The Readiness For Return-to-Work And Its Influencing Factors In Breast Cancer:A Longitudinal Study

Objective:(1)To understand the level of readiness to return to work and its changing trends of breast cancer patients at different stages;(2)To analyze the dynamic relationship between the readiness to return to work and the stigma,symptom burden,self-efficacy,and coping styles of breast cancer patients at different stages;(3)To explore the factors influencing the readiness to return to work of breast cancer patients at different stages.Methods:Patients with breast cancer from the breast diagnosis and treatment center of a tertiary grade-A hospital in Ganzhou City,Jiangxi Province from December 2021 to January 2023 were selected as the study subjects and followed up at four stages:before the first chemotherapy(T1),in the middle of chemotherapy(T2),at the end of chemotherapy(T3),and 3 months after chemotherapy(T4).General data questionnaire,Consumer Experience of Stigma Questionnaire(CESQ),Memory Symptom Assessment Scale(MSAS),General Self-Efficacy Scale(GSES),Medical Coping Modes Questionaire(MCMQ)and Readiness for Return-to-work Scale(RRTW)were used for paper questionnaires.SPSS 26.0 software was used for statistical analysis of the data,and the main statistical methods used were:descriptive analysis,Mann-Whitney U test,Kruskal-Wallis H test,Univariate repeated measure analysis of variance,Spearman correlation analysis,and ordered logistic regression analysis.Results:1.Questionnaire collection:129 breast cancer patients were initially included,116 breast cancer patients finally completed the survey,13 were lost,the effective recall rate was 89.9%,and the number of lost patients showed no statistical difference with the number of all follow-ups in terms of general information(P>0.05);2.Distribution and changes of the number of patients with breast cancer’s readiness to return to work at different stages:The readiness to return to work of breast cancer patients at different stages was at a lower stage overall.Most patients in T1-T4 stage were in the intention stage.Patients in the action readiness and behavior stage appeared in T2 period,patients in the pre-intention stage in T3 and T4 period decreased compared with T2 period,and patients in the action-readiness and self-assessment stage in T3 and T4 period increased compared with T2 period.3.Correlation between readiness to return to work and stigma,symptom burden,self-efficacy and coping styles in breast cancer patients:(1)Stigma was negatively correlated with readiness to return to work in T1-T4periods(r=-0.519～-0.659,P<0.05);(2)Symptom burden(physical symptoms)was negatively associated with readiness to return to work during T1 and T3-T4 periods(r=-0.321～-0.367,P<0.05),symptom burden(psychological symptoms)was negatively associated with readiness to return to work during T2-T3periods(r=-0.348～-0.394,P<0.05),and symptom burden(total distress index)were negatively associated with readiness to return to work during T1-T3periods(r=-0.295～-0.357,P<0.05);(3)Self-efficacy was positively correlated with readiness to return to work in T1-T4 periods(r=0.467～0.704,P<0.01);(4)Coping style(confrontation coping)was positively related to readiness to return to work in T1-T4 periods(r=0.385～0.605,P<0.05),coping style(yielding coping)was negatively related to readiness to return to work in T3period(r=-0.308,P<0.05),coping style(avoidance coping)was negatively related to readiness to return to work in T1-T3 periods(r=-0.266～-0.357,P<0.05).4.Ordered logistic regression analysis of factors influencing readiness to return to work at different stages in breast cancer patients:(1)During T1 period,confrontation coping(OR=1.297,P<0.001)was a protective factor for readiness to return to work;stigma(OR=0.820,P<0.001),avoidance coping(OR=0.879,P=0.048),having one or fewer children(OR=0.218,P=0.035),having two children(OR=0.175,P=0.007)were risk factors for readiness to return to work;(2)During T2 period,self-efficacy(OR=1.366,P<0.001),confrontation coping(OR=1.270,P=0.001),and the number of chemotherapy sessions was4(OR=6.812,P=0.003)were protective factors for readiness to return to work;stigma(OR=0.816,P<0.001),avoidance coping(OR=0.783,P=0.004),poverty relief(OR=0.033,P=0.041)were risk factors for readiness to return to work;(3)During T3 period,self-efficacy(OR=1.160,P=0.011),confrontation coping(OR=1.403,P<0.001),and the number of chemotherapy sessions was4(OR=6.724,P=0.003)were protective factors for readiness to return to work;stigma(OR=0.744,P<0.001)as a risk factor for readiness to return to work;(4)During T4 period,self-efficacy(OR=1.891,P<0.001),confrontation coping(OR=1.488,P=0.001),and the number of chemotherapy sessions was4(OR=7.157,P=0.010)were protective factors for readiness to return to work;stigma(OR=0.755,P<0.001),occupation as a farmer before the disease(OR=0.051,P=0.012)were risk factors for readiness to return to work.Conclusion:1.The overall readiness to return to work in breast cancer patients was at a lower stage.In different treatment stages,the number of patients in the intention stage accounted for the majority;With the progress of the disease,the level of readiness to return to work of breast cancer patients gradually increased.2.Different factors affect the readiness to return to work of breast cancer patients at different stages:(1)Socio-demographic factors:number of children as risk factors for readiness to return to work in T1 period;form of health care costs as risk factors for readiness to return to work in T2 period;occupation prior to illness as risk factor for readiness to return to work in T4 period;(2)Disease-related factors:number of chemotherapy sessions as protective factor for readiness to return to work in T2-T4 periods;stigma as a risk factor for readiness to return to work in T1-T4 periods;self-efficacy as a protective factor for readiness to return to work in T2-T4 periods;in coping styles,avoidance coping as a risk factor for readiness to return to work in T1-T2 periods,confrontation coping as a protective factor for readiness to return to work in T1-T4 periods.