Oncological occupational rehabilitation to enhance return to work in cancer patients.

For cancer survivors, work resumption is related to quality of life and
economic independence. However, rates of lasting return to work among cancer
survivors are suboptimal. Inadequate guidance by an occupational physician, and
persisting fatigue due to chemotherapy, are two of the main predictors of
failure to return to work. We expect that early individual counseling by an
occupational physician specialized in cancer patients, who can discuss
possibilities and barriers for return to work and provide personal advice,
combined with moderate-intensity aerobic and resistance exercise during
treatment aimed at maintaining cardiorespiratory fitness and lowering fatigue,
will be an effective strategy to elevate the chances of timely return to work
of oncological patients. Whether it is feasible, useful, and desirable to add
occupational counseling and exercise sessions to usual care in the hospital,
needs to be investigated.

Primary objective:
To determine the feasibility, perceived usefulness, and patients' satisfaction
regarding occupational rehabilitation during chemotherapy in a clinical
setting, consisting of counseling by an occupational physician, and an exercise
program supervised by a sports physician.

Secondary objective:
To determine the changes between baseline and follow-up in e.g. fatigue,
quality of life, work ability, and return to work among oncological patients
who received the abovementioned occupational rehabilitation, and to calculate
its costs.

Feasibility study with measurements at baseline, after 1, 4, 6, 12, and 18
months.
Patients will be invited to participate by their oncologist before the start of
chemotherapy.
After having provided informed consent, all patients will receive the
counseling and exercise program.
.

The intervention consists of:
three counseling sessions with an occupational physician, who discusses the
disease-related posibilities and limitations for work and the objective and
subjective work capacity of the patient, and provides personal advice on
gradual work resumption, and

moderate intensity aerobic and resistance training, led by a physiotherapist
and supervised by a sports physician, during 12 weeks, twice a week, for one
hour per session. The intensity of the training is based on the results of a
fitness and strength test at baseline.

All patients are 18 years or older; all patients have at minimum a week to
consider participation; the counseling and exercise sessions will take place
in the hospital in which the patients are treated; the time necessary for the
counseling sessions is 2.25 hours, for the 12-week exercise program, the intake
and evaluation by the sports physician, and the intake by the physiotherapist
27 hours, and for filling out the 6 questionnaires 2 hours; appointments for
the two sports medical assessments and three counseling sessions will be made
in consultation with the patient; if a patient is unable to attend a session
due to (the consequences of) his chemotherapy, he will not be obliged to do
so; there are no invasive measurements, i.e. no urine, saliva or blood will be
collected; according to the ACSM, exercise during treatment is effective and
safe; the intervention is carried out by an occupational physician experienced
in counseling oncological patients, and by sports physicians and
physiotherapists experienced in exercise training of oncological patients after
treatment; there will always be an oncologist present in the hospital during
the counseling and exercise sessions; there are no risks associated with
participation.