Fehmidah Munir

Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment.

Introduction: Recent improvements in cancer treatment have not only increased cancer survivorship but also peoples’ ability to work during and following treatment. However, the impact that both diagnosis and treatment has on cancer survivors’ ability to fully engage in paid work is not yet entirely understood. This study aims to explore the role of symptoms, work adjustments and cancer disclosure to supervisors and co-workers on working during primary cancer treatment and return to work following treatment. Method: 328 cancer survivors responded to a 33 item questionnaire that assessed cancer-specific variables e.g. type and treatment, symptoms experienced during and following treatment, disclosure of cancer and adjustments and supports available at work. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment. Results: The findings indicate that opportunities to work flexibly (OR=2.43, CI 1.21–4.02), disclosure to colleagues (OR=3.03, CI 1.28–8.19), difficulties managing fatigue (OR=2.08, CI 1.22–3.85), and paid time off to attend all medical appointments (OR=.4, CI .30–.87) were associated with continuing to work during treatment. Correlates of return to work included difficulties managing fatigue (OR=1.49, CI 1.42–6.18), managing the stress of cancer (OR=2.80, 1.05–5.34), managing physical changes associated with cancer (OR=.46, CI .13–.95), received advice from their doctor about work (OR=1.47, CI 1.09–2.84) and return to work meeting with employer (OR 1.99, 1.2–5.09). Conclusions: This study highlights the importance of symptom management in cancer survivors who work and the potential impact of workplace adjustments on the ability of cancer survivors to navigate in the world of work.

Differential Impact of the FMR-1 Full Mutation on Memory and Attention Functioning: A Neuropsychological Perspective

Memory and attention processing were examined in a group of 15 adult Fragile-X syndrome (FXS) males with Fragile-X mental retardation 1 (FMR-1) full mutation and compared to two control groups: a learning disabled (LD) control and a normal functioning control. Performance was assessed across a wide range of tasks including working memory, recognition memory, selective attention, sustained attention, and attentional switching. All three groups performed at a comparable level on recognition memory tasks, and the Fragile-X males and LD control group performed worse than the control group on tasks of working memory and sustained attention. On a task of executive function, the Fragile-X males demonstrated a significant deficit in comparison to the LD control group and the normal control group, but performed better than the LD control group and at a comparable level to the control group on tasks of selective attention. Molecular analyses of the lymphocyte DNA provided little evidence for a correlation between expansion size and performance on tasks of memory and attention. The findings from the present study are discussed in the context of functional neuroimaging and brain-behavior-molecular correlates.

Spatial cognition in males with Fragile-X syndrome: evidence for a neuropsychological phenotype.

Spatial performance in a group of young Fragile-X syndrome males with FMR-1 full mutation was compared to a learning disabled control group comprising young Downs syndrome males and two control groups of mainstream schoolchildren. Performance was assessed across a wide range of spatial tasks including visuo-construction, visuo-spatial memory, visuo-motor, and visuo-perception. The findings indicate a task-specific rather than global deficit in spatial performance in Fragile-X males with visuo-constructive and visuo-motor skills most vulnerable. Molecular analysis of the lymphocyte DNA found minimal evidence for a correlation between CGG expansion size and spatial performance, although tasks with a visuo-perceptual component correlated negatively with expansion size indicating that the further away the number of repeats are from the 200 threshold the poorer the performance.

Women's perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study.

AIMS AND OBJECTIVES To investigate womens awareness of chemotherapy-induced cognitive changes, their perception of cognitive limitations in carrying out daily tasks and subsequent return to work decisions and perceptions of work ability. BACKGROUND Evidence suggests that women diagnosed with breast cancer experience cognitive changes as a consequence of chemotherapy treatment. Although these changes tend to be subtle deficits in memory, concentration and the ability to organise information, there has been no published research identifying how they can impact patients ability to work and subsequent employment decisions. DESIGN This was a qualitative study. METHOD Data were collected from breast cancer survivors using semi-structured interviews with two focus groups (n = 6, n = 7). Interviews were transcribed verbatim and analysed using template analysis. RESULTS Data were categorised into four main themes: (1) awareness of cognitive changes during and following chemotherapy, (2) cognitive ability and confidence in return to work, (3) impact of cognitive changes on work ability and (4) information on the cognitive side effects of chemotherapy. CONCLUSIONS The views and experiences of breast cancer survivors towards returning to work and subsequent work ability were affected by chemotherapy-induced cognitive impairment. More specifically the appraisal of returning to work and ability to manage work were influenced by three interrelated factors: (1) actual cognitive ability following chemotherapy, (2) awareness of cognitive failures by the women and their families and (3) the subsequent impact on their confidence in carrying out daily tasks including work tasks. RELEVANCE TO CLINICAL PRACTICE More information and support is needed to help patients with cancer to manage chemotherapy-induced cognitive impairments in home and workplace. Nurses are increasingly asked about the impact of cancer and its treatment on work and are therefore well positioned to offer this advice. Subsequently, nurses require additional knowledge and guidance to provide this information and support.

