Psychological changes among breast cancer patients completed treatment and factors influencing their return to work during rehabilitation: A qualitative study

Abstract

Background

As the most common cancer among women, returning to work has become a problem for breast cancer patients in the rehabilitation period.

Objective

To explore in-depth the psychological changes that breast cancer patients undergo and the factors that hinder or facilitate their return to work after cancer treatment.

Methods

The study used a phenomenological approach and involved a sample of ten breast cancer patients who had returned to work or planned to return to work while on endocrine therapy or after completing all curative treatments.

Results

Two themes emerged from the interviews: (1) the mental journey of breast cancer patients when they returned to work, which involved three stages: avoiding returning to work, embracing reality and setting sail again, and grasping today and harvesting the future; (2) factors that affected breast cancer patients’ return to work, including economic pressure, work stress, the patient's mindset towards their illness, pursuit of social values, and social support.

Conclusions

Based on these influencing factors, interventions should be developed to enable patients to maintain a positive and optimistic attitude during their rehabilitation process.

Keywords

breast neoplasms return-to-work rehabilitation survivorship psychology qualitative research

Introduction

Breast cancer is the most common malignant tumour affecting women worldwide.¹ The onset age of breast cancer is relatively lower in China, with the incidence rate peaking at 55 after rising gradually from age 20.² A relatively large proportion of patients are young and middle-aged. This trend is concerning given that most women diagnosed with breast cancer are typically in essential stages of their family life and career, resulting in significant losses to their family and social functions. Consequently, the number of young breast cancer survivors is increasing, and returning to work is becoming a trend among survivors. A bibliometric study shows that return-to-work after cancer has attracted global attention from researchers, with breast cancer being the most studied type.³ Returning to work includes going back to one's previous job or finding new employment after being absent for a period due to illness or injury.⁴ This has been proven to improve patients’ physical, psychological, and social functions, as well as their overall quality of life,^5,6 and is even associated with better survival rates.⁷ The situation of breast cancer survivors returning to work varies across countries. In a retrospective study conducted in France, 89% of survivors had returned to work at the time of inclusion in the study (three years after diagnosis).⁸ The return-to-work rate among Asian breast cancer patients three years after diagnosis ranges from 64.2% to 65.3%.⁹

To improve the return-to-work rate among breast cancer patients, it is crucial to understand the psychological aspects and influencing factors of their return to work. However, during treatment, breast cancer patients may face various challenges that temporarily prevent them from returning to work. Breast cancer patients undergoing curative treatments, such as surgery, chemotherapy, and radiation therapy, often encounter physical and psychological difficulties upon returning to work.^10,11 The affected limbs may not fully recover after surgery,^12,13 and chemotherapy-induced nausea and vomiting may reduce patients’ work adaptability. Additionally, chemotherapy-induced hair loss may cause patients to avoid colleagues, while psychological issues related to the treatment may negatively impact patients’ attitudes toward returning to work.¹⁴ Due to the need for frequent hospital visits during treatment, patients may find it difficult to manage their time effectively for work. These factors may cause some patients undergoing treatment to be in a state of “temporarily not returning to work,” thereby failing to reflect the true psychological dynamics of patients returning to work.^15,16 From two recent systematic reviews on return to work among breast cancer patients, it is evident that current qualitative studies target populations both during and after treatment. However, these studies have not systematically summarized the psychological journey of breast cancer patients returning to work.^17,18 Furthermore, no longitudinal quantitative studies focusing on the psychological changes associated with returning to work in breast cancer patients have been identified to date. To comprehensively understand the psychological dynamics of patients returning to work, we should exclude those who experience temporary absences due to treatment factors during the treatment period.

Qualitative research is a method used to explore and understand phenomena, primarily for studying complex social and behavioral issues.¹⁹ Phenomenological research, a type of qualitative method, aims to understand and describe how individuals experience and perceive specific phenomena.²⁰ Its core purpose is to delve into individuals’ subjective experiences and consciousness to uncover the essence and meaning behind these experiences. Using in-depth phenomenological interviews, this method can capture and comprehend the psychological dynamics and subjective factors affecting breast cancer survivors as they return to work–achievements that quantitative research often cannot achieve.

