de Moor JS et al. Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors. JNCI 2018 Oct 1;110(10):1041-1047. [Abstract]
The Healthcare Delivery Research Program (HDRP) has outlined a research agenda to optimize work outcomes for people who are diagnosed with cancer. These recommendations were developed following an HDRP-led workshop in August 2016 that convened a multidisciplinary group of 29 individuals with collective expertise in oncology, cancer care delivery, cancer survivorship, rehabilitation, work disability, employment law, employee benefits and workplace wellness. The workshop covered four core questions, including:
- What observational research is needed to address a broad range of work limitations among cancer patients and survivors?
- What types of interventions are needed to prevent and/or mitigate work limitations among cancer patients and survivors?
- If the goal is to develop survivor-, provider- and employer-based interventions to address work limitations among cancer survivors, how do we get there?
- What is the most important direction this field needs to go and what is the most actionable way to get there?
Research recommendations to improve the assessment of cancer-related work outcomes and the implementation of effective interventions are as follows.
Recommendations for Patient-level Research
- Include employment outcomes in cohort studies of cancer survivors to characterize how patient sociodemographic characteristics, behaviors, cancer type, treatment, and toxicities affect cancer-related work outcomes.
- Characterize barriers to employment and identify modifiable risk factors for employment outcomes as part of cohort studies of cancer survivors.
- Identify and test interventions to mitigate the impact of cancer and its treatment on employment outcomes.
- Test strategies to help cancer survivors and their families understand their legal rights and access programs and policies that are relevant for their needs.
Recommendations for Provider- and Health System-level Research
- Characterize the extent to which healthcare providers talk to their patients about employment, the content of these conversations, and the impact of these conversations on treatment decisions, care coordination, and work outcomes.
- Systematically screen patients for work limitations and concerns throughout the course of treatment in a manner that aligns with clinic staffing and workflow and effectively informs care.
- Assess employment outcomes as part of clinical trials and routine clinical practice. Capture employment information in the electronic health record (EHR) to understand how specific treatments impact work outcomes.
Recommendations for Employer-level Research
- Conduct research to inform training about legal issues protecting employees with cancer and best practices for managing health issues in the workplace.
- Develop tools and approaches that will improve patient-employer communication and inform workplace accommodations, job retraining, and other assistance.
- Conduct research to address the unique needs of small employers and employees who do not typically have access to current programs and policies.
- Ground research on cancer-related work outcomes in an understanding of employers’ experiences and resources for managing employees with cancer or other health problems.
Cross-cutting Research Recommendations
- Identify and develop standardized measures of work outcomes and risk factors for employment outcomes and integrate these measures into research and practice.
- Identify how best to integrate evidence-based, employment-focused interventions into healthcare delivery and employer settings to maximize impact and improve patient outcomes.