mental health study in cancer survivors
Each year more and more people are diagnosed with cancer. This number is predicted to increase even more in the future. Despite this, early diagnoses and a significant enhancement of treatment have also led to a growing number of cancer survivors in recent years. The increase in recoveries has paved the way for re-employment and workability for cancer patients. Why do cancer survivors work after recovery? Aside from financial reasons, many people come back to work for personal development and a sense of identity. For cancer survivors, work is known to increase their self-worth and sense of accomplishment. While resuming work and normal life is the most recommended path for cancer survivors, not all are lucky to have this option. Reasons pertaining to the physical health, mental health, or emotional effects of treatment can change the lifestyle of a cancer survivor.
The Study
The goal of the study was to compare working and non-working patients over a period of 12 months. The study compared subjects based on cancer type, socio-demographic, and mental health parameters. The researchers identified prevalence rates of patients returning to work 12 months after baseline assessment.
Methods
The study was performed as part of a longitudinal survey among 1398 patients in 13 national Comprehensive Cancer Centers in Germany. A total of 430 cancer patients younger than 65 years (age M = 52.4 years, SD = 8.1; 67.0% females) were included in the study.
Socio-demographic, cancer-specific, and mental health parameters (Depression: Patient Health Questionnaire, Anxiety: Generalized Anxiety Disorder Scale, Distress: Distress Thermometer) were assessed at baseline during hospitalization and at 12 months follow-up. Subjects completed a set of questionnaires at T1 and T3 assessing socio-demographic parameters (e.g. gender, age, relationship status, educational level) and clinical data.
Medical information about the disease was verified also by checking medical records. Mental health parameters (Depression, Anxiety, Distress) were analyzed with the questionnaires Patient Health Questionnaire, Generalized Anxiety Disorder Scale (GAD-7), and the Distress Thermometer.
The researchers divided the sample into two groups according to their status of employment at T3: working and non-working participants. Working participants were defined as having returned to work after 1 year and were not on sick leave at T3. Non-working participants were defined as not having returned to work after 1 year or being unemployed or being on sick leave at T3.
A total of n = 317 patients (73.7%, 95% CI [69.5–77.7]) have returned to work, while n = 113 patients (26.3%, 95% CI [22.3–30.5]) did not. For women returning to work a prevalence rate of 72.2% (n = 208) was identified (95% CI [67.0–77.8]) while a total number of 76.8% (n = 109) men have returned to work at T3 (95% CI [69.7–83.8]).
Return to work rates did not significantly differ between men and women (Chi2(1) = 1.01, p = 0.315). At T3, 67% of those returning to work were full-time employed, 19.9% worked at least part-time, 9.8% worked less than part-time, 2.2% were in partial retirement, and only 0.9% resumed their professional education. 11.7% returned to blue-collar, 62.8% to white-collar jobs while 10.1% were public officials and 11.4% were self-employed at T3. The remaining 4.1% were categorized as “other” or missing.
Inclusion Criteria
Inclusion criteria were restricted according to the aim of the present study. The researchers selected only patients, who were employable before cancer diagnosis. That means that participants aged ≥65 years were excluded from the analysis as well as participants with missing data regarding the status of employment and sick leave at T1 or T3.
The original sample consisted of N = 1398 participants. Of those, they had to exclude n = 347 participants aged ≥65 years, n = 196 participants not employable before cancer diagnosis, and n = 425 participants due to missing data regarding the status of employment or sick leave at T1 or T3. The final sample resulted in a number of n = 430 participants.
Data analysis
For data analysis, the researchers used the software IBM SPSS statistics. For descriptive statistics, researchers depicted frequencies, mean values, standard deviations, and ranges. We calculated 95% confidence intervals to indicate the precision of the estimation for the prevalence of employment status at t3. Student’s t-tests, Mann-Whitney-U-tests, and χ2-test were used to assess the differences in socio-demographic and clinical features. We used Bonferroni corrections for multiple testing.
Furthermore, we conducted three mixed analyses of variances (ANOVAs) to examine differences in mental health parameters between groups over time (T1 and T3). A binary logistic regression analysis was conducted with the variable “employment status” at t3 as the independent variable. A significance level of p < 0.05 was predefined in all analyses.
Study limitations
The strength of the study is its multicenter and longitudinal design and the evaluation of cancer patients from different hospitals in Germany during both hospitalization and one year later. Limitations of the study are the exclusion of a great number of patients for the analyses due to missing data on sick leave, employment, or treatment status. Representativity might thus be disputable and generalization of results must be treated with caution. Further, return to work rates vary depending on the time passed since cancer diagnosis. Thus, further measurement points could have revealed more information, especially on the associations of sociodemographic and cancer-specific parameters.
Results
Among all the patients, a total of 73.7% returned to work after one year, meaning the majority of cancer patients were able to work again after a year of treatment and hospitalization. There were not many differences in socio-demographic parameters, but there were key differences in the presence of metastases, tumor, and treatment status.
Mixed analysis of variances revealed significant interactions between working status and time for depression (p = 0.009), anxiety (p = 0.003) and distress (p = 0.007). Non-working patients reported higher levels of depression, anxiety, and distress than working patients over time. A logistic regression showed significant associations between lower depression (p = 0.019), lower distress (p = 0.033) and the absence of a tumor (p = 0.015) with working status.
Key Takeaways
- Most cancer survivors returned to work after a year.
- Cancer survivors who didn’t go to work had higher levels of depression, anxiety, and distress than working patients.
- After controlling for cancer-specific factors, mental health parameters were still independently associated with working status. Return to work can thus be associated with improved mental health in cancer survivors.
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