Therefore, we conducted a qualitative study to investigate the psychological changes experienced by breast cancer patients who have completed curative treatment (i.e., those currently receiving only endocrine therapy or who have completed all treatments) and have returned to work. And to identify the factors that influence their return to work. The study's results are anticipated to serve as a foundation for developing personalized interventions to facilitate patients’ return to work.

Methods

Design

The study employed a phenomenological research method, utilizing semi-structured interviews to elicit breast cancer patients’ perspectives on returning to work and the factors that facilitate or hinder their return.

Sampling and recruitment

The study utilized a purposive sampling method to recruit breast cancer patients from a hospital in Guangzhou who were either receiving endocrine therapy, had returned to work, or were planning to return to work after completing all curative treatments. From August 1 to 31, 2019, semi-structured interviews were conducted with the participants to explore their views on returning to work and the factors that may encourage or hinder their return to work.

Population and sample

The Readiness for Return-To-Work (RRTW) scale was used to determine the patient's return to work status.^21,22 The RRTW scale was developed by Canadian scholar Dr Franche based on the return-to-work readiness model using the transtheoretical model.²³ In the preliminary phase of this study, we conducted the survey using the Chinese version of the RRTW scale. The content validity of the Chinese version of the RRTW scale is 0.97, with standardized regression coefficients ranging from 0.61 to 0.83. The Cronbach's α for the various dimensions of the scale ranges from 0.753 to 0.843, and the test-retest reliability ranges from 0.797 to 0.828, indicating good reliability and validity.²² The inclusion criteria consisted of a pathological breast cancer diagnosis, currently only receiving endocrine therapy or having completed all treatments, active work status before diagnosis, aged 18–60 years, and an independent understanding of one's condition. The exclusion criteria included clinical stage IV, metastatic cancer, severe cognitive impairment or mental disorder, severe systemic infection, severe anemia, cachexia, and other serious complications.

Sample size

The sample size was determined by reaching data saturation, meaning that no new information was emerging and the data began to repeat. Approximately 9–17 cases were included.²⁴

Data sources/collection

Based on a thorough literature review, a preliminary interview guide was developed and refined based on feedback from a pre-study case. The final interview guide included questions such as: (1) How has your breast cancer diagnosis affected your desire to return to work? (2) What factors influenced your decision to return to work? (3) How have you coped with any physical or emotional challenges related to returning to work?

Informed consent was obtained from all participants, assuring them that their personal information would be kept confidential, that the recordings would be exclusively utilized for research purposes, and that indirect identifiable information such as gender, age, education, and marital status could be published anonymously. Two trained interviewers, including a senior breast cancer case manager and a nurse with extensive experience working with breast cancer patients, conducted the semi-structured interviews in a quiet doctor's office. The interviewers achieved consensus on the interview questions and adjusted the interview outline as necessary during the interviews. All interviews were audio recorded for later analysis. The two interviewers, with their respective professional backgrounds and extensive experience, provided profound clinical insights for the study. Additionally, various methods were employed to minimize potential biases, ensuring the transparency and reliability of the research outcomes. These methods included triangulation of data sources, such as collecting information from patients at different stages of recovery and from diverse workplaces to ensure a comprehensive understanding; peer debriefing, where the research team regularly discussed coding and emerging themes with external experts to challenge assumptions and refine interpretations; member checking, by sharing preliminary findings with participants to confirm accuracy and resonance with their experiences; and maintaining a reflexive journal, where interviewers documented their thoughts, decisions, and potential biases throughout the research process to enhance self-awareness and objectivity.

Data analysis

The interview recordings were transcribed verbatim and checked for accuracy within 24 h of data collection. Data analysis was conducted simultaneously with data collection. Two researchers independently coded and analyzed the data using Colaizzi's seven-step phenomenological analysis method. Any discrepancies in coding and analysis were resolved through discussion and consensus. A third researcher with expertise in qualitative research reviewed and confirmed the final themes and categories. The researchers maintained reflexivity and kept a reflective journal to document their personal biases and assumptions throughout the analysis process.

Ethical considerations

The study was conducted under the Declaration of Helsinki and ethical principles for medical research involving human subjects. The Institutional Review Board reviewed and approved the study protocol. The participants were informed of the study's purpose and procedures and provided with written informed consent. They were also assured that their participation was voluntary and that their data would be kept confidential and used only for research purposes. The researchers ensured that the participants were free to withdraw from the study at any time without any consequences. The audio recordings and transcripts of the interviews were stored securely and accessible only to the researchers involved in the study. All personal information of the participants was replaced with alphabets, ensuring anonymity.

