Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors

Janet S. de Moor; Catherine M. Alfano; Erin E. Kent; Wynne E. Norton; Diarmuid Coughlan; Megan C. Roberts; Melvin Grimes; Cathy J. Bradley


J Natl Cancer Inst. 2018;110(10):1041-1047. 

In This Article

Abstract and Introduction


Major knowledge gaps limit the development and implementation of interventions to improve employment outcomes among people with cancer. To identify research priorities to improve employment outcomes after cancer, the National Cancer Institute sponsored the meeting "Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors." This article describes research recommendations stemming from the meeting. At the patient level, longitudinal studies are needed to better understand how patient sociodemographic and clinical characteristics and their experiences at work shape employment outcomes. Interventions that mitigate the impact of cancer and its treatment on employment are critical. At the provider-level, future research is needed to characterize the extent to which physicians and other healthcare providers talk to their patients about employment concerns and how that information is used to inform care. Additionally, there is a need to test models of care delivery that support routine screening of employment concerns, the capture of employment outcomes in electronic health records, and the effective use of this information to improve care. At the employer level, evidence-based training programs are needed to prepare supervisors, managers, human resources staff, and occupational health professionals to address health issues in the workplace; and future interventions are needed to improve patient –employer communication and facilitate workplace accommodations. Importantly, research is needed that reflects the perspectives and priorities of patients and their families, providers and healthcare systems, and employers. Transdisciplinary partnerships and stakeholder engagement are essential to ensure that employment-focused interventions and policies are developed, implemented, and sustained in real-world healthcare delivery and workplace settings.


Cancer and its treatment frequently lead to symptoms that interfere with the ability to work, placing cancer survivors and their families at risk for financial hardship and psychosocial distress.[1–6] Common side effects such as fatigue, lymphedema, and cognitive limitations can lead to poor work outcomes, such as prolonged sick leave, schedule and role changes, and job loss.[7–12] Additionally, the time demands associated with cancer treatment may also make it difficult to sustain employment, forcing some survivors to work less, take a leave of absence, or withdraw from the labor force entirely.[13–15]

Approximately two-thirds of people diagnosed with cancer return to work at some point after diagnosis.[7] However, work outcomes vary widely by disease and treatment, sociodemographic, and workplace characteristics. Survivors diagnosed with advanced disease and who receive intensive treatment are more likely to take extended sick leave, report loss of productivity if they remain at work, and non employment if they are no longer able to work. For adolescent and young adult (AYA) cancer survivors, cancer can be particularly disruptive because their diagnosis often coincides with entering or preparing for the work force.[16,17] Additionally, survivors with lower socioeconomic status, racial and ethnic minority survivors, survivors employed in demanding jobs, and those who lack accommodating employers are more likely to report poor work outcomes.[7,18–21] It is also widely accepted that a survivor's job performance, satisfaction, and engagement prior to cancer diagnosis are important drivers of work outcomes after cancer.[22] However, few studies have examined these relationships and their impact on employment and job performance.

Minimizing work-related consequences is not generally a focus of cancer treatment, and few interventions exist to help people with cancer maintain their engagement and precancer job performance at work. Major knowledge gaps limit the ability to develop and implement interventions to improve cancer-related employment outcomes. Among populations where employment outcomes are not well documented, descriptive work is needed to better understand the scope and predictors of different employment outcomes. Among populations where employment outcomes are better understood, research is needed to identify effective interventions and to implement those interventions into practice.

In response to persistent gaps in the literature, the National Cancer Institute's Division of Cancer Control and Population Sciences convened a 1.5-day meeting to develop a research agenda focused on optimizing work outcomes among cancer survivors. A select group of 29 oncologists, occupational therapists, rehabilitation practitioners, employment representatives, researchers, and research funders were convened for the meeting, "Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors," held August 11–12, 2016, to examine the problem of cancer-related work limitations from multiple perspectives. For the purposes of the discussion, cancer survivors were defined as anyone who had been diagnosed with cancer, including individuals who were currently receiving treatment. Work outcomes included returning to work (RTW) as well as job retention (ie, working during treatment and recovery), absenteeism, presenteeism (ie, functional limitations interfering with productivity), opportunities for promotion and advancement, and job satisfaction. Additional information about the meeting and the participants can be found at: This article describes the research needs identified from the meeting, which have been further elaborated through subsequent discussions among meeting participants and collaborators.