Medizinisch-beruflich orientierte Rehabilitation (MBOR) in der Onkologie – 2-Jahres-Erfahrungen mit einem standardisierten, multimodalen Therapiekonzept

Porpuse The gain of early detection and the improvement of cancer treatment have led to an increased prevalence of cancer survivors. The return to work (RTW) after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this study was the evaluation of a multidisciplinary rehabilitation concept (Scheidegger MBOR concept) to identify factors and barriers for a successful RTW. Methods During indoor rehabilitation all patients were screened for higher risk to fail RTW. After positive screening a multidisciplinary standardized treatment (job-related physio- and ergotherapy, coaching by social service and psycho-oncologists, information about aftercare) was decreed. At onset of treatment inhibitory factors for returning to work, psychical distress (NCCN distress thermometer) and presence of chronical pain (NRS) in comparison to a control group (n=100) were recorded and medical or social recommendations for RTW were analyzed. Results 282 pts (similar to 4.4%) with higher risk to fail RTW were included. 54 pts (19.1%) with symptomatic visceral metastasis were excluded. So, 228 pts were included. In 25.9% a limited illness-related pension and in 18.2% work-promoting measures (e.g., retraining) were recommended. In 38.6% a gradual re-integration at workplace was advised. Patients complained more often about chronic pain (P=0.13) with stronger intensity (P=0.007) and more physical distress (P<0.001). As inhibitory factors weakness/fatigue (42,5%), mental stress (34,7%), disease-promoting working conditions (18,4%) or lack of appreciation/mobbing (14,9%), age (15,7%), pain (13,1%). Disease or treatment-related symptoms (CIPN, lymph edema) were specified less frequently (<10%). Discussion In comparison to other rehabilitation areas proportion of patients with risk to fail RTW is lower after cancer treatment. Yet, vocational advancement and RTW for cancer patients is important as well as the acceptance of the rehabilitation concept was high. Main obstructions for RTW are fatigue, stress and work-related factors were specified. Conclusions Considering these data future concepts for professional reintegration and RTW have to focus on reduction of fatigue, motivation, stress reduction and work-related factors, ideally in cooperation with employers.