Work-related predictors of not returning to work after inpatient rehabilitation in cancer patients

Figures & data

Figure 1. Patient flowchart of the study.

Table I. Characteristics of the responders at the beginning of rehabilitation (t1, N = 333).

	n	Whole sample (N = 333)	n	Return to work one year after the end of rehabilitation (N = 264)	n	No return to work one year after the end of rehabilitation (N = 69)	p
Age (M, SD)	333	49.4 (7.3)	264	49.4 (7.1)	69	49.5 (8.3)	0.894^1
Gender	333	%	264	%	69	%
Female		75.7		76.1		73.9	0.702^2
Education	327^6	%	258^6	%	69	%
Up to 9 years		20.2		19.0		24.6	0.051^2
10 years		52.3		50.4		59.4
12–13 years		27.5		30.6		15.9
Occupational status	322^6	%	254^6	%	68^6	%
Employed		91.6		95.7		76.5	< 0.001^3
Unemployed		6.5		3.1		19.1
Other		1.9		1.2		4.4
Type of occupation	326^6	%	257^6	%	69	%
Blue-collar job		19.6		15.6		34.8	0.004^3
White-collar job		71.5		75.9		55.1
Self-employed		5.2		5.1		5.8
Public servant		3.7		3.5		4.3
Household income per month	317^6	%	251^6	%	66^6	%
Up to 1000€/up to 1287$^4		7.2		6.4		10.6	0.012^2
1000–2000€/1287–2575$^4		32.2		28.3		47.0
2000–3000€/2575–3862$^4		36.0		39.0		24.2
3000–4000€/3862–5150$^4		14.2		14.3		13.6
More than 4000€/more than 5150$^4		10.4		12.0		4.5
Cancer site	333	%	264	%	69	%
Breast		43.8		46.6		33.3	0.043^2
Digestive organs		19.5		18.9		21.7
Lymphoid, haematopoietic and related tissue		9.6		8.3		14.5
Female genital organs		8.7		8.0		11.6
Endocrine glands and related structures		3.3		3.4		2.9
Respiratory system and intrathoracic organs		2.7		1.5		7.2
Other		12.3		13.3		8.7
Tumour stage (UICC)	333	%	264	%	69	%
Stage 0		3.3		2.3		7.2	0.031^2
Stage 1		31.2		34.5		18.8
Stage 2		24.0		23.9		24.6
Stage 3		12.3		12.1		13.0
Stage 4		6.0		4.5		11.6
Other^5		8.7		8.0		11.6
Treatment	333	%	264	%	69	%
Surgery		91.0		92.8		84.1	0.024^2
Chemotherapy		56.2		54.2		63.8	0.152^2
Radiation		55.0		54.5		56.5	0.769^2
Hormone therapy		34.8		36.7		27.5	0.153^2
Months since diagnosis (M, SD)	332^6	10.2 (11.0)	263^6	10.5 (11.7)	69	9.1 (7.4)	0.210^1

¹t-test, two-tailed; ²χ²-test; ³Fisher´s exact test; ⁴Conversion rate 26/03/2013; ⁵As tumours of lymphoid, haematopoietic and related tissue are not classified via UICC, they are summarised as ‘other’; ⁶Different sample sizes due to missing values within some variables.

Table II. Mental health and occupation-related variables at the beginning of rehabilitation in cancer patients who did return and who did not return to work one year later (t1, N = 333).

	Return to work one year after the end of rehabilitation (N = 264) M (SD)	No return to work one year after the end of rehabilitation (N = 69) M (SD)	p^1	d
Anxiety and Depression – HADS
Anxiety	6.8 (3.7)	8.1 (4.2)	0.011	−0.33
Depression	4.7 (3.5)	6.4 (4.1)	0.001	−0.45
Occupation-related variables
Effort-reward imbalance – ERI	M (SD)	M (SD)	p^1	d
Effort^2	14.9 (5.1)	16.7 (5.5)	0.012	−0.34
Reward	48.1 (6.6)	44.3 (8.6)	0.002	0.50
	n (%)	n (%)	p^3	d
Effort-reward imbalance (cut-off ≥ 1)	16 (6.8)	14 (22.6)	< 0.001	–
Need for rehabilitation – SIBAR	n (%)	n (%)	p^3	d
Risk of early retirement	24 (10.4)	32 (53.3)	< 0.001	–
Occupational stress	32 (12.4)	26 (38.2)	< 0.001	–
Subjective need of occupational rehabilitation	66 (25.8)	18 (27.3)	0.806	–
Occupational rehabilitation recommended	12 (5.3)	21 (36.8)	< 0.001	–
Duration of sick leave (last 12 months)	n (%)	n (%)	p^3	d
No sick leave	33 (12.8)	8 (11.9)
0–5 weeks	49 (19.0)	4 (6.0)	0.022	–
6–25 weeks	88 (34.1)	21 (31.3)
26–62 weeks	88 (34.1)	34 (50.7)
Subjective work ability at the last job at the beginning of rehabilitation	n (%)	n (%)	p^3	d
Fully able to work (6 hours or more)	145 (56.2)	12 (17.4)
Limited able to work (less than 6 hours)	108 (41.9)	43 (62.3)	< 0.001	–
Not able to work	5 (1.9)	14 (20.3)
Participation within the occupational rehabilitation programme	n (%)	n (%)	p^3	d
Occupation-related intervention	153 (58.0)	29 (42.0)	0.018	–

