Accommodations in the workplace for cancer survivors: A systematic review

Abstract

Background

Workplace accommodations play a crucial role in supporting cancer survivors’ return to work. Understanding the available evidence on these accommodations can inform policies and practices that enhance workforce reintegration.

Objective

This systematic review aims to map and synthesize evidence on workplace accommodations for cancer survivors, addressing the research question: How does the literature report accommodations in the workplace for cancer survivors?

Methods

A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and the Journal of Cancer Survivorship, identifying 372 articles published between 2012 and 2022. Studies included were peer-reviewed, focused on return-to-work accommodations for cancer survivors, available in Portuguese or English, and accessible online. The review analyzed studies involving men and women aged 15 or older with various cancer types.

Results

After applying inclusion criteria, 31 articles were analyzed. Research activity peaked in two specific years, but publications were consistent throughout the period. The reviewed studies employed diverse methodologies, including literature reviews, qualitative, mixed-methods, and quantitative approaches. Workplace accommodations were categorized into key themes: organizational changes, environmental support, public and company policies, employer and employee education, comprehensive multidisciplinary support, and communication strategies.

Conclusions

The findings emphasize the significance of organizational changes in facilitating cancer survivors’ return to work. Robust public policies, inclusive workplace environments, and effective communication are essential for sustainable reintegration. Employer commitment and multidisciplinary support play critical roles in ensuring long-term success.

Keywords

chronic illnesses vocational rehabilitation return to work processes and best practice occupational health

Introduction

Cancer is the second leading cause of death globally, accounting for 9.9 million deaths in 2020.¹ Globally, one in every six deaths is related to the disease. However, due to advances related to the diagnosis and treatment of cancer, an increase in the number of survivors of this pathology has been observed in recent years, even though survival rates present inequality between high-income countries and medium-and-low-income countries World Health Organization.¹

With the increase in survival rates, the term cancer survivorship has been adopted in the literature as a specific field of study, whose concept has evolved over time. Initially, Maher² defines a cancer survivor as “someone who has completed initial treatment without apparent evidence of disease.” However, institutions such as the National Cancer Institute of the United States take a broader approach, considering survivorship as encompassing not only the clinical condition but also the physical, psychosocial, and economic aspects related to cancer, from the moment of diagnosis to the end of life.³ Further expanding this perspective, the National Coalition of Cancer Survivors defines survivorship as the experience of living with, through, and beyond a cancer diagnosis.³ In this context, it is critical to highlight that many cancer survivors are of working age; however, the systematic review with meta-analysis conducted by De Boer and colleagues⁴ demonstrated that these individuals are 1.37 times more likely to be unemployed compared to participants in the control group.

Given the above, it is essential to include the promotion of return-to-work activities in therapeutic plans for people with cancer.⁵ Contemplating the reintegration of this population into the workplace requires, on one hand, understanding work as an activity that significantly influences the mental development and identity of workers, as it stimulates creativity, the enhancement of skills and competencies, and drives the acquisition of knowledge.^6,7 On the other hand, it involves reevaluating strategies that address the specific challenges faced by cancer survivors in the professional context, considering both health-related issues, such as fatigue, cognitive difficulties, and mental health problems resulting from cancer or treatment, as well as the demands of the labor world, such as organizational and environmental factors.^8,9

Another important dimension relates to employment conditions, including the sector of activity, employment status, and type of contract. Findings from a European multi-country study indicate that self-employed cancer survivors are more likely to remain active at work during treatment; however, they often experience worse financial outcomes when compared to those in formal employment arrangements.¹⁰

It is observed that there are review studies that focused on aspects related to the return to work of cancer survivors, addressing prognosis related to incapacity for work, return to work, or equivalent concepts.^11,12 Qualitative reviews that explored this population's perception of returning to work were also identified.^13,14 Although fundamental in their analyses, these studies have predominantly focused on evaluating the challenges and factors associated with cancer survivors returning to work.

