After the relatively slow start for Cochrane reviews in cancer, there are an ever increasing number tackling the effects of interventions relevant to this disease. Cochrane reviews examine the evidence on screening, treatment, management of the consequences of treatment, and palliative care. This collection was added to this month by a new review of ways to help cancer patients overcome a major challenge faced by many after diagnosis and treatment, going back to work. This is a rising problem for all the right reasons: improvements in the detection and treatment of cancer are producing an increasing the number of cancer survivors.

The authors of the new Cochrane review sought both randomized trials and controlled before-after studies of a wide variety of interventions. They were interested in psychological, physical, medical or multidisciplinary strategies; as well as any studies that looked specifically at vocational interventions aimed at employment and return-to work. However, they found none of the latter, with existing research dominated by studies which tackle the problem from a healthcare perspective.

The research base in the review comprises 14 randomised trials and four before-after studies. These recruited more than 1600 patients and examined a total of 18 different interventions. The most successful results came from the studies of three multidisciplinary approaches, which had combined physical, psychological and vocational elements. There was little or no evidence that these categories of intervention were effective on their own.

For example, there was low quality evidence that return-to-work rates were similar for psychological interventions compared to usual care, and, also, that physical training was no more effective. The eight randomized trials of medical interventions; such as radiotherapy, surgery and chemotherapy; also provided low quality evidence that the extent of the intervention had little impact on whether or not patients returned to work.

On the other hand, multidisciplinary interventions did lead to higher return-to-work rates than usual care. These interventions included, for example, physiotherapy or exercise, counselling and encouragement to go back to work from a cancer nurse. The authors of the Cochrane review suggest that this combination of approaches is effective because it targets the variety of factors that can prevent or delay return to work, including fatigue and depression.

This Cochrane review is available in full at http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007569/frame.html

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February 28 2011