Accumulating evidence suggests that most employed breast cancer survivors are able to return to work but often experience difficulties in the process. The objective of this study was to identify: (i) factors experienced as barriers to and facilitators of the return-to-work (RTW) process, (ii) which factors were important during initial and post RTW, and (iii) possible solutions to RTW problems. Twelve breast cancer survivors participated in semi-structured interviews. Interviews were thematically analyzed using MAXQDA, software for qualitative data analysis. We used the World Health Organization's International Classification of Functioning, Disability and Health as a conceptual framework. Participants experienced many barriers to and facilitators of RTW. In line with previous studies, we found that work environmental factors, such as support from a supervisor, importance of work, and physical or psychological side-effects (such as fatigability), influenced RTW. In addition, we found that barriers included temperament and personality functions, "job lock", and societal attitudes, while facilitators comprised taking care of one's health, skills/coping, and support from family and healthcare professionals. During the initial RTW phase, physical or psychological side-effects hampered work resumption, while during the post RTW phase, a lack of understanding from the work environment was problematic. Participants mentioned that guidance from healthcare professionals and information for supervisors and colleagues should be improved. To enhance RTW among breast cancer survivors, interventions should focus on barriers and facilitators for individuals at different time points in the RTW process. Better guidance from healthcare professionals and information for supervisors and colleagues could also enhance the process.

Objectives The purpose of this study was to review the literature on the content of interventions focusing on return to work, employment status, or work retention in patients with cancer. Furthermore, the effect of the interventions on return to work was assessed in studies reporting return to work. Methods A literature search was conducted using the databases MEDLINE, PsycINFO, EMBASE and CINAHL. Articles that described a work-directed intervention focusing on return to work, employment status, or work retention in patients with cancer were included. The content of the work-directed part of the interventions was assessed based on two criteria for content analysis: 1. does the setting fit the shared care model of cancer survivor care? 2. Does the intervention target work ability and physical workload? For studies reporting return-to-work outcomes, the return-to-work rates were assessed. For studies that used a control group the ORs and the 95% CIs were calculated. Results Twenty-three articles describing 19 interventions met the inclusion criteria. Seven studies reported return-to-work outcomes of which four used a control group. Only three interventions aimed primarily at enhancing return to work or employment status. The most frequently reported work-directed components were encouragement, education or advice about work or work-related subjects (68%), vocational or occupational training (21%), or work accommodations (11%). One intervention fit the shared care model of cancer survivor care and five interventions enhanced work ability or decreased physical workload. The rate of return to work ranged from 37% to 89%. In one of the four controlled studies the intervention increased return to work significantly and in the other studies the results were insignificant. Conclusions Only few interventions are primarily aimed at enhancing return to work in patients with cancer and most do not fit the shared care model involving integrated cancer care. Future studies should be developed with well-structured work-directed components that should be evaluated in randomised controlled trials.

Background Healthcare workers can suffer from work‐related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational‐level interventions. Objectives To evaluate the effectiveness of stress‐reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress‐reduction intervention or another type of stress‐reduction intervention in reducing stress symptoms. Search methods We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. Selection criteria We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. Data collection and analysis Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one’s attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one’s attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work‐related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self‐reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow‐up (> 12 months after the intervention ended). Main results This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress‐reduction intervention Fifty‐two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) ‐0.37, 95% confidence interval (CI) ‐0.52 to ‐0.23; 41 RCTs; 3645 participants; low‐certainty evidence) and medium term (SMD ‐0.43, 95% CI ‐0.71 to ‐0.14; 19 RCTs; 1851 participants; low‐certainty evidence). The SMD of the short‐term result translates back to 4.6 points fewer on the MBI‐emotional exhaustion scale (MBI‐EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low‐certainty evidence) about the long‐term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress‐reduction intervention Forty‐two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD ‐0.55, 95 CI ‐0.70 to ‐0.40; 35 RCTs; 2366 participants; low‐certainty evidence) and medium term (SMD ‐0.41 95% CI ‐0.79 to ‐0.03; 6 RCTs; 427 participants; low‐certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI‐EE. No studies reported the long‐term effect. Focus on work‐related, individual‐level factors versus no intervention/no stress‐reduction intervention Seven studies studied an intervention in which the focus is on altering work‐related factors. The evidence is very uncertain about the short‐term effects (no pooled effect estimate; three RCTs; 87 participants; very low‐certainty evidence) and medium‐term effects and long‐term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low‐certainty evidence) of this type of stress management intervention. A combination of individual‐level interventions versus no intervention/wait list/no stress‐reduction intervention Seventeen studies studied a combination of interventions. In the short‐term, this type of intervention may result in a reduction in stress symptoms (SMD ‐0.67 95%, CI ‐0.95 to ‐0.39; 15 RCTs; 1003 participants; low‐certainty evidence). The SMD translates back to 8.2 fewer points on the MBI‐EE. On the medium term, a combination of individual‐level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD ‐0.48, 95% CI ‐0.95 to 0.00; 6 RCTs; 574 participants; low‐certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low‐certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress....