long-term work retention after treatment for cancer: a systematic review and meta-analysis

Almost half of people diagnosed with cancer are working age. survivors have increased risk of unemployment, but little is known about long-term work retention. this systematic review and meta-analysis assessed work retention and associated factors in long-term cancer survivors. we searched medline/pubmed, embase, psychinfo, and cinahl for studies published 01/01/2000–08/01/2019 reporting work retention in adult cancer survivors ≥ 2 years post-diagnosis. survivors had to be in paid work at diagnosis. pooled prevalence of long-term work retention was estimated. factors associated with work retention from multivariate analysis were synthesized. twenty-nine articles, reporting 21 studies/datasets including 14,207 cancer survivors, were eligible. work retention was assessed 2–14 years post-diagnosis. fourteen studies were cross-sectional, five were prospective, and two contained both cross-sectional and prospective elements. no studies were scored as high quality. the pooled estimate of prevalence of long-term work retention in cancer survivors working at diagnosis was 0.73 (95%ci 0.69–0.77). the proportion working at 2–2.9 years was 0.72; at 3–3.9 years 0.80; at 4–4.9 years 0.75; at 5–5.9 years 0.74; and 6+ years 0.65. pooled estimates did not differ by cancer site, geographical area, or study design. seven studies assessed prognostic factors for work retention: older age, receiving chemotherapy, negative health outcomes, and lack of work adjustments were associated with not working. almost three-quarters of long-term cancer survivors working at diagnosis retain work. these findings are pertinent for guidelines on cancer survivorship care. professionals could focus support on survivors most likely to have poor long-term work outcomes.