A qualitative meta-synthesis on return to work decision-making, experiences, and challenges in cancer survivors

Returning to work (RTW) after cancer treatment is a complex process considering the negative impact of cancer therapy on clinical, psychological, and social outcomes of cancer survivors. Yet, it is an important step that survivors have to consider in their life after the disease. This meta-synthesis aims to investigate qualitative evidence on what impacts return-to-work decisions, and what challenges and experiences cancer survivors encounter while returning to work. Three scientific databases (PubMed, Scopus, and Embase) were systematically searched to identify qualitative studies investigating return-to-work decisions, challenges, and experiences. The meta-synthesis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the included studies was assessed with The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Twenty-nine studies were included in this review. Thematic analysis identified 5 interconnected themes: (1) RTW decision-making (including findings that work serves as a “distraction from cancer” and “desire for normalcy/independence”), (2) role of support, (3) impact of cancer on work ability (highlighting the significant of both physical and cognitive impairment), (4) financial aspects, and (5) challenges of returning to work(including stigma and discrimination). The findings demonstrate that these themes are not isolated but collectively map the full RTW pathway. This meta-synthesis uniquely integrated RTW decision-making, experiences, and challenges into a single qualitative synthesis. The findings demonstrate RTW’s positive impact on survivors’ quality of life and discuss 5 interconnected themes impacting the RTW journey. This work provides actionable targets for interventions and policy: strengthening support systems, addressing physical and cognitive work ability, and reducing workplace stigma. Furthermore, the findings can provide a foundational framework for future research to undertake deeper investigation of each individual theme.