The impact of colorectal cancer, self-efficacy and social support on work ability and employment status: a longitudinal study

Each year approximately 90,000 new cases of cancer are diagnosed in people of working age in the United Kingdom (UK) (Morrell & Pryce, 2005). The potential impact of cancer and its treatment on working life is substantial, with approximately 40% of all cancer patients taking time off work during treatment and recovery (Short, Vasey & Tunceli, 2005). However, little information is available on employment outcomes for those managing colorectal cancer. Colorectal cancer is a commonly diagnosed cancer with approximately 36,000 people diagnosed each year in the UK. Although research demonstrates promising return to work outcomes for this group, not enough is known about the factors (variables) impacting their return to work intentions, work ability and employment outcomes. The aims of this research were to: examine the return to work intentions, work ability and employment outcomes of colorectal cancer patients over six months; explore the role of self-efficacy and psychosocial well-being, and explore the role of health professionals in providing work-related support and information to patients. Findings from these studies may help to better inform future interventions to support this cancer group. Fifty participants newly diagnosed with colorectal cancer were recruited from three Acute NHS Trusts (n = 27) across the Midlands and a support group (n = 23) affiliated to a National Cancer Charity. Participants completed questionnaires at three time points: baseline (post surgery or pre-treatment); follow-up time 1 (3 months), and follow-up time 2 (6 months). As well as illness and demographic characteristics, the questionnaires measured job self-efficacy, work ability, cancer self-efficacy, quality of life, fatigue and depression. A sub-sample of participants (n = 10) completed a monthly diary over six months. This captured temporal fluctuations and patterns in cancer management, return to work intentions and work ability and the factors impacting upon these (self-efficacy and social support). Finally, 18 health professionals participated in semi-structured interviews that explored the nature and type of work-related advice currently provided to colorectal cancer patients. Data were analysed using both quantitative (ANOVAs and regression) and qualitative techniques (thematic analysis). The questionnaire study identified varying levels in self-assessed work ability and psychosocial well-being. Most importantly, positive changes in perceptions of cancer self-efficacy F (1.02, 61.12) = 14.70, p = 0.0005, and job self-efficacy F (2, 94) = 10.85, p = 0.0005 were detected over time; however, interactions between treatment type and time did not emerge (p > 0.05). Factors related to perceived work ability outcomes cross-sectionally included type of occupation (β = 0.31, t = 2.65, p = 0.0005) and quality of life (β = 0.42, t = 2.57, p = 0.01) at baseline, treatment type (β = -0.19, t = -1.94, p = 0.05) at follow-up time 1 and job self-efficacy at follow-up time 1 (β = 0.57, t = 4.40, p = 0.0005) and time 2 (β = 0.50, t = 2.92, p = 0.006). In contrast, factors related to employment status (i.e. working, not working) were job self-efficacy (OR = 2.20, 95% CI: 1.17 4.13) at baseline and occupation (OR = 0.03, 95% CI: 0.00 0.86), and perceived work ability (OR = 3.05, 95% CI: 1.00 12.80) at follow-up time 2. Along with self-assessed work ability at baseline (β = 0.67, t = 3.99, p = 0.0005), receiving chemotherapy alone or a combination of treatments (i.e. other than surgery alone) (β = -0.24, t = -1.99, p = 0.05) were the strongest predictors of follow-up work ability (independent of age and occupation). Finally, treatment type (OR = 9.91, 95% CI: 1.57 62.50) was also identified as the strongest predictor of employment status approximately six months after diagnosis. Findings from the diary study suggest that self-efficacy beliefs were important in understanding employment outcomes and return to work intentions. The role of such beliefs was multi-faceted and results infer that several factors seemed to impact return to work intentions and self-efficacy temporally. Treatment, symptoms and decrements in perceived work ability were identified as the most prominent factors that served as barriers preventing resumption of work. Moreover, there was a degree of disparity between return to work intent and work ability. Additionally, the diary study identified variation in work-related advice and guidance provided to colorectal patients. Subsequently, some participants may have been under the impression that they were unable to work, especially during treatment. Results from the interview study found that health professionals attempted to provide guidance to working-aged patients. However, the nature of such guidance varied due to experience, knowledge and time constraints. Furthermore, participants highlighted a lack of knowledge and an insufficient evidence base were barriers to providing more appropriate guidance. The majority of participants stated that this was an aspect of patient care that falls short and to address the issue a concerted multi-disciplinary effort was required. In short, the findings indicate that the factors related to work ability, return to work intentions and employment outcomes of colorectal cancer patients varied over time, whereby certain variables took precedence over others at particular time points. Furthermore, the results suggest that self-efficacy beliefs are important; however, it is crucial to point out that self-efficacy is unlikely to operate as a stand-alone factor. Indeed, it is argued that it may be a construct that is considered in future research endeavours alongside pre-existing findings, which would inevitably help towards gaining a more comprehensive account of the factors related to the work outcomes of individuals affected by cancer.