Sævar Berg Gudbergsson

A comparative study of living conditions in cancer patients who have returned to work after curative treatment

Goals of workThe goal of this study was to explore living conditions among disease-free cancer survivors participating in the labour force after successful primary treatment. Their living conditions were compared with the conditions of matched controls from the general Norwegian population.Patients and methodsLiving conditions are social indicators that stimulate social inclusion and reduce exclusion such as economy, employment, health, housing and social participation. A questionnaire covering living conditions with established questions from population surveys was mailed to 852 cancer survivors and 1,548 controls. Valid responses were obtained from 51% cancer survivors (216 women with breast cancer, 49 men with prostate cancer, and 165 with testicular cancer) and 39% controls (317 women and 279 men).Main resultsCompared to their controls cancer survivors showed no difference in work hours or full-time jobs, but reported significantly poorer physical and mental work capacity. This was associated with significantly more somatic diseases among survivors and poorer general health status in male survivors. The survivors had significantly smaller households and more living space than controls. No significant differences were observed concerning economy or social participation, except that significantly more female survivors than controls stated that they had enough friends.ConclusionsIn spite of poorer health, tumour-free survivors after breast, testicular, and prostate cancer report mostly equal living conditions compared to matched controls. The protection hypothesis of holding jobs as a precondition for normal living condition was confirmed in our study of a sample of cancer survivors with good outcome.

Social support at work and work changes among cancer survivors in Norway

Aims: To investigate how cancer survivors (CSs) experience the cancer-related support they get at the workplace, the proportion of CSs who change work due to cancer and the sociodemographic and work-related factors associated with CSs’ work changes. Methods: CSs of the 10 most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15—39 months after primary treatment. All CSs who were working when diagnosed were included in the analyses (n = 1115). Leaving the workforce and making other important changes in paid work were regarded as work changes. Results: When diagnosed with cancer, 84% of the CSs experienced their supervisor as caring vs. 90% for colleagues. At the time of the survey, 84% were still working; 24% had made changes in work due to the cancer. Work changes due to cancer were most common among CSs who reported low supervisor support related to the cancer (odds ratio (OR) 0.78) and high physical (OR 2.48) and psychological job demands (OR 1.39) at the time of diagnosis. Work changes were more common among self-employed CSs than among employees (OR 2.03). CSs with high education (OR 0.59) and medium income (OR 0.66) made fewer work changes than other CSs, but these differences were not significant when controlled for the work factors. Conclusions: Close follow-up by supervisors should be a key element in workplace health promotion programmes for CSs. Further, the programmes should target both physical and psychosocial work factors.

A controlled study of job strain in primary-treated cancer patients without metastases

To explore job strain in Norwegian primary-treated cancer survivors compared to matched controls from the general population. The study has a cross-sectional, matched case-control design. A sample of 417 employed cancer survivors (208 females with breast cancer and 209 males with testicular or prostate cancer) who had been diagnosed 1–5 years prior to the study and were tumor-free rated themselves on the Demands-Control-Support Questionnaire (DCSQ). Their ratings were compared to those of 417 employed controls from the general population, matched with the survivors on time of investigation, gender, age and municipality of living. No differences in job strain were observed between cancer survivors and controls, or between subgroups of survivors, except that female survivors experienced more strain than males. In certain subgroups statistically significant differences on the DCSQ were found: older survivors showed higher scores on demands than their controls, female survivors reported lower control and higher strain than male survivors, and older male survivors felt higher demands than younger ones. However, the effect sizes of these differences were so small (<0.20) that they hardly were relevant for the work situation. In multivariate analyses survivorship versus control status was not significantly associated with any of the DCSQ measures. The job strain of these cancer survivors did not differ in any work relevant way from their controls, and survivorship status was not significantly associated with job strain. A longer follow-up of survivors is necessary in order to draw conclusion about the stability of these findings over time.

Change in employment status of 5-year cancer survivors

AIMS To follow the employment status of 5-year cancer survivors for 5 years after diagnosis with their first lifetime invasive cancer and to identify socio-demographic, work-related and cancer-related predictors of employment status after 5 years. METHODS This prospective registry study concerned all 3278 people in Norway (18-61 years old) diagnosed with their first lifetime invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 6368) matched by sex, age, educational level and employment status in 1998. RESULTS The employment rate among male cancer survivors declined steadily every year, from 94% the year before diagnosis (1998) to 77% 5 years after diagnosis (2004). This change did not differ significantly from that of male controls. The employment rate of female survivors also declined steadily, from 87% (1998) to 69% (2004). This decline was greater than that among female controls, and in 2004 survivors had a significantly lower employment rate. For both men and women, the significant pre-diagnosis predictors of being employed in 2004 concerned higher socio-economic position. For both sexes, lung cancer survivors had the highest decline in employment rate, and male skin cancer survivors had a lower decline in employment rate than controls. Socio-demographic and work-related factors explained more of the variance in employment status than did cancer diagnosis. CONCLUSION The employment rate among 5-year cancer survivors did not change significantly except for female survivors. Low socio-economic position is a risk factor for decline in employment rate and should be focused on to prevent cancer-related inequity.

Early retirement and non‐employment after breast cancer

This study examined whether workplace support, sociodemographic factors and co‐morbidity are associated with early retirement or non‐employment due to other reasons among breast cancer survivors. We also compared quality of life and chronic symptoms (pain, fatigue, anxiety and depression) among employed, retired and other non‐employed breast cancer survivors.

