Author: Huiting Zhang, MSN., RN; Case Manager, Head Nurse, Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
Breast cancer patients having undergone curative treatment, including surgery, chemotherapy and radiation therapy, often face problems upon returning to work .after completion of such treatments. For example, the function of the affected limbs may not have fully recovered after surgery, while nausea and vomiting caused by chemotherapy may affect the patients’ adaptability to work. In addition, hair loss as a result of chemotherapy may lead to a tendency of the patients to avoid facing their colleagues. These patients would also face a repertoire of psychological issues as a result of the treatment, which may potentially have negative effect on their attitudes towards returning to work. A better understanding on the factors that would hamper and facilitate the patients to return to work after cancer treatment is needed, in order to address the psychological issues that contribute to the patients’ reluctance to return to work. Therefore, we conducted a qualitative study that explores the psychological changes and influencing factors of breast cancer patients having completed their curative treatment and were returning to work during the rehabilitation period. Study findings may provide a basis for constructing individualized interventions that facilitate patients to return to work.
We used a phenomenological approach to conduct this study. Ten breast cancer patients who were either receiving endocrine therapy or having completed all curative treatments, who have returned to work or were planning to return to work, were recruited. Semi-structured interviews were conducted with the patients to explore their views upon returning to work, and the factors that may encourage or hamper them from doing so.
Two themes were generated from the interview data. The first theme pertains to the journey of the breast cancer patients in promoting their mental health when they returned to work. The journey has three phases. First, ‘Avoid and surround themselves’, where the patients showed a low willingness to return to work when they were still at the early stage of treatment. Second, ‘Forget the past, set sail again, when they would try to let go of their pain and illness, accept the reality and resume their work, after a period of recovery at post-treatment. Finally, ‘grasp today and harvest the future’, where the patients who had returned to work, after a period of adjustment, could work as normal, believing that their illness had brought unexpected benefits, while feeling satisfied with their job, and being hopeful and optimistic for their future. The second theme involves the factors affecting breast cancer patients' return to their work after completing their treatment. Economic pressure, work ability and experience, the correct mentality in the face of the illness, the pursuit of social values, and social support were identified to be the stimulating factors for patients to return to work, while work pressure was found to be a hindering factor.
Indeed, the process for patients to return to work is dynamic, where the patients’ feelings would change over the course of rehabilitation from their illness. They will have different attitudes towards returning to work at different times. Returning to work can help to forget the pain of their illness, improve their self-value, and return to a normal life. In the future, medical staff should carry out relevant interventions that address the influencing factors of patients returning to work. For example, rehabilitation volunteer groups may be set up, where the patients can receive social support from the medical staff, enabling the patients to maintain positivity and optimism during their rehabilitation.