: 10.1093/jnci/djv382
5. Stone DS, Ganz PA, Pavlish C, Robbins WA. Young adult cancer survivors and work: a systematic review. J Cancer Surviv. 2017;11(6):765-781.
6. Guy GP Jr, Berkowitz Z, Ekwueme DU, Rim SH, Yabroff KR. Annual economic burden of productivity losses among adult survivors of childhood cancers. Pediatrics. 2016;138(Suppl 1):S15-S21.
7. Denlinger CS, Sanft T, Baker KS, et al. Survivorship. Version 2.2018. NCCN Clinical Practice Guidelines in Oncology. J Natl Comp Canc Netw. 2018;16(10):1216-1247.
8. Survivorship Care Plan. Journey Forward. www.journeyforward.org/what-is-cancer-survivorship-care-planning. Accessed January 3, 2019.
9. Cancer + Careers. Cosmetic Executive Women Foundation/Cancer and Careers. 2019. www.cancerandcareers.org/en. Accessed January 3, 2019.
10. Hoffman B. Working It Out: Your Employment Rights as a Cancer Survivor. Silver Spring, MD: National Coalition for Cancer Survivorship; 2012.