Nevertheless, up to this point, the existing literature lacks a systematic comprehension of the accommodations required in the workplace to cater to the specific needs of those who have overcome cancer. Such as flexible working hours, ergonomic adjustments, task redistribution, and organizational changes—which are essential to ensure the continued employment and well-being of these workers in the post-treatment context. These accommodations are fundamental to promoting a sustainable and respectful return to work that considers the health conditions and new needs of cancer survivors.

In this context, the aim of this review is to map the available evidence concerning workplace accommodations for cancer survivors. Thus, this investigation had the following question as its starting point: How does the literature report accommodations in the workplace for cancer survivors?

Methodology

This systematic was conducted following the Preferred Reporting Items for Systematic Reviews for Systematic Reviews (PRISMA). The protocol for this research has been registered on the International Prospective Register of Systematic Reviews [Prospero] platform under a code [omitted for anonymous review].

Eligibility criteria

For inclusion in this review, documents met the following criteria: articles published in peer-reviewed journals, which dealt with the return to work of cancer survivors, and which addressed the accommodations made in this context; published in Portuguese and English; freely accessible in full or that could be retrieved via (omitted for blind review), between 2012 and 2024. Regarding study populations, the inclusion criteria encompassed research involving working-age men and women (i.e., over 15 years old) and addressing all types of cancer. Duplicate records, letters to the editor, experimental pre-clinical studies, case series, brief communication, expert opinions, reports of experiences, and studies related to the child population were excluded.

Information sources and search strategy

The search for relevant information was conducted in two phases. The first phase took place between September and October 2022, and it involved using three sources: PubMed, Web of Science, and the Cochrane Library. In addition to database searches, a manual search was conducted in the Journal of Cancer Survivorship, as an exploratory search revealed a significant number of articles from this journal addressing the review topic. The research team received assistance from an experienced librarian to draft the search strategies, and the details of each strategy applied to different data sources are presented in Table 1.

Table 1.

Search strategies in different data sources.

Database	Search Strategy	Results
PubMed	Cancer Survivors [Tiab]] AND [Work [Tiab]]] AND [accommodations [Tiab]] Filter: last ten years	29
PubMed	[Return to work] AND [[Neoplasms[mesh] OR Neoplasm* [Tiab] OR Oncol* [Tiab] OR Cancer* [tiab] OR Carcino[Tiab] OR Leukemia[mesh] OR Leukemia[Tiab] Oncology patient[tiab] OR Lymphoma [mesh] OR Lymphoma[tiab]]]. Filters: last ten years and free full-text	13
Web of Science	"Cancer Survivors” [Topic] AND Return to Work” [Topic]. Filters: last ten years and review article	101
Cochrane Library	"Cancer Survivors” AND “Return to Work” OR “Work” OR “Workplace” AND “Accommodations” Filter: last ten years	51
Journal of Cancer Survivorship	Manual search using the term “accommodation.” No filters	78
TOTAL		272

Between March and April 2024, a second round of data collection was initiated to update the review. This phase involved utilizing three databases, PubMed, Scopus, and Web of Science, spanning the previous decade. Adjusting information sources and search strategies was implemented to expand the search parameters and ensure a more comprehensive retrieval of articles. The Table 2 displays the search strings executed in each database and the corresponding results.

Table 2.

Search strategies employed across Various data sources: second round.

Database	Search strategy	Results
PubMed	[((“Cancer Survivors"[All Fields] OR “Cancer Patients"[All Fields] OR “Cancer Recovery"[All Fields] OR “Cancer Remission"[All Fields]) AND (“Return to Work"[All Fields] OR “Vocational Rehabilitation"[All Fields] OR “Employment after Cancer"[All Fields] OR “Occupational Reintegration"[All Fields]) AND “Workplace Accommodations"[All Fields]) OR “Job Accommodations"[All Fields] OR “Workplace Adjustments"[All Fields] OR “Employment Support"[All Fields]) AND (y_10[Filter])	302
Scopus	TITLE-ABS-KEY ((“Cancer Survivors” OR “Cancer Patients” OR “Cancer Recovery” OR “Cancer Remission”) AND (“Return to Work” OR “Vocational Rehabilitation” OR “Employment after Cancer” OR “Occupational Reintegration”) AND (“Workplace Accommodations” OR “Job Accommodations” OR “Workplace Adjustments” OR “Employment Support”)) AND PUBYEAR > 2013 AND PUBYEAR < 2025 AND (LIMIT-TO (DOCTYPE, “ar”) OR LIMIT-TO (DOCTYPE, “re”))	33
Web of Science	(TS = (“Cancer Survivors” OR “Cancer Patients” OR “Cancer Recovery” OR “Cancer Remission”) AND TS = (“Return to Work” OR “Vocational Rehabilitation” OR “Employment after Cancer” OR “Occupational Reintegration”) AND TS = (“Workplace Accommodations” OR “Job Accommodations” OR “Workplace Adjustments” OR “Employment Support”)) – publication date from 2014-01-01 to 2024-03-20	17
TOTAL		352