Rigors

This qualitative study on breast cancer patients returning to work demonstrated rigor through its systematic approach. It employed purposeful sampling, conducted semi-structured interviews, and employed thematic analysis. Multiple researchers ensured intercoder reliability, while member checking enhanced credibility. Reflexivity was maintained, acknowledging potential biases, and researcher positionality was transparent. These measures contributed to the study's trustworthiness, ensuring the comprehensive exploration of breast cancer patients’ experiences when returning to work.

Results

Participants

Ten female breast cancer patients, aged 26 to 50 years old, participated in the study. The duration since diagnosis ranged from 15 to 81 months. All participants, except for one who had graduated from middle school, had a bachelor's degree or above. Only one participant was unmarried. One patient was previously a farmer, while the rest were teachers, medical professionals, or other types of professionals. Three patients had completed treatment, and the remaining seven were still undergoing endocrine therapy. Seven patients had returned to work, while three were planning to return. The participants’ general information is presented in Table 1.

Table 1.

Participants’ general information (N = 10).

Number	Gender	Age (years)	Marital status	Education level	Diagnosed to date (months)	Stage of treatment	Pre-diagnostic occupation	Current occupation	Return to work states	Return to work distance confirmed (months)
A	Female	50	Married	Bachelor	81	None	Middle School administrator	Administrator	Active maintenance	3
B	Female	42	Married	Bachelor	15	Endocrine therapy	Primary School teacher	Unemployed	Intention	–
C	Female	26	Single	Bachelor	25	Endocrine therapy	Financier	Unemployed	Action readiness-self-assessment	–
D	Female	45	Married	Bachelor	25	Endocrine therapy	Statistician	Statistician	Active maintenance	10
E	Female	44	Married	Middle school	35	Endocrine therapy	Farmer	Independent online retailer	Uncertain maintenance	10
F	Female	34	Married	Bachelor	41	None	Technical Secondary School teacher	Unemployed	Action readiness-behavior	–
G	Female	42	Married	Bachelor	69	Endocrine therapy	Head nurse	Nurse	Active maintenance	2
H	Female	50	Married	Bachelor	61	None	Staff	Union president	Active maintenance	10
I	Female	36	Married	Master	34	Endocrine therapy	Staff	Staff	Active maintenance	8
J	Female	50	Married	Bachelor	64	Endocrine therapy	School doctor	School doctor	Active maintenance	8

Key theme 1: breast cancer patients’ mental journey upon returning to work

The first theme of the study relates to breast cancer patients’ mental health journey upon returning to work. The journey was found to have three distinct phases: avoiding returning to work, embracing reality and setting sail again, and grasping today and harvesting the future.

Avoiding returning to work

During the early stages of diagnosis and treatment, patients exhibited low motivation or willingness to return to work.

I didn't want to go to work a year ago, but now I think of it as an escape. I feel sick, it is important to save my life, to take care of my illness, to exercise. I lived in my own world, with all my energy and all my thoughts on my illness. When I first got out of surgery, I wasn't doing so well, and I kept thinking about all the breast I'd lost. (Patient H)

I quit my job as soon as I got sick! I don't want my co-workers to know, nor my boss. And that job is so stressful, it's killing me. (Patient C)

Embracing reality and setting sail again

After a post-treatment recovery period, participants tended to release their pain and illness, accept their new reality, and return to work.

It's important to learn to forget that you're a patient. Learn to forget, learn to let go, learn to start again. I've been trying to lose weight and shave my face. Don't think about how many days there are. Live how you want to live! (Patient A)

Now that the treatment is over, I have begun to look for less stressful jobs. I'm a young man. I need to get back on track. (Patient C)

A lot of things take time to fade away. I was lazy to go to work after I got sick, so I went only when I wanted to. And then I started to feel really good about myself. I was just sick. It's all right now. It's no big deal. I'd like to go back to work. (Patient H)

Grasping today and harvesting the future

After a period of adjustment, participants who returned to work reported normal working, finding unexpected benefits from their illness, feeling satisfied with their job, and being hopeful and optimistic about their future.