¹t-test, two-tailed; ²Analyses based on the six-item version of the ERI; ³χ²-test.

Table III. Multivariate analyses of the predictors of not returning to work one year after the end of rehabilitation with (N = 477) and without imputed data (N = 241¹).

	Not returning to work one year after rehabilitation
	odds ratio (N = 477) (95% confidence interval)	p^2	odds ratio (N = 241^1) (95% confidence interval)	p^2
Patients’ characteristics
Education
Up to 10 years	1.511 (0.631–3.623)	0.354	1.444 (0.430–4.847)	0.552
Occupational status
Employed	Ref		Ref
Unemployed/other	6.633 (2.953–14.900)	< 0.001	5.521 (1.108–27.510)	0.037
Type of occupation
White-collar job/self-employed/public servant	Ref		Ref
Blue-collar job	2.292 (1.144–4.592)	0.019	1.697 (0.568–5.067)	0.343
Household income per month
Up to 2000€/2575$^3	Ref		Ref
Between 2000€/2575$ and 4000€/5150$^3	0.641 (0.336–1.224)	0.178	0.803 (0.307–2.100)	0.655
More than 4000€/5150$^3	0.643 (0.156–2.656)	0.541	1.040 (0.196–5.517)	0.963
Cancer site
Breast cancer	Ref		Ref
Cancer of the digestive organs	1.654 (0.674–4.058)	0.272	1.366 (0.343–5.442)	0.658
Other	1.702 (0.777–3.731)	0.184	2.721 (0.923–8.022)	0.070
Tumour stage
Stage 0–2	Ref		Ref
Stage 3–4	2.404 (1.151–5.020)	0.020	1.374 (0.463–4.078)	0.567
Other	0.702 (0.299–1.650)	0.417	0.622 (0.169–2.291)	0.475
Surgery	0.759 (0.277–2.084)	0.593	0.748 (0.158–3.543)	0.714
Mental health
Depression (HADS)	1.068 (0.984–1.158)	0.114	1.062 (0.939–1.201)	0.338
Occupation-related variables
Effort-reward imbalance (cut-off ≥ 1) (ERI)	2.246 (0.619–8.159)	0.219	2.405 (0.651–8.890)	0.188
Risk of early retirement (SIBAR)	3.462 (1.735–6.908)	< 0.001	3.773 (1.343–10.601)	0.012
Occupational stress (SIBAR)	2.066 (0.954–4.471)	0.066	1.835 (0.624–5.397)	0.270
Duration of sick leave
0–5 weeks	Ref		Ref
6–25 weeks	1.313 (0.551–3.126)	0.539	1.837 (0.561–6.014)	0.315
More than 25 weeks	2.091 (0.881–4.962)	0.094	1.096 (0.314–3.826)	0.885
Subjective work ability at the last job
Able to work (6 hours or more)	Ref		Ref
Limited ability to work (less than 6 hours)	3.498 (1.686–7.257)	0.001	4.129 (1.004–33.478)	0.009
Not able to work	13.174 (3.804–45.618)	< 0.001	5.799 (1.004–33.478)	0.049
Participation within the occupational rehabilitation programme
Occupation-related intervention	0.816 (0.428–1.556)	0.537	0.893 (0.341–2.342)	0.818

N = 477: Multicollinearity tolerance values between 0.718 and 0.909; Nagelkerkes R² 51%; N = 241: Multicollinearity tolerance values between 0.629 and 0.908; Nagelkerkes R² 47%.

¹Due to missing values within the predictor variables, of 333 patients, a total of 241 patients could be included in the analysis; ²Wald Test; ³Conversion rate 26/03/2013.