中青年癌症生存者重返工作干预方案的系统评价

Interventions to enhance return-to-work among young and middle-aged cancer survivors:a systematic review

目的·系统评价中青年癌症生存者重返工作(return-to-work)干预方案的应用情况及其在改善癌症生存者工作相关结局中的效果。方法·计算机检索PubMed、Cochrane Library、Embase、中国知网、万方等8个电子数据库,检索时限为建库到2022年8月2日,纳入重返工作干预方案对癌症生存者工作相关结局的随机对照试验(randomized controlled trial,RCT)和类实验研究。由2名研究者一组独立对文献进行筛选、资料提取,并采用JBI (Joanna Briggs Institute)文献真实性评价工具进行方法学质量评价。结果·共纳入13篇原始研究,涉及11套重返工作干预方案,含2 045例癌症生存者;其中7项为RCT研究。系统评价结果显示,有10项干预方案为多学科干预,干预内容包含疾病/心理健康教育、小组讨论、物理康复、工作能力锻炼、多学科团队会议和咨询等模块,其中3项干预方案还将雇主纳入支持方案中。干预持续时间从7 d到1年不等。纳入的干预方案中有8项以重返工作率作为主要结局指标,但仅3项报道了差异具有统计学意义,而其中2项为未设置对照组的类实验研究设计;纳入的干预方案在重返工作时长、工作改变情况、工作能力、工作意义等工作相关结局指标上并未呈现较明确的积极效果。结论·癌症生存者重返工作干预方案的内容、形式、强度、频次差异较大,且干预对工作相关结局的效果尚不明确。国内在该领域的干预研究仍待开发和探索,研究者应进一步挖掘癌症生存者重返工作的影响机制,并基于此制定多学科协作的干预方案来帮助中青年癌症生存者重返工作,回归社会。此外,受研究质量和干预方案异质性的限制,上述结论仍需更多高质量的原始研究做进一步验证。

Objective·To systematically evaluate the application of return-to-work intervention programs to young and middleaged cancer survivors and its effectiveness in improving work-related outcomes in cancer survivors.Methods·An initial literature search of eight electronic databases,including PubMed,Cochrane Library,Embase,CNKI and Wanfang was conducted with a time frame from inception to Aug 2nd,2022 to collect randomized controlled trials(RCTs)and quasi-experimental studies of return-towork interventions on work-related outcomes among cancer survivors.Two researchers independently conducted literature screening,data extraction,and methodological quality evaluation using the JBI(Joanna Briggs Institute)Methodology Quality Evaluation Tool.Results·A total of 13 original studies were included,involving 11 return-to-work intervention programs,containing 2045 cancer survivors.The results of the systematic evaluation showed that 10 of the intervention programs were multidisciplinary,with intervention modules on disease/mental health education,group discussions,physical rehabilitation,work capacity exercises,multidisciplinary team meetings and counselling.Among them,three interventions also included employers in the support program.The duration of the interventions ranged from 7 d to one year.Eight of the included interventions took return-to-work rates as a primary outcome,but only three reported that the difference was statistically significant,two of which were quasiexperimental studies without control group.Besides,no clear positive effects were found on work-related outcome such as length of return-to-work,change of work status,work ability,and work meaning.Conclusion·The content,format,intensity and frequency of return-to-work intervention programs for cancer survivors vary widely,and the effects of interventions on work-related outcomes are still unclear.Researchers should further explore the mechanisms that influence cancer survivors′return-to-work,and develop multidisciplinary intervention programs based on this to effectively help young and middle-aged cancer survivors return-to-work and society.In addition,due to the limitations of study quality and intervention program heterogeneity,more high-quality experimental studies are needed to further validate the above findings.