Study selection process and risk of bias assessment

The Rayyan app^® was used to screen abstracts and titles and eliminate duplicates. Then, the retrieved records were imported into the Mendeley^® reference manager, and the selection process for eligibility for study titles and abstracts was carried out independently by two researchers (BS and CA). Three researchers (BS, JN, and CA) screened the full texts. In case of disagreement, meetings were held to reach a consensus among the evaluators.

Data collection process

The authors developed and followed a structured protocol for data extraction to ensure consistency to the objetive of this review. This protocol included collecting bibliometric information (such as author name, year of publication, journal, and methodological approach), as well as specific content related to workplace accommodations for cancer survivors and the type of cancer addressed in each article. Two researchers (BS and CA) independently extracted the data using a spreadsheet tool that organized and mapped the relevant variables for this review. Discrepancies were discussed and resolved by consensus to ensure reliability of the extracted data.

Synthesis methods

This review adopted a convergent integrated approach, aligned with methodological guidelines in the field of mixed methods systematic reviews, such as those followed by JBI.¹⁵ The strategy aimed to gather and integrate evidence from studies with diverse methodological designs (qualitative, quantitative, mixed methods, and systematic reviews) in order to synthesize findings from all these sources and respond to the review objective.

Given this heterogeneity, quantitative findings were initially converted into “qualitized” data—that is, transformed into textual or narrative descriptions that could be meaningfully integrated with qualitative data. This transformation enabled a uniform analysis across different types of evidence and was essential for identifying thematic patterns.

Data synthesis occurred in two complementary stages. The first involved a bibliometric analysis, which, based on information extracted from the studies, synthesized characteristics of the publications, methodological trends, and geographical distribution of the work, with results presented in tables and charts. This was followed by a thematic analysis structured in three main steps: line-by-line coding of findings from primary studies, development of descriptive themes, and finally, generation of analytical themes that grouped the evidence into six thematic dimensions related to workplace accommodations.¹⁶

This approach enabled the systematic integration of findings, regardless of methodological origin, and ensured rigor and transparency in the analytical process. As the focus of the review was on thematic synthesis rather than effect sizes, no statistical metrics or sensitivity analyses were applied. Due to the diversity of contexts and cancer types reported, it was not feasible to conduct comparisons across these variables.

Bias assessment

Although no formal assessment of reporting bias or certainty of the evidence was conducted, all included studies were critically analyzed to assess the robustness of their methodologies and their alignment with the research objectives. This critical appraisal ensured that the methodological approaches were appropriate and that the findings contributed meaningfully to the synthesis.

Results

The search results are presented in Figure 1. In total, 372 articles were retrieved, and after the screening process, by reading titles, abstracts, and full text, 31 documents were retained for analysis.

Figure 1.

Flowchart regarding the selection process of studies included in this review.

Characteristics of the studies

This section presents a bibliometric analysis of the studies included in this review. Table 3 demonstrates the set of these articles and provides a breakdown of the characteristics relevant to the analyses carried out in this research.

Table 3.

Characteristics of the included studies regarding methods, type of cancer, and accommodations addressed.

