Interventions to enhance return-to-work for cancer patients

Multidisciplinary interventions might possibly enhance return-to-work compared to usual care for patients with cancer, but the evidence is insufficient for conclusions.

The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and inadequate intention-to-treat adherence), by indirectness (differences in studied patients and interventions) and by imprecise results (limited study size for each comparison).

Summary

A Cochrane review included 15 RCTs with a total of 1835.

Two studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).

Seven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. We found low quality evidence that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).

Five RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback-assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). There were no differences in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).

Clinical comments

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Ədəbiyyat

1. de Boer AG, Taskila TK, Tamminga SJ et al. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2015;(9):CD007569.