Work Factors Related to Psychological and Health-Related Distress Among Employees with Chronic Illnesses

Objective: This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses. Methods: The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires. Results: Both low psychological well-being and high health-related distress were associated with an increase in work limitations (β=0.20, SE=.03; and β=0.19, SE=.01, respectively), poorer management of illness symptoms at work (β=−0.17, SE=.12; and β=−0.13, SE=.02), high presentieesm (β=0.19, SE=.25; and β=0.14, SE=.05) and low workplace support (β=−0.05, SE=.22; and β=−0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (β=0.18, SE=.08) and long-term sickness absence (β=0.10, SE=.06). Conclusions: To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.

The role of communication and support in return to work following cancer-related absence

Objective: Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post‐return period; and second, by drawing on a research sample working in the United Kingdom.

Receptive and Expressive Language Skills in Children with Cri-du-Chat Syndrome.

Receptive and expressive language skills were assessed in 13 children with cri-du-chat syndrome. Two patterns of performance were found. One pattern was the discrepancy between the childrens chronological ages and their presumed language ages. The second pattern was the receptive-expressive discrepancy with reduced expressive skills compared to receptive skills. One implication of these findings is that remediation that focuses on receptive skills may be more effective than traditional verbal methods.

Employment and the common cancers: correlates of work ability during or following cancer treatment

AIMS To provide an in-depth review of the impact of cancer and cancer-related issues on work ability for those working during or following cancer treatment. METHODS Of total, 19 papers published between 1999 and 2008 on cancer and work ability were reviewed. RESULTS Studies have shown that most types of cancers result in decreased work ability compared to healthy controls or those with other chronic conditions. Some cancer types have more decreased work ability than other types. Decreased work ability is associated with type of treatment (chemotherapy), treatment-related side-effects (e.g. fatigue) and co-morbidity with other health conditions. For most cancers, work ability improves over time irrespective of age. CONCLUSIONS More longitudinal research is required to fully determine the impact of cancer and its treatment on work ability, occupational health services can help such employees make a full recovery and maintain employment by regularly assessing work ability and working hours so that work adjustment and support can be appropriately tailored.

The nature of the spatial deficit in young females with Fragile-X syndrome: a neuropsychological and molecular perspective.

Spatial performance in a group of young Fragile-X syndrome females with FMR-1 full mutation was compared to two control groups of mainstream schoolchildren. Performance was assessed across a wide range of spatial tasks including visuo-spatial, visuo-construction, visuo-motor, visuo-perception and spatial-memory. A spatial deficit emerged only on those tasks which comprised a visuo-constructive component, with the Fragile-X group performing worse overall. All other tasks were performed at a comparable level across the three groups. Molecular analysis of the lymphocyte DNA found minimal evidence for a correlation between expansion size and spatial performance. In addition, there was no evidence for a correlation between the proportion of active to inactive unmethylated FMR-1 genes (activation ratio) and spatial performance. These results conflict with recent reports of a correlation between activation ratio and intellectual functioning.

Sickness absence management: Encouraging attendance or ‘risk-taking’ presenteeism in employees with chronic illness?

Purpose. To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees. Methods. A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies. Results. Participants reported that attendance management polices and the point at which systems were triggered, posed problems for employees managing chronic illness. These systems presented risk to health: employees were more likely to turn up for work despite feeling unwell (presenteeism) to avoid a disciplinary situation but absence-related support was only provided once illness progressed to long-term sick leave. Attendance management polices also raised ethical concerns for ‘forced’ illness disclosure and immense pressures on line managers to manage attendance. Conclusions. Participants felt their current attendance management polices were unfavourable toward those managing a chronic illness. The policies heavily focused on attendance despite illness and on providing return to work support following long-term sick leave. Drawing on the results, the authors conclude that attendance management should promote job retention rather than merely prevent absence per se. They outline areas of improvement in the attendance management of employees with chronic illness.