AuthorsYear	Study design	Cancer type	Accommodations
Alleaume et al. 2020 ¹⁷	Quantitative Study	Breast, Lung, Colon-rectum, Aero Digestive Tract or UADT, Bladder-kidney-prostate, Thyroid, NH Lymphoma, Melanoma, Cervix-uterus	Adjustment in workload; reduced hours; job change; company policies; part-time therapeutic work.
Azua et al. 2023 ¹⁸	Quantitative Study	Breast cancer	Collaboration among professionals, employers, and survivors to enhance communication and ensure personalized guidance and rehabilitation programs.
Berger et al. 2015 ¹⁹	Qualitative Study	Unspecified	Home office; breaks during the day; specific adaptations.
Butow et al. 2014 ¹³	Qualitative Review	Unspecified	Establish goals; plan work around patterns and symptoms; take short breaks; incorporate occupational legislation
Chiu et al. 2014²⁰	Quantitative Study	Unspecified	counseling, training, job readiness, job placement assistance, workplace support, transportation, rehabilitation technology, reader and interpreter services, technical assistance, information and referral services
Chow et al. 2014 ²¹	Systematic Review	Unspecified	Work flexibility; changes in tasks; modifiable environmental factors; work rotations.
De Boer et al. 2015 ²²	Systematic Review	Unspecified	Behavioral training; career counseling; adjustment to working hours; modified tasks or modified work locations; improved communication.
De Rijk et al. 2020 ²³	Qualitative Study	Unspecified	Redistribution of specific tasks; flexible working hours; adapted work; formal plan; return-to-work policies and legislation; activity planning.
Dorland et al. 2016 ²⁴	Qualitative Study	Unspecified	Task spreadsheet; adaptations to the guidelines according to needs.
Fassier et al. 2018 ²⁵	Mixed Methods	Breast cancer	Social support at work from colleagues and employer, work adaptation [tasks and/or schedule)
Fry; Rumrill 2024 ²⁶	Literature Review	Unspecified	Flexible schedules, telecommuting, schedule modifications, natural supports, flexible leave policies, communicating with other employers and community agencies about accommodation techniques and resources, insurance policies and licenses, guidance on social security, leave laws, and health insurance.
Goss et al. 2014 ²⁷	Quantitative Study	Breast cancer	Establishing the relationship between our occupational health service and managers, employment policies encouraging adjustments to facilitate return-to-work, and generous sick pay and leave provisions.
Gruß et al. 2019 ²⁸	Qualitative Study	Colorectal	working from home and returning to work gradually facilitates employer communication that respects survivors’ values and preferences, elicits information about survivors’ work limitations and required accommodations, and regular check-ins to assess their well-being, increasing awareness amongst public policy employees about relevant legislation.
Jaffe et al. 2021 ²⁹	Mixed Methods	Breast cancer, colorectal cancer, cervical cancer, or prostate cancer	Paid time off, employment protection policies, access to benefits, flexible working.
Kollerup et al. 2021 ³⁰	Quantitative Study	Breast cancer, colon, and melanoma skin cancer	Implement flexible work schedules, offer psychological support services, and develop and implement supportive workplace policies. Conduct training to raise awareness about accommodating employees with cancer
Kong et al. 2022 ³¹	Qualitative Study	Breast cancer, colorectal cancer, cervical cancer, or prostate cancer	Flexible working hours; rest areas for short breaks; home office.
Kurosawa et al. 2022 ³²	Quantitative Study	allogeneic hematopoietic cell transplantation (allo-HCT) survivors	Flexible schedule and reduced work hours,
Mak et al. 2014 ³³	Qualitative Study	Unspecified	Modify tasks assigned to the adjusted workload; work adaptation practices; support groups with occupational therapists and physiatrists; governmental approaches to organization.
Moskowitz et al. 2014 ³⁴	Quantitative Study	Breast, testicular, colorectal, prostate, Hodgkin lymphoma, and non-Hodgkin lymphoma	Flexibility in the workplace; communication strategies; work accommodation; educational interventions.
Motoi et al. 2023 ³⁵	Quantitative Study	lung, gastric, colorectal, breast, and cervical cancer were surveyed.	Establishments can better support employees with cancer by providing information on treatment, precautions, and primary cancer knowledge. Workers benefit from various provisions like sickness benefits, paid leave, shorter hours, flexible commuting, and remote work options. These measures, including changes in commuting methods and access to a cancer-specific leave program, create a supportive environment for employees facing cancer diagnoses.
Paltrinieri et al. 2022 ³⁶	Systematic Review	Unspecified	Return to work plans; flexible schedules; modifications to job functions; retraining and support; adaptive aids
Sohn et al. 2021 ³⁷	Scoping Review	Breast Cancer	RTW interventional programs include accessible RTW information, instructions for structured RTW plans, and support groups. Professional education and education on the importance of counseling and peer support.
Stehle et al. 2022 ³⁸	Systematic Review	Unspecified	Ergonomic education; multi-component education intervention programs; work-related advice.
Stepanikova et al. 2016 ³⁹	Qualitative Study	hematopoietic stem cell transplantation recipients	Flexibility in work hours; Adjustment in tasks (autonomous job; job with little stress; job with few physical demands); secure job; continuous insurance coverage through an employer.
Stergiou-Kita et al. 2016 ⁴⁰	Qualitative Study	Unspecified	Gradual return plans; flexible schedules; modification of job duties; recycling and support in the workplace; adaptive technology modifications in the physical environment.
Stergiou-Kita et al. 2016 ⁴¹	Qualitative Study	Unspecified	Support in the workplace; communication of health professionals with survivors and the workplace.
Stone et al. 2017 ⁴²	Qualitative Study	Breast Cancer, leukemia or lymphoma, melanoma, testicular, or thyroid cancer.	Sought advice from an ergonomics specialist to adjust her workstation, enabling comfortable work without lymphedema. Delegate to trusted subordinates or family to manage small business operations, changing work schedules for energy and efficiency. Due to limited resources, self-accommodation and advocacy were often necessary for survivors in small business or entrepreneurial settings.
Thomson M; Siminoff L. 2018 ⁴³	Mixed Methods	Hematological cancers	Changed working hours; licenses to attend appointments; teleworking.
Tiedtke et al. 2020 ⁴⁴	Qualitative Study	Unspecified	accepting more breaks or temporarily offering work with a diminished workload,
Von Ah et al. 2018 ⁴⁵	Quantitative Study	Breast Cancer	Adaptations for re-entry into the workplace; return-to-work policies and programs; flexible schedules; location and workload adjustments.
Wu et al. 2024 ⁴⁶	Qualitative Review	Unspecified	RTW-related educational support following the completion of clinical treatment.

