Key messages

– Multidisciplinary and physical interventions are likely to be helpful for people with cancer to get back to work.

– Psycho-educational interventions likely result in little to no difference in getting back to work, and we are uncertain about the effect of vocational interventions.

What is this review about?

Each year, more people survive after diagnosis and treatment for cancer. Many cancer survivors live well, although they can continue to experience long-lasting problems such as fatigue, pain and depression. These long-term effects can cause problems with their participation in working life. Therefore, cancer is a significant cause of absence from work, unemployment and early retirement. People with cancer, their families and society at large all carry part of this burden. In this Cochrane review, we evaluated how well people with cancer can be helped to get back to work.

What did we want to find out?

We wanted to find out if non-medical interventions are better than usual care to improve getting back to work. We also wanted to find out if those interventions led to better quality of life. We considered four types of intervention:

– psycho-educational interventions (people with cancer learnt about physical side effects, stress and coping, and they took part in group discussions);

– vocational interventions (aimed at work-related issues);

– physical interventions (people with cancer took part in physical exercises such as walking); and

– multidisciplinary interventions (vocational counselling, patient education, patient counselling, physical exercises or combinations of these).

What did we do?

We searched for studies that looked at interventions aimed at improving getting people with cancer back to paid employment (employee or self-employed). We compared and summarised the results of the studies, and rated our confidence in the evidence, based on factors such as study methods and study size.

What did we find?

We found 15 studies that involved 1477 people with cancer that measured getting back to work. All studies were conducted in high-income countries. Nine studies were aimed at people with breast cancer and two studies at men with prostate cancer.

– Psycho-educational interventions probably result in little to no difference in getting back to work or quality of life.

– Physical interventions and multidisciplinary interventions likely lead to more people with cancer getting back to work than when they received care as usual. A physical intervention will probably help 50 to 244 per 1000 people returning to work on top of the average of 627 per 1000 people who return to work without intervention. A multidisciplinary intervention will probably help 69 to 219 people per 1000 more return to work. They may result in little to no difference in quality of life.

– We are uncertain about the effects of vocational interventions on getting people back to work.

What are the limitations of the evidence?

We are moderately confident that physical and multidisciplinary interventions likely increase the number of people with cancer getting back to work. Our confidence was reduced because some studies did not clearly report how they were conducted. We have little confidence in the evidence about psycho-educational interventions, and we have no confidence in the evidence about vocational interventions. The main reasons for reducing our confidence were that studies used methods that were likely to introduce errors in their results, and we found only one very small study on vocational interventions. Further research could change the results of this review.

How up to date is the evidence?

The evidence is up to date to August 2021.