多專業策略協助癌症存活者返回職場


  【24drs.com】癌症存活者人數快速增加,且許多人認為返回職場協助他們改善生活品質。然而,許多存活者也必須對抗癌症以及/或是其治療所帶來的醫療與精神效應,因為這可能影響他們返回職場的工作能力。
  
  這項新的綜合分析結果指出,相較於傳統照護,多專業策略介入可以讓更多人回到工作崗位。接受多專業介入的癌症存活者,包括接受物理、精神與職業訓練,克服挑戰成功率與回到職場的可能性是傳統照護的2倍。
  
  這些研究結果由荷蘭阿姆斯特丹學術醫學中心克羅尼爾職業健康機構的Angela de Boer博士與同事們線上發表於考科藍系統性綜論資料庫的一項綜合分析。
  
  【問題嚴重度】
  de Boer與同事們指出,工作年齡成人診斷出罹癌的情況越來越常見,且倖存者中將近半數不到65歲;其中大部分患者將會有物理、情緒與社交問題,例如疲倦、疼痛、認知功能缺損、焦慮與憂鬱,這些都會變成慢性問題。
  
  作者們表示,比起一般大眾,癌症存活者沒有工作的比例高出1.4倍;那些長期的物理與精神效應會讓社交功能受損,接著也會影響找工作或維持一項工作的能力;此外,這些問題讓他們處於無法工作以及提早退休的風險。
  
  【沒有針對工作的職業訓練介入】
  作者們表示,提供癌症存活者讓他們返回工作崗位的協助是很重要的,目前這項分析是為了評估增加他們再次就業介入的效益。
  
  這項分析共收納了14項隨機分派研究以及4項介入前後研究,有1,652位受試者,所有研究都是在高收入國家進行,其中7項在美國;另外,有8項研究介入是針對乳癌患者。
  
  研究中的介入方式可分為四類:精神、物理、醫學與多專業(結合精神、就業訓練、物理、以及/或是醫學介入)。
  
  其中3項研究使用多專業策略,包括物理訓練結合病患衛教或是諮詢。在這組中,2項研究納入職業諮詢訓練,目的在鼓勵患者們回到職場,或訓練工作相關技能。第3項研究則包括行為生物回饋。
  
  作者們發現,這些多專業介入並未包括醫療;更令人驚訝的是,沒有研究針對讓他們返回職場或就業相關職業訓練介入進行研究。
  
  他們發現這是令人注目的,因為我們預期會有針對返回職場的介入,包括與工作相關的部分,例如工作調適或主管相關事項。
  
  作者們進一步指出,過去在較年輕的癌症存活者身上進行的研究發現,職業復健介入,包括工作訓練、協助尋找工作、以及安置服務,都與得到工作勝算較高有關。
  
  不過,這些研究發現並未讓Steven D. Passik博士感到驚訝;他是紐約市斯隆凱德琳癌症中心一位臨床精神學家,他在由健康行為新聞機構發出的新聞稿中表示,疲倦、疼痛與相關問題都是多面向的,需要一種整合式的策略。
  
  Passik博士解釋,返回職場計畫是難能可貴的,且即使研究結論是醫院可能是多專業介入「最理所當然的機構」,因為這些專業人員都在同一個屋簷下,但是這樣的計畫在美國並不常見。
  
  Passik博士猜想只有在規模較大的中心,有許多正規的服務,才會有這樣的計畫,他表示,這樣的策略要在社區推廣會是個挑戰。
  
  【對於生活品質沒有影響】
  作者們發現,精神介入相較於常規照護,回到職場的比例相似(勝算比[OR]為2.32),且證據等級不高。非常低品質的證據顯示,物理訓練在提高返回職場機率上並沒有比常規照護高(OR為1.20)。
  
  針對醫療介入的研究結果顯示,「功能保留法」與更激進的治療,兩者返回職場的機率相當(OR為1.53;95%信賴區間為0.95-2.45)。
  
  然而,中等品質的證據顯示,多專業介入比常規照護有更高的返回職場機率(OR為1.87)。作者們表示,多專業介入或常規照護對於生活品質預後並沒有顯著影響。
  
  這項研究由荷蘭大學研究計畫SIG返回職場途徑、芬蘭工作環境基金會提供外在資助。作者們表示沒有相關資金上的往來。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6465&x_classno=0&x_chkdelpoint=Y
  

Multidisciplinary Strategies Help Cancer Survivors Return to Work

By Roxanne Nelson
Medscape Medical News

February 23, 2011 — The number of cancer patients who survive their disease is rapidly growing, and many find that returning to their jobs helps improve their quality of life. However, many survivors must also contend with the long-term medical and psychological effects of cancer and/or its treatment, which can affect their ability to work.