The analysis of publications from 2012 to 2024 indicates two peak years with high research activity: 2016 with six documents and 2014/2020 with five each. However, at least one publication was released yearly, suggesting a sustained research interest despite yearly fluctuations. The distribution of articles within the journals included in this review is shown in Figure 2.

Figure 2.

Distribution of the studies included in this review by a scientific journal.

The predominance of scientific production in this review pertains to the field of oncology, evident from the concentration of articles published in oncology-specific journals, notably the Journal of Cancer Survivorship (n = 12). Additionally, articles have been disseminated across occupational and public health fields. Qualitative methods were the most used in the research designs of the articles included in this review (n = 11). These documents used semi-structured interviews (n = 7),^{20,25,41–44} focus groups (n = 3),^24,31,33 or both (n = 1)²⁰ as the procedure of data collection. The quantitative studies (n = 10) were included, with the following designs: analytical studies – cross-sectional (n = 8)^{19,22,24,29,32,34,36,37} and prospective cohort (n = 1).¹³ This review also retrieved three studies with mixed approaches (n = 3).^27,31,45

Synthesis of evidence regarding workplace accommodations for cancer survivors

The thematic analysis of the articles included in this review allowed for the construction of six thematic categories related to accommodations that aim to help cancer survivors return to work: organizational changes, environmental support, public and company policies, education of employer and employees, comprehensive multidisciplinary support for cancer survivor workers’ return to work and communication.