I think that after getting sick, I have gained a lot of things, such as making friends with a lot of patients, receiving care and concern from colleagues, traveling to many places, the children are mature and the pressure is less. Previously, my stress came from family and life. Now I put down a lot of things and I have learned to let go, especially family and life. Less responsibility, less burden. In the past, I would manage my child's homework every day, and it was easy to get angry. Now I don't care, I don't look at it at all. On the contrary, now he has good grades, is independent, and more disciplined. (Patient D)

I used to be a farmer; it was difficult and without status. I am now doing micro-business, making more money than before, easier! Being sick leads to seeing other possibilities and finding a different way out for yourself! (Patient E)

I think this illness is a reminder to be nice to yourself and live every day seriously! Even though I changed positions, there was no big difference. I'm still a nurse. I'm an undead cockroach! (Patient G)

Key theme 2: factors affecting breast cancer patients’ return to work

The second identified theme pertains to the factors influencing breast cancer patients’ decision to return to work following their treatment. The study revealed that economic pressure, work stress, mindset towards the illness, pursuit of social values, and social support were motivational factors for patients to return to work. Conversely, work-related stress emerged as a hindering factor.

Economic pressure

Some patients believe that finances are a significant factor in motivating them to return to work and that work helps to boost their family income.

Economics is still my main factor. Not going to work will still have an impact on the home economy, and there are still family members to support. (Patient D)

Although my family's financial conditions are OK, it is too little to get a salary of about 3000 yuan a month! Going back to work, I can earn more wages. (Patient F)

Work stress

Although work stress can be a significant barrier to patients’ return to work, several measures were identified to mitigate its impact. For instance, most patients were able to change departments or were provided with reduced workloads by their employers upon their return, which effectively decreased their work-related pressure. Furthermore, the patients’ past work abilities and experiences were found to help reduce work stress and served as driving factors for their return to work.

Although I said that I didn't have to be a class teacher when I went back to work, I was still afraid to go back to work. Today's students are not easy to manage, and I was really angry and dizzy every day when I was a class teacher. But after that, it is possible that I will still be the class teacher. Either way, there's always going to be a trip back to work. (Patient F)

I've gone back to work, but I've changed departments, and the pressure isn't that great and it's not that hard. (Patient I)

I have been working normally since I got sick, because the work is very easy, so there is no pressure. (Patient J)

I feel like I have my own business ability and experience, so there is no pressure to work. (Patient A)

I think I have no problem doing tasks at work, I have been working for more than 20 years, there is no problem! (Patient B)

Mindset towards the illness

The majority of patients emphasized the significance of adopting a proper mindset towards the illness, wherein comprehending the disease and disassociating from the role of a patient facilitated their return to their usual routines and professional engagements.

Society should promote positive energy. Don't keep feeling like a patient. (Patient A)

Everyone gets sick. Now there is no need to disengage yourself from a normal life because of illness. (Patient B)

Give positive energy to your family and yourself. Being sick is nothing remarkable. If you have nothing to do at home all day long, you will be very decadent and your family will be affected. And at home all day long, you will think wildly. I went to work with my own social network, friends, and colleagues, and chatted. (Patient G)

Pursuit of social values

Apart from fulfilling their physiological needs, patients also aspire to achieve a high quality of life. They believe that returning to work can enhance the purpose and significance of their lives.

If you don't work, you will lose a lot of life meaning. (Patient D)

I am a graduate of a prestigious university and have a relatively strong personality. If I don't go out to work, I feel like a waste. (Patient I)

If you don't go to work, you will be empty and do nothing. You will turn into an empty nester. (Patient J)

Social support

A comprehensive social support system consisting of family and friends, colleagues’ care, peer influence, and professional opinions is a crucial factor in facilitating breast cancer patients’ return to work.

