Employment experiences after cancer: A systematic review and meta-synthesis of the evidence

Background: Cancer survivors experience a range of disadvantages and difficulties in the workplace related to psychological, physical, financial and work environment issues or career prospects, yet for many being able to work is crucial to maintaining or resuming a normal life.

Aims: To systematically review and synthesise findings from qualitative studies exploring attitudes, experiences, problems and strategies in relation to employment, retention and/or return to work.

Methods: Seven electronic databases were searched for qualitative studies on cancer and employment. Key authors and major cancer charities were contacted. Full texts of papers meeting inclusion criteria were appraised for quality. Themes and definitions were analysed using the meta-synthesis process advocated by Noblit and Hare (1988), facilitated by NVIVO 8 software. .

Results: Twenty-five of the 13,233 screened papers were eligible for inclusion. Cancer was associated with financial burden, income loss, social dislocation, diminished self-esteem and negative implications for individuals' self concept. Positive work experiences depended on good organisational and/or interpersonal support. Survivors were frequently perceived negatively by employers/ colleagues, and struggled to balance work and treatment demands. Open communication, acceptance of changed capabilities; good self-management skills were seen as helpful strategies. Synthesised findings have produced a new conceptual model representing the impact of cancer on identity embedded in a socio-environmental context.

Conclusions The conceptual model derived from the existing literature may guide future studies on employment experiences after cancer.