Organizational changes

Regarding organizational changes, the articles mentioned strategies that were used to encourage the return to work of cancer survivors, such as flexibility in work hours,^{4,21,23,26,29–32,34–36,39,40,42,43,45} changes in duties or functions,^23,24,35,38 and formulating a formal plan for returning and remaining in the workplace.^21,24,39,43 Flexibility enables individuals to perform tasks in alignment with their abilities, contributing to successful reintegration into work.¹⁷ Work breaks^{20,21,32,33,46} and home office or teleworking^{20,28,30,37,45} are also strategies related to work flexibilization, frequently mentioned in the literature.

Five articles cited formulating a formal plan for returning and remaining in the workplace for cancer survivors.^{21,24,26,31,39,43} Structuring a plan, involves reintroducing the activities, considering the time the individual was away. It is essential to consider recognizing clinical symptoms and increasing adjustments, grading the time and tasks of each activity to plan a flexible routine.⁴³

A helpful strategy for returning to work would be to graduate the activity – adjusting tasks to the needs and capabilities of cancer survivors to enhance learning and address issues such as absenteeism.²¹ Another procedure cited in the literature is the adoption of energy conservation strategies, which help manage energy expenditure during and between activities and can be classified from simpler to more complex tasks.⁴⁴ To support the transition back to work, sick leave management also plays an important role in facilitating a gradual return. In addition, problem assessments and resource analyses are necessary for both the worker and the workplace.²⁵

Environmental support

Regarding environmental support, five articles mentioned that in addition to personal and occupational factors, the environmental context also influences the implementation of accommodations^{21,31,34,40,42} Therefore, accommodations such as rest areas and ergonomic adaptations refer to strategies used in the work environment²³ to aid cancer survivors in returning to work.

Public and company policies

The articles discussing accommodation for cancer survivors to return to work highlighted public and insurance company policies as significant factors.^{13,18,20,23,25–30,33,35,39} These policies can provide access to benefits like sickness and injury benefits,³⁵ paid leave on an hourly basis,³⁷ paid time off, post-diagnosis employment assurance policies,³⁰ and continuous insurance coverage through employers.³⁸ According to the research explored in this review, these factors aid in returning to and retaining employment for this group.

Two other articles highlighted the influence of each country's policies and legislation as responsible and decisive in implementing accommodations.^13,23 The role of policies falls directly on the return to work, as it involves the employer in support and at which stages of the process it can favor the use of accommodations.²³ To achieve this, it is necessary to formulate concise policies and protocols to be followed in the workplace for a safe return, supported by the employer and other work relationships.¹³

Education of employer and employees

Among the articles reviewed, some emphasized the importance of educating employers about the needs of cancer survivors.³⁵ In contrast, others highlighted the necessity of ensuring employee education through vocational rehabilitation programs and other strategies.^{18,20,25,27,34} Two articles have mentioned that employer education is crucial for employees to return to work and to initiate early discussions about viable options during this period^35,38 From this perspective, the first conversation between the employee and employer should involve themes related to the importance of work and flexibility at the organizational level. This first approach may occur with the support of occupational health professionals, which can put the entire context of activities into perspective.³⁷ Also, it is vital to initiate and maintain communication with the workplace and consider health/prognosis-related issues (i.e., more recurrences, less favorable cancer diagnoses, reduced ability to work at the time of referral) or lack of involvement.³⁵

Comprehensive multidisciplinary support for cancer survivors return to work

Within this topic, articles propose psychological support^30,37,42 alongside recommendations advocating for the involvement of multidisciplinary teams.^4,33,34 Regarding multidisciplinary support, articles mentioned this alternative as an adaptation strategy.^47,48 The interventions focus on a combination of vocational counseling, communication between teams, worker education, and cognitive-behavioral therapy to improve the rate of the return-to-work process for cancer survivors.^20,32

Communication

Six articles cited communication as a pivotal strategy for cancer survivors returning to work^{4,18,26,28,34,41} Communication with or between managers, colleagues, and health professionals is fundamental in coordination in the return-to-work plan. This practice aims to mitigate stigmas related to the disease and uncertainties about what can or cannot be shared with others.^4,34 In this context, it is highlighted the importance of dialogue between members of the health system and the workplace to encourage this contact of intersectoral readiness to strengthen the flow of information that considers the culture of the work environment and all preparation that can be developed for the survivor in this returning process.⁴¹