The closest people (relatives and intimate friends) are still the main motivation. (Patient A)

The atmosphere of the unit is very good, and everyone cares about me. It is also very embarrassing to push the work to others during the leave. (Patient D)

Because I work in the hospital, my colleagues know that I am sick. (Patient G)

It seems that none of the other patients around me have said that they will not go back to work. It may be related to the positive attitude of our patient group, which affects each other. (Patient B)

I think patients can influence each other. I remember singing when I was hospitalized, and my fellow patients in the same ward sang along with me. Then we became good friends. (Patient D)

What we want to hear is that the doctor just said that you can't die. A simple sentence or two from a health care worker may be able to help a patient. If the doctor says, “You're okay, you can go to work,” then we dare to go to work! (The patient had tears in his eyes while talking about the medical staff). (Patient A)

Discussion

To our knowledge, our study is the first to explore the longitudinal psychological changes in convalescent breast cancer patients returning to work, thus addressing the lack of longitudinal studies on this topic. The participants investigated in this study were all convalescent patients, avoiding the influence of treatment factors that lead to their temporary absence from work. Since both mentality and sense of social value are difficult to quantify, this study supplements the deficiency of quantitative research through in-depth qualitative interviews.

Our study explores the psychological changes experienced by breast cancer patients during their rehabilitation, after completing curative treatment and returning to work. Our study included only convalescent patients, eliminating the influence of treatment factors that lead to temporary absences from work. Thus, our findings have representative significance. We identified a dynamic process of mental transition in breast cancer patients’ return to work: avoiding returning to work, embracing reality and setting sail again, and grasping today and harvesting the future. Our findings are consistent with conclusion that returning to work is a complex and evolving process.¹⁷ This highlights the importance of considering patients’ mental states when facilitating their return to work.

The findings of this study suggest that economic pressure, work stress, mindset towards illness, pursuit of social values, and social support crucially influenced breast cancer patients’ return to work, consistent with previous research.^25–27 Some patients cited economic factors as the primary motivator for returning to work, especially those with higher incomes.⁸ Patients with higher incomes generally have better educational backgrounds and stronger self-efficacy.⁵ They tend to enjoy superior working conditions and greater job security. Even after breast cancer treatment, they can return to work more quickly, often securing positions that are less physically demanding and offer favorable conditions.^28,29 Social support, including support from family, friends, colleagues, fellow patients, and professionals, was also found to be an important factor in promoting patients’ return to work, consistent with foreign studies.^30–32 Work stress was identified as a barrier to returning to work, consistent with related findings,^33,34 and past work ability and experience were found to help reduce work-related stress, promoting patients’ return to work.³⁵ Additionally, qualitative interviews revealed that a positive attitude towards illness and the potential to create higher social value through returning to work motivated patients. As these factors are difficult to quantify, this study adds to the current quantitative research by providing in-depth qualitative insights. This suggests that future large-sample quantitative studies should focus on patients’ mindset and sense of social value, and design tools that can effectively measure these factors.

Based on the results, facilitating the return to work for breast cancer survivors requires not only attention to their physical recovery, but also necessitates comprehensive consideration of psychosocial status, occupational characteristics, and social support networks, implementing coordinated, multidisciplinary, and tailored interventions.^30,36 Medical staff need to recognize the factors influencing breast cancer patients’ return to work and implement appropriate interventions. One possible intervention is establishing rehabilitation volunteer groups, which can provide patients with social support from medical staff and help them maintain an optimistic outlook during their recovery and return to work. Additionally, healthcare professionals should focus on providing patients with the necessary education and resources to help them manage their illnesses and promote a healthy work-life balance. Effective communication and coordination with patients’ family members and employers are also crucial. For example, advising family members on how to care for the patient, and discussing with employers the possibility of adjusting job roles to reduce work stress or physical labor. Overall, the findings of this study suggest that healthcare professionals, employers, and social support networks can facilitate a successful return to work for breast cancer patients, particularly through tailored support and accommodations.^30,37

Limitations

This study has several limitations that should be taken into consideration. Firstly, the sample size was relatively small, which may limit the generalizability of the findings to other breast cancer patients. Secondly, the participants in this study may have shown a bias towards returning to work, as they all expressed a positive attitude towards it. In future research, it would be beneficial to include patients who are hesitant to return to work. Lastly, the current study only provides a cross-sectional view of the participants’ experiences and cannot objectively assess changes in the patients’ psychological state over time. To address this limitation, future research should consider conducting longitudinal observational studies.

