RTW can be considered as a crucial determinant of the quality of life for cancer survivors, especially because it is associated with a feeling of self-esteem, return to normal activity and sense of identity11,14. Most previous studies regarding employment status of cancer survivors focused on prostate and breast cancer, which are common in Europe15,16. To date, our study was the first to investigate the relationship between work, treatment, and disease-related factors and RTW in workers who are diagnosed of gastric cancers. Furthermore, we found the effects of RTW on survival outcomes of these cancer survivors.
Numerous studies have examined the association between employment status and cancer survivors. Bradley et al. demonstrated that patients with prostate cancer were less likely return to work than those without cancer16. Most head and neck cancer survivors returned to work within 6 months after treatment17. Compared to cancer free controls of similar age, breast cancer survivors show reduced work ability and higher unemployment18. Patients with a history of malignant brain tumors, colorectal, testicular and other cancers are reported lower work productivity, impaired physical activity and distressed mental status19,20. However, relationship between employment and RTW after treatment in workers with gastric cancer is rarely discussed in previous studies and still unknown. In a cross-sectional study, Lee et al. demonstrated that patients with gastric cancers had difficulties at work because they experienced more fatigue and had lower work capacity than general population13. The prevalence of depression was high in gastric cancer survivors and was related to increased risk of psychiatric morbidity21,22. According to previous studies, fatigue, exhaustion, anxiety, and depression are the potential barriers for cancer survivors making decision of RTW23–25.
Sociodemographic factors, treatment related factors, and work-related factors are reported to influence work ability and RTW decision of cancer survivors12,26,27. Older people are more likely to have sick leave and unemployment that lead to decreased likelihood of RTW28,29. In this cohort study, we observed that higher income was associated with decreased likelihood of RTW, which was differed from previous studies30,31. Muijen et al. demonstrated that higher education and wage was associated with increased risk of work disability25. The result was consistent with our finding, however, the mechanism of high educated workers having less work participation should be investigated in future studies. In the present study, we observed that workers who underwent surgical treatment were more likely to return to work. In contrast, those who receive chemotherapy and radiotherapy are associated with reduced likelihood of RTW. The surgical intervention for tumor is the only possibility to cure a patient with early gastric cancer32. In addition, most early stage cancer patients have less symptoms and better quality of life after operation that can return to work earlier33. Chemotherapy and radiotherapy are reported to be risk factors for cancer survivors not having RTW23,34. Side effects of chemotherapy such as depression, fatigue, and cognitive deficits contribute to the incapacity to work35.
In this study, we represented that RTW might increase the survival rate of gastric cancer survivors compared those unemployed. Lee et al. displayed that Eastern Cooperation Oncology Group (ECOG) performance status was positively associated with work disability in gastric cancer survivors13. Performance status, which is a quantification of cancer patients' general well-being and activities of daily life, has been used to evaluate survival outcome in many cancer types36. Several studied have reported that increased physical activity is significantly associated with reduced mortality37,38. Taken together, reemployed cancer survivors might have better survival rate than those without RTW because they had higher physical activity and lower fatigue that could maintain their quality of life.
There are several limitations in the study. First, we couldn’t distinguish from the types of gastric cancer surgery which patients had in the present study. A previous study indicated that total gastrectomy was associated with increased risk of nonworking among gastric cancer survivors13. The prognosis may differ from different surgical procedures that influence patients’ willingness of RTW. Second, educational level is considered as an important factor in employment39. However, the information of education was unavailable from the databases. Last, we couldn’t collect the information about the motivation of RTW and job satisfaction in the study.