CTM201 Protocol Development Essay.

Breast cancer is a rising health concern across the globe at present times and is marked as the most common form of cancer among women. Treatment for breast cancer involves chemotherapy and surgical interventions in combination with radiation therapy. The recent trend indicates that breast cancer survivors resume their normal work life in spite of the fact that occupational health services and health care services are not sufficient. A phenomenological study explored the return of breast cancer patients to work with the study being carried out with six survivors. An in-depth unstructured interview was carried out, and analysis was done with the help of the adapted version of Colaizzi’s approach. The study gave rise to four significant themes. Women reported that the effect of breast cancer persists for a considerable amount of time. A proportion of the participants noted that they had to gain emotional strength for making progress with their career after returning to work. The presence of adequate occupational health services acts a positive influence. The findings of the study imply that workplace interventions have the potential to foster the reintegration of breast cancer survivors into their work life (1).

In this context, it is to be noted that breast cancer survivors in their employment years show greater chances of going back to work after receiving primary treatment. Existing literature has attempted to give an overview of the perceptions of the survivors and provide an indication of the significant outcomes and variables. The knowledge has been serving as a base for developing possible interventions that could support breast cancer survivors having a desire to return to their work. A number of literature have been carried out by researchers who have explored different dimensions of the research topic. One such review was conducted on the topic of a return to work among patients with breast cancer. The databases searched were MEDLINE, SCOUP, CINAHL AND PUBMED. The articles retrieved were published between the year 2004 and 2014. A total of 25 articles highlighted three major outcomes: work performance, work ability and return-to-work period. The independent variables that emerged to be most important were individual characteristics, health and well-being, work environments and work demand, the functioning of systems, and cultural and societal factors. However, there is still a lack of literature on proper interventions that are effective in supporting a return to work among survivors of breast cancer. Further research is required for bringing into limelight the roles and responsibilities of the government in bringing reforms in the existing policies (2).

Another crucial study in the same field was on employment and breast cancer and had a meta-ethnography approach. The purpose of the study was to analyse the qualitative evidence existing on the lived experience of the breast cancer survivors in relation to their return to work. The literature search was carried out with a paper published between 1999 and 2010.  Ten articles were considered for addressing the research aims. Four concepts were found to be emerging from the papers reflecting sickness absence, influencing factors, work-related problems, work ability and experiences of return to work. Synthesis of the concepts gave rise to four final interpretations. These included employment after cancer, physical impairment due to treatment, comprehension of breast cancer by the employer, and fear and anxiety arising due to chances of failure at work. The results were an indication that there is an urgent need of educating the employers adequately about the maximum working capability of breast cancer survivors after treatment has been done. More support facilities that are improved in nature are required in this regard. Such facilities demand the support and guidance of employment legislation. Occupational health departments must come forward and help to make this channel a more clearer process. In addition, health care professionals must have more active involvement in educating breast cancer patients in relation to returning to work after treatment (3).

Correlates of return to work for breast cancer survivors was explored in an article that carried out a study with 416 employed women. The patients were newly diagnosed with breast cancer and were identified from the Metropolitan Detroit Cancer Surveillance System. Telephonic interview was carried out 12 months and 18 months after diagnosis. Identification of correlates of return to work at 12 and 18 months was done using multivariate logistic regression. It was concluded from the paper that a high percentage of the patients with breast cancer who are already employed prefer returning to work after treatment. In such case, workplace accommodations play an important role in motivating the patients to get back to work. Moreover, there is a negative association between employer discrimination of cancer and return to work of survivors. Employers play a major role in the due course of success achieved by patients after they get back to work (4).

