Return to Work and Survival Outcomes among Gastric Cancer Survivors: A Nationwide Population-based Cohort Study

Background: Return to work (RTW) is widely used in occupational and rehabilitation research as a marker for recovery after illness. For cancer survivors, returning to employment may be influenced by demographic factors, comorbid conditions, treatment exposures, and job characteristics. Aim: We conducted a retrospective cohort study to evaluate determinants of RTW among Taiwanese workers newly diagnosed with gastric cancer and to examine whether RTW is associated with long-term survival. Methods: Using linked national databases, 4467 eligible workers diagnosed between 2004 and 2015 were followed for up to 11 years. Predictors of RTW at the 2- and 5-year time points were assessed with Cox regression, and survival differences by RTW status were evaluated using Kaplan–Meier methods. Results: Older age, male sex, selected comorbidities, receipt of chemotherapy or radiotherapy, and manual occupations were associated with a lower probability of RTW, whereas surgery and earlier pathologic stage increased the likelihood of returning to employment. After multivariable adjustment, stage I disease showed markedly higher RTW hazards compared with more advanced stages (hazard ratio [HR] = 4.67, 95% confidence interval [CI]: 2.99–7.31 at year 2; HR = 7.44, 95% CI: 4.12–13.43 at year 5). Across all stages, reemployed survivors demonstrated superior survival, and RTW remained associated with reduced all-cause mortality (adjusted HR = 0.49, 95% CI: 0.38–0.65). Conclusion: Interventions that address modifiable barriers and reinforce facilitators of RTW may support workforce reintegration and improve outcomes among gastric cancer survivors.