The results of a new meta-analysis suggest that multidisciplinary interventions can lead to higher return-to-work rates than usual care. Cancer survivors who received multidisciplinary interventions, which included physical, psychological, and vocational components, were nearly twice as likely to overcome challenges and successfully return to work as those who received usual care.

The findings, reported by Angela de Boer, PhD, from the Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, the Netherlands, and colleagues come from a meta-analysis published online February 16 in the Cochrane Database of Systematic Reviews.

Scale of the Problem

Dr. de Boer and colleagues point out that cancer diagnoses in working-age adults are becoming increasingly common, and almost half of all survivors are younger than 65 years. However, a significant proportion will experience physical, emotional, and social problems, such as fatigue, pain, cognitive deficits, anxiety, and depression, all of which can become chronic.

Cancer survivors are 1.4 times more likely to be unemployed than the public at large, the authors note. These long-term physical and psychological effects can impair social functioning, which in turn can affect the ability to find or keep a job. In addition, these issues place them at risk for work absenteeism and early retirement.

No Vocational Interventions Addressing Work

Therefore, the authors say, it is important that cancer survivors are provided with assistance that supports a return to work. The current analysis was conducted to evaluate the effectiveness of interventions geared toward enhancing a return to work.

Included in the analysis were 14 randomized controlled trials and 4 controlled before/after studies, for a total of 1652 participants. All of the studies were conducted in high-income countries, with 7 describing research from the United States. In addition, the interventions in 8 studies were geared toward breast cancer patients.

The studies selected for the analysis included 4 categories of interventions: psychological, physical, medical, and multidisciplinary (a combination of psychological, vocational, physical, and/or medical interventions).

Three of the studies used a multidisciplinary approach that involved physical training combined with patient education or counseling. Of this group, 2 incorporated vocational counseling training that was aimed at encouraging patients to return to work and to develop work-related coping skills. The third study included behavioral biofeedback.

The authors found that none of the multidisciplinary interventions included a medical component; more surprising was the fact that none of the studies focused on vocational interventions that addressed return to work or employment-related issues.

They found this "remarkable" because "one would expect interventions aimed at return to work to consist of work-related components, such as work adjustments or involvement of the supervisor."

The authors further point out that previous research conducted in young cancer survivors showed that vocational rehabilitation interventions, including job training, assistance in searching for a job, and placement services, were all associated with increased odds of obtaining work.

Few and Far Between

The findings did not surprise Steven D. Passik, PhD, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York City.

"Fatigue, pain, and similar problems are all multifaceted, and a comprehensive approach is called for," he said in a release that was issued by the Health Behavior News Service.

Dr. Passik explained that return-to-work programs "are few and far between." And even though the study authors concluded that a hospital may be the most "apparent setting" for multidisciplinary interventions because all the providers are located under one roof, he noted that these types of programs are not commonly available in the United States.

"I would bet that it's only the big centers that have anything formal," Dr. Passik said, and added that it could be a challenge to expand this type of strategy to facilities out in the community.

No Effect On Quality of Life

The authors found low-quality evidence of similar return-to-work rates for psychological interventions, compared with care as usual (odds ratio [OR], 2.32). There was also very low evidence that suggested physical training was not more effective than usual care in terms of improving return-to-work rates (OR, 1.20).

The studies focused on medical interventions demonstrated low-quality evidence that "functioning conserving approaches" had return-to-work rates similar to more radical treatments (OR, 1.53; 95% confidence interval, 0.95 to 2.45).

However, there was moderate-quality evidence that showed that multidisciplinary interventions led to higher return-to-work rates than care as usual (OR, 1.87). The authors also note that there were no differences between the effect of multidisciplinary interventions or usual care on quality-of-life outcomes.

External funding for the study was provided by SIG Pathways to Work, University Research Programme, the Netherlands; and the Finnish Work Environment Fund. The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. 2011;2:CD007569.

    
相關報導
長期癌症存活者比較可能有嚴重的心理壓力
2008/10/3 下午 02:28:00

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