Therapies considered for breast cancer have a deep impact on the choices made by patients to return to their work life. Primary endocrine therapy (PET) is aa suitable alternative to surgery that is usually followed by endocrine therapy. Choice of treatment is sensitive to prefer patience of patients and decision support is very much needed in this regard. Older patients are considered as passive decision makers. A study used the Coping in Deliberation (CODE) framework for gaining insight into decision making as well as coping procedures in older women who have faced breast cancer and have taken up major decisions. The aim was also to inform the development of a decision support intervention (DSI). A semi-structured interview was conducted with 35 women whose age was between 75 and 98 years. Appraisals of treatment options were only partial, and the majority of the women wanted to have the treatment done quickly. It is to be noted that a number of factors play a role in the due course of receiving treatment. These included scope for choice, consequences and benefits of treatment, past experiences of treatment, instincts regarding the choice of treatment and recommendations given by health care professionals. It was concluded from the study that older women benefit extensively from DSIs that can support decision making and coping in any clinical setting (5).

The research gaps in the domain of decision making process by women who are breast cancer survivors with regards to work life can be hereby outlined. Researchers must highlight urgently the different factors, and each’s intensity that drives decision making and perception of women regarding getting back to work after breast cancer treatment. There is an immediate need for studies of good quality that can successfully evaluate the effectiveness, feasibility, benefits and costs of workplace interventions. The process of delivery of workplace interventions also requires particular attention (6). Continued research is warranted in the field of advanced support systems that facilitate proper decision making process for the women. Results of previous studies have considered both qualitative and quantitative research methodologies. Nevertheless, a number of qualitative research is required so that exploratory studies are lead to more in-depth information (7). Research can be challenging as there is a potential risk of missing out on significant information while extracting information from the patients. It is to be kept in mind that such challenges are to be avoided at all costs (8).

From the literature review, it can be concluded that there is a scarcity of adequate literature that discusses the decision making process of women after receiving breast cancer treatment in relation to getting back to work. Decisions pertaining to work participation are crucial for understanding how interventions can be delivered addressing the arising issues faced by women. The proposed study would highlight the factors influencing women with breast cancer to resume work participation and make treatment decisions. The study would be a narrative review exploring the perceptions and viewpoints of the concerned participants.

The literature search is to be conducted in electronic databases such as Medline, PubMed, CINAHL and Google Scholar. The articles searched would be have publishing date after the year 2013. A systematic literature search would be conducted in this regard and full text articles would be considered for the review. The search terms to be used for the literature search would be decision, women, breast cancer, work, diagnosis, treatment, worklife, participation, information, advice, support, perception.  

1. Banning M, Griffths E. The Lived Experience of Women Returning to Work after Breast Cancer. Occupational Medicine & Health Affairs. 2014 May 15:1-8.
2. Sun Y, Shigaki CL, Armer JM. Return to work among breast cancer survivors: A literature review. Supportive Care in Cancer. 2016 Nov 21:1-0.
3. Banning M. Employment and breast cancer: a meta? European journal of cancer care. 2011 Nov 1;20(6):708-19.
4. Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for breast cancer survivors. Journal of Clinical Oncology. 2006 Jan 20;24(3):345-53.
5. Lifford KJ, Witt J, Burton M, Collins K, Caldon L, Edwards A, Reed M, Wyld L, Brain K. Understanding older women’s decision making and coping in the context of breast cancer treatment. BMC medical informatics and decision making. 2015 Jun 10;15(1):45.
6. Olsson M, Nilsson M, Fugl-Meyer K, Petersson LM, Wennman-Larsen A, Kjeldgård L, Alexanderson K. Life satisfaction of women of working age shortly after breast cancer surgery. Quality of Life Research. 2017 Jan 9:1-2.
7. Drageset S, Lindstrøm TC, Underlid K. “I just have to move on”: Women's coping experiences and reflections following their first year after primary breast cancer surgery. European Journal of Oncology Nursing. 2016 Apr 30;21:205-11.
8. Nilsson MI, Saboonchi F, Alexanderson K, Olsson M, Wennman-Larsen A, Petersson LM. Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this. Journal of cancer survivorship. 2016 Jun 1;10(3):564-72.