title: Supporting return-to-work in the face of legislation: stakeholders' experiences with return-to-work after breast cancer in Belgium.
abstract: BACKGROUND
  The diagnosis of breast cancer increasingly implies a return-to-work (RTW) challenge as survival rates increase. RTW is regarded as a multidisciplinary process and a country's legislation affects the degree of involvement of the different stakeholders. We elucidated on bottlenecks and contributing factors and the relationship between policy and practice regarding RTW of employees with breast cancer as perceived by Belgian (Flemish) stakeholders.
  
  
  METHODS
  Three multidisciplinary groups (n = 7, n = 9, n = 10) were interviewed during a breast cancer conference. Treating physicians (n = 4), employers (n = 6), social security physicians (n = 3), occupational physicians (n = 4), survivors (n = 5) and representatives of patient associations (n = 4) were included. The major theme was the legal and practical role in the RTW process as experienced by the participants. Qualitative thematic analysis was performed to analyse stakeholders' experiences of women's RTW after breast cancer.
  
  
  RESULTS
  The stakeholders reported different perspectives. Employees focus on treatment and feel ill-informed about the RTW options. Treating physicians do not feel competent about advising on work-related questions. Employers have to balance the interests of both the business and the employee. Social security physicians assess ability to work and facilitate RTW options. Occupational physicians see opportunities but the legislation does not support their involvement. Stakeholders expressed the need for coordination and reported finding ways to accommodate the employee's needs by being flexible with the legislation to support the RTW process.
  
  
  CONCLUSIONS
  Two factors might hamper RTW for breast cancer patients: the varying stakeholder perspectives and Belgian legislation which emphasizes the patient or disability role, but not the employee role. When stakeholders are motivated they find ways to support RTW, but improved legislation could support the necessary coordination of RTW for these patients.
authors: Department of Occupational, Environmental and Insurance Medicine, Katholieke Universiteit Leuven, Kapucijnenvoer 35/5, 3000 Louvain, Belgium. corine.tiedtke@med.kuleuven.be
authors: Corine
authors: C
authors: Tiedtke
authors: Peter
authors: P
authors: Donceel
authors: Lieve
authors: L
authors: Knops
authors: Huget
authors: H
authors: Désiron
authors: Bernadette
authors: B
authors: Dierckx de Casterlé
authors: Angelique
authors: A
authors: de Rijk
mesh_terms: D000328:Adult; D001530:Belgium; D001943:Breast Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D004651:Employment; D005260:Female; D017144:Focus Groups; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D009786:Occupational Health Services / Q000458:organization & administration*; D036301:Qualitative Research; D012050:Rehabilitation, Vocational; D018582:Sick Leave; D017741:Survivors / Q000523:psychology; D014937:Work