Recommendations for further research

Firstly, future studies could explore the role, long-term outcomes and sustainability of workplace support programs for breast cancer patients, investigating their effectiveness in promoting successful reintegration and maintaining employment. Additionally, future research directions will further explore the cultural and socioeconomic backgrounds of breast cancer patients. Investigating the impact of cultural and socioeconomic factors on the experiences of breast cancer patients returning to work could provide valuable insights for tailoring interventions to diverse populations. Furthermore, longitudinal studies examining the trajectory of patients’ mental journey when returning to work could shed light on the long-term challenges and coping strategies employed. Finally, this study has a relatively small sample size. Future research could enhance the generalizability of findings by increasing the sample size.

Conclusions

The present study highlights that returning to work for breast cancer patients is a dynamic process that can help them overcome the pain of the illness and improve their sense of self-worth, ultimately allowing them to return to a normal life. Our findings reveal that several factors can impact patients’ return to work, including economic pressure, work stress, positive mindset face of illness, pursuit of social values, social support, and work-related stress. Therefore, it is vital for medical professionals to develop interventions that specifically address these factors to better support breast cancer patients in their return to work. Overall, this study contributes to a deeper understanding of the psychological changes and challenges experienced by breast cancer patients while returning to work.

Footnotes

Acknowledgements

The authors thank all the participants for their contributions to this study. This research abstract was orally presented at ICCN 2022 – the International Conference on Cancer Nursing

ORCID iDs

Liping Zhang

Minshan Liang

Huiting Zhang

Ethical approval (name of institute and number)

Approval was obtained from the ethics committee of Sun Yat-sen University Cancer Center (No.GYXHY-2020-003). The procedures used in this study adhered to the tenets of the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from all participants.

The authors declare no financial and personal relationships with other people or organizations that could inappropriately influence their work.

Funding

This studay was funded by the 2020 Medical Scientific Research Foundation of Guangdong Province of China (A2020088) and Guangzhou Concord Medical Humanities Research and Education Fund (23000-3050070).

Declaration of conflicting interests

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

References

Bray

Laversanne

Sung

, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74: 229–263.

SiYi

MaoMao

, et al. Age distribution and trend of disease burden for female breast cancer worldwide and in China. China Cancer 2023; 32: 1–7.

Luo

Liu

Chen

. A visualized and bibliometric analysis of cancer vocational rehabilitation research using CiteSpace. Work (Reading, Mass) 2025; 80: 567–578.

Porro

Durand

Petit

, et al. Return to work of breast cancer survivors: toward an integrative and transactional conceptual model. J Cancer Survivorship: Res and Pract 2022; 16: 590–603.

Lange

Lequesne

Dumas

, et al. Cognition and return to work status 2 years after breast cancer diagnosis. JAMA Network Open 2024; 7: e2427576.

Magnavita

Di Prinzio

Meraglia

, et al. Supporting return to work after breast cancer: a mixed method study. Healthcare (Basel, Switzerland) 2023; 11: 2343.

Yang

Chen

, et al. Return to work and mortality in breast cancer survivors: a 11-year longitudinal study. Int J Environ Res Public Health 2022; 19: 14418.

Hequet

Hamy

Girard

, et al. Variation over time of the factors influencing return to work and work capacities after a diagnosis of breast cancer: a study on the behalf of the Seintinelles research network. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 2022; 30: 5991–5999.

Ran

Yun

Yangzong

, et al. Status quo of returning to work among Asian breast cancer survivors and its influence factors: a scoping review. Mil Nurs 2024; 8: 70–73.

10.

Bøhn

Vandraas

Kiserud

, et al. Work status changes and associated factors in a nationwide sample of Norwegian long-term breast cancer survivors. J Cancer Survivorship: Res Pract 2024; 18: 375–384.

11.

Plym

Johansson

ALV

Bower

, et al. Impact of chemotherapy, radiotherapy, and endocrine therapy on sick leave in women with early-stage breast cancer during a 5-year period: a population-based cohort study. Breast Cancer Res Treat 2020; 182: 699–707.

12.

Akezaki

Nakata

Kikuuchi

, et al. Factors associated with return to work of breast cancer patients following axillary lymph node dissection. Work (Reading, Mass) 2021; 70: 271–277.

13.

Sun

Shigaki

Armer

. The influence of breast cancer related lymphedema on women's return-to-work. Women's Health (London, England) 2020; 16: 1745506520905720.

14.