Discussion

This study aimed to gather and analyze evidence regarding accommodations in the work environment for cancer survivors. The results indicate that several studies included in this review have considered the type of cancer in their analysis, often published in oncology journals. This consideration can be attributed to the unique nature of each type of cancer, its treatments, and the physical, emotional, and social symptoms that can impact the ability to work, necessitating specific adaptations. The findings of meta-analyses indicate elevated risks of unemployment among survivors of breast cancer, gastrointestinal cancers, and cancers of the female reproductive organs. Conversely, survivors of blood cancer, prostate cancer, and testicular cancer did not exhibit an increased risk of unemployment.⁴

In examining the concentration of publications in oncology journals, it is crucial to emphasize that while disease-related aspects are significant, our review underscores the necessity of a comprehensive evaluation encompassing various modifiable and non-modifiable factors to determine accommodations. These factors include personal preferences, work environment, employer support, family and societal support, healthcare infrastructure, and public policies. About research design of the articles included in this review, studies with a quantitative and mixed approach allowed for exploring essential variables to consider when and how to choose accommodations. The researchers pointed out the importance of considering the type of cancer, symptoms that remained, treatment effect, and the medical report to define workplace accommodations^18,20,45 as well as individual characteristics, like sex, age at diagnosis, income, education level, and family type.^17,30,32,43

Also, the analysis demonstrated that having a desire to work and perform non-physical job tasks increased the odds of remaining employed.⁴³ Moreover, professional characteristics (type of employment contract at diagnosis, job placement, sector of employment, occupational health advice to cancer patients and their employers, company size and socio-professional category, congruent communication, physical effort, and need to bend, kneel, or crouch) should also be considered.^17,43 Problems such as mistreatment, discrimination, lack of accommodations, and being passed over for promotion at work were linked to reduced sustainability in the workplace.³⁴

The qualitative studies retrieved by this review analyzed in detail the changes in survivors’ attitudes and behaviors regarding work-related issues, influenced by stigma, personal choices, and organizational dynamics. They also examined structural barriers—such as policies, politics, and economic factors—that stakeholders must address to support cancer survivors in returning to and remaining in work activities.^{20,25,26,30,33,35,41–44,46}

In relation to workplace accommodations, the findings highlight the relevance of organizational strategies in facilitating the return to work. Flexibility appears as a central theme, with adjustments in working hours and tasks to meet individuals’ needs and capabilities. Accommodations tailored to the specific challenges faced by this group offer a structured approach to reintroducing activities, considering both personal circumstances and clinical factors.

In some countries, the return to work is organized in stages with the support of the organization's manager and occupational services.²³ Aspects such as replacing more complex tasks with simpler ones, reducing demands, planning activities, implementing energy conservation strategies, and structuring a routine adapted to the worker's skills and experience depend on the internal organization and the legislation in force. Considering the current context – marked by neoliberal models that promote task rotation, flexible working hours, and precarious labor relations – a conflict emerges between the company's interests and values and workers’ fear of asserting their rights or making suggestions related to the organization and execution of activities.³⁸

Coordination between the personnel responsible for occupational health, the employer, and the work team is needed to develop a successful return plan jointly; however, is difficult to arrange and execute precisely because it is a complex dynamic, reverberating in the cancer survivor's professional reintegration.⁴⁶ For this reason, this paper indicates the need for more studies that guide how to implement organizational accommodations and environmental support for this population, considering the type and variables of each organization and providing tailor-made solutions to respond to their demands.⁴⁹ Furthermore, although documents in this review address the importance of formulating public policies in the return-to-work process for cancer survivors, there is no outline of how decision-makers can improve guidelines to favor this process.^23,41 Additionally, the structure of public policies regarding occupational health must be reviewed as they focus on individual practices regarding health promotion and prevention and have less guidance related to the return to work of people grappling with severe health conditions such as cancer.

