A Multidisciplinary Team Intervention Model to Facilitate Return to Work for Breast Cancer Survivors: Development, Implementation, and Evaluation
Journal: Advanced Journal of Nursing DOI: 10.32629/ajn.v7i1.5039
Abstract
Objective: To explore the support needs of breast cancer survivors during return to work (RTW) and develop, implement, and evaluate a multidisciplinary team (MDT) intervention model tailored to these needs. Methods: This study adopted a mixed-methods design, consisting of three phases. Phase 1 employed a phenomenological approach to identify support needs through in-depth interviews with 22 breast cancer survivors. Phase 2 developed the MDT intervention model based on identified needs, literature review, and expert consultation. Phase 3 was a randomized controlled trial (RCT) involving 108 participants randomized into an intervention group (n=54) receiving the MDT intervention and a control group (n=54) receiving usual care. Outcome measures included quality of life (EORTC QLQ-C30 and BR23), fatigue (BFI), RTW readiness (RTWRS), and duration of sick leave. Results: Phase 1 identified four core support needs: professional medical support, physical rehabilitation, psychological counseling, and workplace adaptation assistance. The MDT intervention model integrated contributions from oncologists, nurses, rehabilitation therapists, psychologists, and vocational counselors through 10 months of structured interventions. Compared with the control group, the intervention group showed significantly higher scores in overall quality of life (P<0.001), physical function (P<0.001), emotional function (P<0.001), and RTW readiness (P<0.001), along with significantly lower fatigue scores (P<0.001) and shorter duration of sick leave (mean difference: 45.2 days, P<0.001) at 12-month follow-up. Conclusion: The MDT intervention model addressing the specific support needs of breast cancer survivors effectively improves their quality of life, reduces fatigue, enhances RTW readiness, and shortens the time to RTW. This model provides a feasible and effective approach for facilitating successful RTW and holistic rehabilitation of breast cancer survivors.
Keywords
breast cancer survivors; return to work; multidisciplinary team; intervention model; support needs
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[3] Stergiou-Kita M, Grigorovich A, Tseung V, et al. Qualitative meta-synthesis of survivors' work experiences and the development of strategies to facilitate return to work[J]. Journal of Cancer Survivorship, 2014, 8(4): 657-670.
[4] Wang ML, Liu JE, Wang HY, et al. Posttraumatic growth and associated socio-demographic and clinical factors in Chinese breast cancer survivors[J]. European Journal of Oncology Nursing, 2014, 18(5): 478-483.
[5] Yuan YX, Yuan ZP, Shi H, et al. Investigation of general rehabilitation condition in breast cancer patients[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2005, 12(5): 473-476.
[6] de Boer AG, Taskila TK, Tamminga SJ, et al. Interventions to enhance return-to-work for cancer patients[J]. Cochrane Database of Systematic Reviews, 2015, (9): CD007569.
[7] Nieuwenhuijsen K, Bosmans B, Uitterhoeve LL, et al. Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: a pilot study[J]. Journal of Occupational Rehabilitation, 2006, 16(4): 647-657.
[8] Gill H, Gray NM, Ayansina D, et al. Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial[J]. Trials, 2013, 14(1): 175.
[9] Leensen M, Groeneveld IF, van Heide I, et al. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands[J]. BMJ Open, 2017, 7(6): e014746.
[10] Giorgi A. The descriptive phenomenological method in psychology[J]. J Phenomenol Psychol, 1997, 28(2): 235-260.
[11] Lincoln YS, Guba EG. Naturalistic Inquiry[M]. Newbury Park: Sage Publications, 1985.
[12] Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology[J]. Journal of the National Cancer Institute, 1993, 85(5): 365-376.
[13] Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients[J]. Cancer, 1999, 85(5): 1186-1196.
[14] Block FW, Satariano WA, Aziz N, et al. Development of a return-to-work readiness survey for cancer survivors[J]. Journal of Occupational and Environmental Medicine, 2001, 43(10): 873-881.
[15] Luo SX, Liu JE, Cheng A, et al. Breast Cancer Survivors Report Similar Concerns Related to Return to Work in Developed and Developing Nations[J]. Journal of Occupational Rehabilitation, 2019, 29(1): 42-51.
[16] Isaksson J, Wilms T, Laurell G, et al. Meaning of work and the process of returning after head and neck cancer[J]. Supportive Care in Cancer, 2016, 24(1): 205-213.
[17] Petruseviciene D, Surmaitiene D, Baltaduoniene D, et al. Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer[J]. Occupational Therapy International, 2018, 2018: 6798697.
[18] Olsson M, Nilsson M, Fugl-Meyer K, et al. Life satisfaction of women of working age shortly after breast cancer surgery[J]. Quality of Life Research, 2017, 26(3): 673-684.
[19] Wang X, Zhang L, Zhang Y, et al. Prevalence and correlates of cancer-related fatigue among Chinese breast cancer survivors: a cross-sectional study[J]. Supportive Care in Cancer, 2020, 28(1): 249-257.
[20] Duijts SF, Kieffer JM, van Muijen P, et al. Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis[J]. Acta Oncologica, 2017, 56(2): 174-182.
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