Lieb

Wünsch

Schieber

, et al. Return to work after cancer: improved mental health in working cancer survivors. Psychooncology 2022; 31: 893–901.

15.

Ling

Feng

Lin

. Clinical status and influencing factors of return-to-work readiness of breast cancer patients after operation. J Clin Pathol Res 2022; 42: 2792–2799.

16.

Xiaoli

Huiting

Lijuan

, et al. Return-to-work status of breast cancer survivors and its influencing factors. Chin J Mod Nurs 2020; 26: 9.

17.

Tan

FSI

Shorey

. Experiences of women with breast cancer while working or returning to work: a qualitative systematic review and meta-synthesis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 2022; 30: 2971–2982.

18.

King

Stafford

Butow

, et al. Psychosocial experiences of breast cancer survivors: a meta-review. J Cancer Survivorship: Res Pract 2024; 18: 84–123.

19.

Johnston

Dowling

. Qualitative research and cancer nursing: a guide for novice researchers. Semin Oncol Nurs 2023; 39: 151397.

20.

Burch

. Phenomenology’s place in the philosophy of medicine. Theor Med Bioeth 2023; 44: 209–227.

21.

Lee

Kim

Shin

, et al. Psychometric properties of the readiness for return to work scale in occupational rehabilitation in South Korea. BMC Public Health 2023; 23: 39.

22.

Huili

Kun

Qianqian

. Reliability and validity of Chinese version of the readiness for return-to-work scale in breast cancer patients. Chin J Rehab Med 2019; 34: 801–807.

23.

Franche

Corbière

Lee

, et al. The readiness for return-to-work (RRTW) scale: development and validation of a self-report staging scale in lost-time claimants with musculoskeletal disorders. J Occup Rehabil 2007; 17: 450–472.

24.

Hennink

Kaiser

. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med (1982) 2022; 292: 114523.

25.

Marinas-Sanz

Iguacel

Maqueda

, et al. Facilitating factors and barriers in the return to work of working women survivors of breast cancer: a qualitative study. Cancers (Basel) 2023; 15: 874.

26.

Hou

Liu

, et al. Exploring the employment readiness and return to work status of breast cancer patients and related factors. Int J Nurs Sci 2021; 8: 426–431.

27.

Butow

Laidsaar-Powell

Konings

, et al. Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies. J Cancer Survivorship: Res Pract 2020; 14: 114–134.

28.

Tracy

Adetunji

Al Kibria

, et al. Cancer-work management: hourly and salaried wage women's experiences managing the cancer-work interface following new breast cancer diagnosis. PLoS One. 2020;15:e0241795.

29.

Swanberg

Nichols

Vanderpool

, et al. Working poor and working nonpoor cancer survivors: work-related and employment disparities. Cancer Rep (Hoboken, NJ). 2018; 1: e1134.

30.

Sheppard

O'Connor

Jefford

, et al. ‘Beyond cancer’ rehabilitation program to support breast cancer survivors to return to health, wellness and work: feasibility study outcomes. Curr Oncol (Toronto, Ont) 2023; 30: 2249–2270.

31.

Yagil

Goldblatt

Cohen

. Family members’ experiences of the return to work of cancer survivors. Health Soc Care Community 2022; 30: 184–192.

32.

Melnyk

Djukic

Merriman

, et al. An integrative review: women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis. J Adv Nurs 2021; 77: 2144–2154.

33.

Liu

Wang

Yang

, et al. Work productivity loss in breast cancer survivors and its effects on quality of life. Work (Reading, Mass) 2021; 70: 199–207.

34.

Şengün İnan

Günüşen

Özkul

, et al. A dimension in recovery: return to working life after breast cancer. Cancer Nurs 2020; 43: E328–Ee34.

35.

Kollerup

Ladenburg

Heinesen

, et al. The importance of workplace accommodation for cancer survivors - the role of flexible work schedules and psychological help in returning to work. Econ Hum Biol 2021; 43: 101057.

36.

Martin

Di Meglio

Menvielle

, et al. Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 2022; 30: 8287–8299.

37.

Popa

AE.

Moving beyond the patients’ views on the process of return to work after cancer: a qualitative evidence synthesis on articles published between 2008 and 2017. Work (Reading, Mass). 2022;72:1299–1310.