title: Design of a multicentre randomized controlled trial to evaluate the effectiveness of a tailored clinical support intervention to enhance return to work for gastrointestinal cancer patients.
abstract: Gastrointestinal (GI) cancer is frequently diagnosed in people of working age, and many GI cancer patients experience work-related problems. Although these patients often experience difficulties returning to work, supportive work-related interventions are lacking. We have therefore developed a tailored work-related support intervention for GI cancer patients, and we aim to evaluate its cost-effectiveness compared with the usual care provided. If this intervention proves effective, it can be implemented in practice to support GI cancer patients after diagnosis and to help them return to work.
  
  
  
  We designed a multicentre randomized controlled trial with a follow-up of twelve months. The study population (N = 310) will include individuals aged 18-63 years diagnosed with a primary GI cancer and employed at the time of diagnosis. The participants will be randomized to the intervention or to usual care. 'Usual care' is defined as psychosocial care in which work-related issues are not discussed. The intervention group will receive tailored work-related support consisting of three face-to-face meetings of approximately 30 min each. Based on the severity of their work-related problems, the intervention group will be divided into groups receiving three types of support (A, B or C). A different supportive healthcare professional will be available for each group: an oncological nurse (A), an oncological occupational physician (B) and a multidisciplinary team (C) that includes an oncological nurse, oncological occupational physician and treating oncologist/physician. The primary outcome measure is return to work (RTW), defined as the time to a partial or full RTW. The secondary outcomes are work ability, work limitations, quality of life, and direct and indirect costs.
  
  
  
  The hypothesis is that tailored work-related support for GI cancer patients is more effective than usual care in terms of the RTW. The intervention is innovative in that it combines oncological and occupational care in a clinical setting, early in the cancer treatment process.
  
  
  
  METC protocol number NL51444.018.14/Netherlands Trial Register number NTR5022 . Registered 6 March 2015.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.c.zaman@amc.nl.
authors.forename: AnneClaire G N M
authors.initials: AG
authors.lastname: Zaman
authors.affiliation: Gastrointestinal Oncological Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kristien M A J
authors.initials: KM
authors.lastname: Tytgat
authors.affiliation: Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands.|Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jean H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Monique H W
authors.initials: MH
authors.lastname: Frings-Dresen
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Angela G E M
authors.initials: AG
authors.lastname: de Boer
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018802:Patient-Centered Care; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D062707:Return to Work / Q000191:economics / Q000523:psychology*; D018582:Sick Leave; D055815:Young Adult
keywords: Employment; Gastrointestinal cancer; Oncological occupational physician; Psycho-oncological care; Return to work; Sick leave