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Zhang Y, Zhu M, Wu X, Meng Y, Pu F, Zhang M. Factors associated with returning to work and work ability of colorectal cancer survivors. Support Care Cancer. 2021 Nov 6. Epub ahead of print.
结直肠癌幸存者重返工作和工作能力的影响因素
Background 研究背景
Colorectal cancer (CRC) is the third most common cancer worldwide, and second in terms of mortality. China has become the country with the highest number of new cases and deaths of CRC every year in the world. With the sustained improvement in the prognosis of CRC, an increasing number of CRC survivors need to face the problem of returning to work (RTW) during or after treatment. RTW can not only improve the quality of life and mental state of survivors, but also improve economic toxicity, increase family income, and reduce social burdens. There are some studies on the RTW of cancer survivors, but not many on CRC survivors, and the investigation of CRC survivors in China is even less. Moreover, few studies focused on the factors affecting the RTW and work ability of CRC patients, let alone the influence of symptom distress and psychological adjustment on them.
结直肠癌（CRC）是全球第三大常见癌症，死亡率位居第二。中国已成为世界上每年新增病例和死亡人数最多的国家。随着大肠癌预后的持续改善，越来越多的大肠癌幸存者需要在治疗期间或治疗后重返工作(RTW)。RTW不仅可以改善幸存者的生活质量和精神状态，还可以改善经济毒性，增加家庭收入，减轻社会负担。关于癌症存活者RTW的研究已有一些，但对结直肠癌存活者RTW的研究并不多，中国对结直肠癌存活者的调查更是少之又少。此外，很少有研究关注影响结直肠癌患者重返工作和工作能力的因素，更不用说症状困扰和心理调整对结直肠癌患者RTW和工作能力的影响。
Objective 研究目的
To describe the status of returning to work and work ability of colorectal cancer survivors and identify the key factors associated with returning to work and work ability of Chinese colorectal cancer patients.
描述结直肠癌幸存者重返工作岗位和工作能力的现状，确定与中国结直肠癌患者重返工作岗位和工作能力相关的关键因素。
Design 研究设计
A cross-sectional study with convenience sampling of 212 CRC survivors recruited from November 2018 to November 2019 in the outpatient clinic of a cancer center affiliated with a university in Guangdong Province, China.
2018年11月至2019年11月，在中国广东省一所大学附属癌症中心的门诊部招募了212名结直肠癌幸存者，进行了方便抽样的横断面研究。
Participants and Setting 研究对象
A convenience sampling of 212 CRC survivors recruited in the outpatient clinic of a cancer center. CRC patients included in this study were (1) diagnosed with primary CRC and completed all basic treatments for cancer, besides surgery and adjuvant treatment; (2) were employed and worked for more than 1 year before diagnosis; (3) over 18 years old and less than the legal retirement age, female patients under 55 years old, male patients under 60 years old; and (4) aware of their own disease diagnosis.
Exclusion criteria were (1) diagnosed with mental illness or cognitive dysfunction; (2) with severe heart, lung, brain, kidney, and other serious diseases; (3) recurrence or metastasis during treatment, or with other malignant tumors; and (4) not able to complete a questionnaire in Chinese.
在一家癌症中心的门诊诊所便利选取212名结直肠癌幸存者。纳入本研究的大肠癌患者（1）被诊断为原发性大肠癌，并完成了手术和辅助治疗外的所有癌症基本治疗；（2）诊断前受雇工作1年以上；（3）18岁以上不满法定退休年龄，女性患者55岁以下，男性患者60岁以下；（4）了解自己的疾病诊断。排除标准为（1）诊断为精神疾病或认知功能障碍；（2）患有严重的心、肺、脑、肾等严重疾病；（3）治疗期间复发或转移，或与其他恶性肿瘤合并；（4）无法用中文填写问卷。
Method 研究方法
We evaluated patient’s return to work (Yes/No), work ability, and factors by questionnaires of the Work Ability Index (WAI), M. D. Anderson Symptom Inventory for Gastrointestinal (MDASI-GI), and the Self-Report Psychosocial Adjustment to Illness Scale (PAIS‐SR). Logistic regression analysis and linear regression were used to find the potential predictors with returning to work and work ability.
我们通过工作能力指数（WAI）、M.D.安德森胃肠道症状量表（MDASI-GI）和自我报告心理社会适应疾病量表（PAIS-SR）的问卷，评估患者重返工作（是/否）、工作能力和影响因素。采用Logistic回归分析和线性回归分析，寻找重返工作和工作能力的潜在预测因素。
Results 研究结果
Participants mostly 145 have returned to work (68.4%). Work ability and psychosocial adjustment of colorectal cancer survivors were at a moderate level. After completing treatment, the patient still had many symptoms, and these symptoms were distress to live. In the two models, survivors with higher family monthly income per capita and lower psychosocial adjustment scores were more likely to have higher work ability and return to work. Survivors with lower symptom distress were more likely to have higher work ability (r = − 0.038, P= 0.010). Survivors with higher work ability were more likely to return to work (OR = 1.193, 95% CI = (1.116,1.274)).
大多数参与者145人（68.4%）重返工作岗位。结直肠癌幸存者的工作能力和心理社会适应处于中等水平。在完成治疗后，患者仍有许多症状, 这些症状对生活来说是痛苦的。在这两个模型中，家庭月人均收入较高、心理社会适应得分较低的幸存者更有可能拥有较高的工作能力并重返工作岗位。症状较低的幸存者更有可能具有较高的工作能力（r=− 0.038，P=0.010）。具有较高工作能力的幸存者更有可能重返工作岗位（OR=1.193，95%CI=（1.116,1.274））。
Conclusions 研究结论
CRC survivors had a low RTW rate and a moderate level of WA. The study confirmed the correlation of symptom dis- tress, psychosocial adjustment, WA, and RTW. Supportive interventions can improve the symptom distress and psychosocial adjustment of cancer survivors, to improve the survivors’ WA and RTW rate.
结直肠癌幸存者重返工作岗位发生率低，工作能力水平适中。该研究证实了症状困扰、心理社会适应与结直肠癌幸存者重返工作和工作能力显著相关，应在未来的干预研究中予以考虑。支持性干预可以改善癌症幸存者的症状困扰和心理社会适应，提高幸存者的工作能力和重返工作岗位率。
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