The associations between living conditions, demography, and the 'impact of cancer' scale in tumor-free cancer survivors: A NOCWO study

Goals of workThe “impact of cancer” scale (IOC) is a new questionnaire that explores attitudes in the physical, psychological, social, and spiritual/existential domains in cancer survivors. This study explores the associations between demography, living conditions (LCs), and the IOC dimensions in disease-free Norwegian survivors who have been treated for breast, prostate, or testicular cancer.Materials and methodsA questionnaire covering demography, LCs, and the IOC was mailed to 852 cancer survivors; 459 (54%) participated. A living condition index (LCI) was calculated based on self-reported education, employment, annual income, health, housing expenditures, and social participation.Main resultsSurvivors with a low LCI level viewed their situation significantly worse on four of five negative IOC dimensions than those with high LCI level. No significant LCI-related differences were observed for the mean scores of positive IOC dimensions. Significant associations were observed between gender, health status, employment, and five to six IOC dimensions. LCs were more often associated with the negative IOC dimensions than the positive ones.ConclusionsThe significant associations between LCs and dimensions of the IOC in tumor-free cancer survivors show that LCs should be considered when health care professionals assist cancer survivors in dealing with the impact the cancer experience had on their lives.

A comparative study of cancer patients with short and long sick-leave after primary treatment

Abstract Background. Sick-leave after primary cancer treatment has hardly been studied. This study compares Norwegian cancer patients (CPs) with shorter (≤8 months) and longer (≥9 months) sick-leave after primary cancer treatment. Our aim was to characterize factors associated with these two types of sick-leave in order to identify possible factors for interventions by which long-term sick-leaves may be avoided. Methods. A mailed questionnaire was completed by a sample of Norwegian CPs 15 to 39 months after primary treatment of the ten most common invasive types of cancer. The groups with shorter (n=359) and longer (n=481) sick-leaves (SSL vs LSL) were compared with each other by self-reported information as to socio-demographic and cancer-related variables, health, quality of life, work ability, work situation and supportive interventions. Results. The LSL consisted of 78% females, and 76% of them had breast or gynaecological cancer. A higher proportion of patients with low level of education, economical problems, treated with chemotherapy, hormones and multimodal treatment belonged to LSL compared to SSL. Significantly more LSL had recurrences of cancer, co-morbidity, regular use of medication, and poorer self-rated health, quality of life and work ability. Compared to SSL, more LSL reported needs for and offers of supportive care such as physiotherapy, physical activities and psychosocial support. A multivariate regression analysis showed that reduced work ability, changes in employment due to cancer, lack of support from supervisors at work, and having had combined treatment were significantly associated with being LSL. Conclusions. Longer sick-leave after primary cancer treatment is associated with combined cancer treatment, lack of support from supervisors and reduced overall work ability. Interventions and counselling related to the work place and reduced work ability could be of value for prevention of long-term sick-leaves.

Received and needed social support at the workplace in Norwegian and Finnish stage 1 breast cancer survivors: A study from the Nordic Study Group of Cancer and Work (NOCWO)

Background. Cross-cultural studies of comparable patients can identify differences of health care services and point to issues of possible improvement. In this cross-sectional study we compared self-reported received and needed social support at the workplace of disease-free breast cancer survivors (BCSs) stage I from Norway and Finland. Methods. Age-matched samples of 135 BCSs from Norway and 148 from Finland were examined using a questionnaire including socio-demographic factors, employment data, measurements of social support at work from supervisors, colleagues and the occupational health service (OHS), and several other measurements. Results. Finnish BCSs had significantly higher education and a higher rate of full-time employment than Norwegian ones. With adjustment for education and work time, Finnish compared to Norwegian BCSs reported significantly less received social support from supervisors, while they received significantly more social support from OHS. No differences were observed in received support from colleagues between Finnish and Norwegian BCSs. Somatic health was most strongly associated with received and needed support from supervisors, colleagues and OHS. Conclusions. The differences in received and needed social support at work observed between Norwegian and Finnish BCSs treated for stage I disease challenge strengthening of OHS for Norwegian BCSs and increased attention by supervisors in Finnish BCSs.

Perceived needs for different components in a rehabilitation program among cancer survivors with chronic fatigue compared to survivors without chronic fatigue

Abstract Background: Knowledge about the user’ needs is important to develop targeted rehabilitation for cancer patients with chronic fatigue (CF). The aims of the study were to examine prevalence of CF in cancer survivors attending an one-week inpatient educational program (IEP) and to identify characteristics of those with CF. Further to examine the perceived needs for different components in a rehabilitation program, need of complex rehabilitation (at least two components) and aspects of health-related quality of life (HRQoL) among survivors with CF versus those without CF. Material and methods: Cancer survivors ≥18 years, diagnosed with different types of cancer within the last 10 years and attending a one-week IEP were invited to this cross-sectional study. CF was assessed by the Fatigue Questionnaire, perceived needs by asking a question about needs for different components in a rehabilitation program and HRQoL was assessed by The Medical Outcomes Study Short Form 36. Results: Of 564 participants, 45% reported CF. Breast cancer, mixed cancer types (including small groups with different cancer types) and comorbidities increased the risk for having CF. Compared to participants without CF, the participants with CF reported more frequently need for physical training (86% vs. 65%, p < 0.001), physiotherapy (71% vs. 55%, p < 0.001) and nutrition counseling (68% vs. 53%, p = 0.001). Among participants with CF, 75% reported need for three or more components whereas 54% reported need for the same number of components among those without CF (p < 0.001). Conclusion: Almost half of the cancer survivors attending the IEP had CF. Physical training, physiotherapy and nutrition counseling were the most frequently reported needs and significantly more often observed in participants with CF than without CF. A higher percentage of those with CF reported need for a complex rehabilitation compared to those without CF. More research is necessary to obtain more knowledge to further make targeted programs to better match cancer survivors’ needs.