title: Interventions to enhance return-to-work for cancer patients.
abstract: BACKGROUND
  Cancer survivors are 1.4 times more likely to be unemployed than healthy people. It is therefore important to provide cancer patients with programmes to support the return-to-work process.
  
  
  OBJECTIVE
  To evaluate the effectiveness of interventions aimed at enhancing return-to-work in cancer patients.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 2, 2010), MEDLINE, EMBASE, CINAHL, OSH-ROM, PsycINFO, DARE, ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com to February 2010, reference lists of included articles and selected reviews, and contacted authors of relevant articles.
  
  
  METHODS
  Randomised controlled trials (RCTs) and controlled before-after studies (CBAs) of the effectiveness of psychological, vocational, physical, medical or multidisciplinary interventions enhancing return-to-work in cancer patients. The primary outcome was return-to-work measured as either return-to-work rate or sick leave duration. Secondary outcome was quality of life.
  
  
  METHODS
  Two authors independently selected trials, assessed the risk of bias and extracted data. We pooled studies with sufficient data, judged to be clinically homogeneous in different comparisons. We assessed the overall quality of the evidence for each comparison using the GRADE approach.
  
  
  RESULTS
  Fourteen articles reporting 14 RCTs and 4 CBAs were included. These studies involved a total of 1652 participants. Results indicated low quality evidence of similar return-to-work rates for psychological interventions compared to care as usual (odds ratio (OR) = 2.32, 95% confidence interval (CI) 0.94 to 5.71). No vocational interventions were retrieved. Very low evidence suggested that physical training was not more effective than care as usual on improving return-to-work (OR = 1.20, 95% CI 0.32 to 4.54). Eight RCTs on medical interventions showed low quality evidence that functioning conserving approaches had similar return-to-work rates as more radical treatments (OR = 1.53, 95% CI 0.95 to 2.45). Moderate quality evidence showed multidisciplinary interventions involving physical, psychological and vocational components led to higher return-to-work rates than care as usual (OR = 1.87, 95% CI 1.07 to 3.27). No differences in the effect of psychological, physical, medical or multidisciplinary interventions compared to care as usual were found on quality of life outcomes.
  
  
  CONCLUSIONS
  Moderate quality evidence showed that employed patients with cancer experience return-to-work benefits from multidisciplinary interventions compared to care as usual. More high quality RCTs aimed at enhancing return-to-work in cancer patients are needed.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Centre, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ.
authors.forename: Angela Gem
authors.initials: AG
authors.lastname: de Boer
authors.forename: Taina
authors.initials: T
authors.lastname: Taskila
authors.forename: Sietske J
authors.initials: SJ
authors.lastname: Tamminga
authors.forename: Monique Hw
authors.initials: MH
authors.lastname: Frings-Dresen
authors.forename: Michael
authors.initials: M
authors.lastname: Feuerstein
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012050:Rehabilitation, Vocational; D017741:Survivors; D014937:Work / Q000523:psychology