In parallel to public efforts, company-level policies are often overlooked. There is limited attention given to the initiatives undertaken by employers to facilitate the return-to-work transition for cancer survivors. Corporate policies on paid leave, flexible work arrangements, and accommodation measures are equally important in promoting successful reintegration and sustained employment. Bridging this gap can contribute to more comprehensive strategies that integrate efforts from both the public and private sectors to support cancer survivors in the workplace.

Another critical aspect of the return-to-work process is the cancer survivor's communication of information related to the disease with co-workers to overcome difficulties and stigma, in addition to acting directly on the employers’ conceptions of their productive capacity.⁴⁹ Regarding the mediation of communication between employees and managers/supervisors, few studies have been seen that have explored the participation of other professionals – such as occupational therapists – in the management and dialogue between both parties, favoring guidelines that fill this gap.⁵⁰

The return to work of cancer survivors must be supported by multidisciplinary interventions to recognize survivors’ potential difficulties in this process, manage groups that promote peer support for understanding issues related to the performance of activities, thematic discussions, and sharing ideas about fears and feelings arising from returning to work activities^49,51

Psychosocial support measures and structural adjustments are essential to improving working conditions for this vulnerable population.⁴⁸ In this context, the worker's ability to advocate for their rights becomes a key factor, as being aware of their entitlements facilitates a smoother return to work. By identifying and proposing appropriate accommodations, cancer survivors can actively contribute to the implementation of these measures, strengthening dialogue with their managers and making the reintegration process more effective.¹⁴ The employer's understanding of the importance of accommodations allowed them to be favored and implemented efficiently, enabling a commitment to embrace the worker's needs and taking responsibility for what is needed for a gradual return that is viable for both.^47,52

Study limitations

The limitations of this study are primarily related to the selection criteria of the articles included in the review, which were restricted to English and Portuguese languages. This restriction may have compromised the comprehensiveness of the findings, as relevant studies published in other languages may have been excluded, thereby limiting the cultural and contextual diversity of the analyzed sample. Furthermore, the heterogeneity among the reviewed studies, which address different types of cancer and various return-to-work scenarios, makes it difficult to compare results and highlights the need for more specific analyses regarding the particularities of each context. A lack of detailed information was also observed concerning the needs of both survivors and organizations, which hinders a deeper understanding of reintegration strategies and the necessary adaptations in the workplace. Occupational factors and work restructuring processes, which directly influence return-to-work possibilities and accommodation requests, were underexplored in the approaches analyzed. Finally, it is worth noting that although the methodological quality of the studies was assessed, no formal instrument was used to evaluate the risk of bias.

Conclusion

This review has identified how the literature addresses workplace accommodations for cancer survivors. The retained studies were primarily qualitative, delving into the perspectives of both cancer survivors and their employers. Quantitative and mixed-methods studies have highlighted vital factors influencing the selection of workplace accommodations, including cancer type, individual characteristics, and professional circumstances. Functional limitations and cognitive functioning also play significant roles. Moreover, workplace challenges such as discrimination and insufficient accommodations can detrimentally affect employment sustainability.

The accommodations examined underscore the significant impact of organizational changes in supporting cancer survivors’ return to work. This scenario emphasizes the need to promote these changes effectively in future research. Addressing the return-to-work needs of cancer survivors demands a shift towards more robust public policy frameworks. Current policies lack actionable guidelines for decision-makers, primarily focusing on individual health practices rather than comprehensive support systems. Bridging this gap requires collaborative efforts to understand survivors’ genuine needs and foster an inclusive workplace environment.

Effective communication between survivors, colleagues, and employers is crucial for overcoming stigma and facilitating a smooth return to work. However, comprehensive guidelines still need to be improved regarding the need for multidisciplinary interventions and empowerment strategies for cancer survivors. Employers’ understanding and commitment to accommodations are vital for facilitating a thriving and sustainable return to work, marking the importance of mutual collaboration and responsibility.

Footnotes

ORCID iD

Beatriz Bandeira dos Santos

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Informed consent

All participants in this study provided their informed consent prior to participation.

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