Table 1.

Summary characteristics (study design, facilitator & barrier of return to work ) of included studies.

Study	Country	Participants/ Sample	Study design	Facilitator for employment & RTW	Barrier of employment & RTW	Controversial/Doubtful/ Other comments on RTW
A. Quantitative Study
E. Ahn et al, 2009, Breast cancer Res treat	South Korea	Breast cancer survivors N = 1594 & comparison group N = 415, female age 20 - 60 yrs	Cross sectional study (data from the five hospital-based breast cancer registries)	Age 40 - 49 No spouse, widow or divorced	Age <40 Low level of education Low household income Women lived with spouse *Fatigue & exhaustion Multiple co-morbidities Advance disease stage & more extensive surgery (e.g. mastectomy) Reduced work related abilities Decrease wages, reduced working hours,	House hold income may be both a cause or result of unemployment Socio-cultural factors as well as certain clinical characteristics influence the decisions of Korean women to return or not to RTW
C. Roelen et al, 2011, Breast Cancer Res Treat	Netherland	Breast cancer patients N = 492 (2008) Breast cancer patients N = 398 (2002), women age <40 - >50 yrs	Longitudinal study (ArboNed register data from 2002 to 2008)	Not described	Not described	The proportion of partial RTW was stable around 70% from 2002 to 2008 but full RTW was decreased from 52% in 2002 to 43% in 2008 -Change in Dutch disability policies in 2004 may be responsible for the decrease full RTW
S. Q. Fantoni et al, 2010, J Occup Rehabil	Northern France	Cancer survivors N = 379, age 18 - 60 yrs	Retrospective cohort study	Higher education women with no husband, moral support from friends and family moral support from the colleagues	Older age (>50 years), lower educational level, fatigue, pain chemo & radiotherapy, lymphoedema psychological constrains lack of moral support from the colleagues or employers	The self-perceived factors must be consider: first to help support these women during their sick leave and second to initiate a work resumption support process which takes into account both the person and her environment.
A. Johnsson et al, 2007, Acta Oncologica	Sweden	Pre-menopausal breast cancer patients N = 270, female age 29 - 54 yrs	Randomized trial	Not described	Advanced tumor stage adjuvant endocrine therapy Chemotherapy Not able to work same extent as previously.	Age, education level, marital status, under age children has no association with RTW
J. A. Hansen et al,2008, J Occup Environ Med	U.S.A	Breast cancer survivors N = 100, female mean age 49.5 years (range 20 - 70) & non-cancer comparison N = 103, mean age 39.8 years (range 20 - 70)	Cross sectional study	Not described	**Fatigue, work limitations depression	Demographic, medical status, and treatment variables were not related to work limitation
K Carlsen, 2013, Acta Oncologica	Denmark	No of cancer survivors = 170 & cancer free control N = 391, age 35 - 64	Cross sectional	Reduce work load, support from supervisors	low income fatigue reduced work ability Poor support from the colleagues and supervisors	Work ability of long-term breast cancer survivors who are disease-free and back in work is impaired in comparison with that of cancer-free women.
M. Drolet et al, 2005 CMAJ	Canada	Breast cancer survivors N = 646 & comparison group: N = 890, female age range 18 - 59 years	Retrospective cohort study	Financial burden Not belonging to a union self-employed, white-collar job	Patients who took chemotherapy, belonging to a union were more likely absented 4 weeks or more from their work	-
M. Drolet et al, 2005 Journal of clinical Oncology	Canada	Breast cancer survivors N = 646 & comparison group: N = 890, female age range 18 - 59 years	Retrospective cohort study	High income(<$ 50,000)	Older age low income (<$ 20,000 compared with ≥$ 50,000 ) union membership	√ Adjuvant therapy (chemo or radiotherapy) did not predict work cessation √ Slightly more survivors were not working 3 years after diagnosis compared with non-cancer women (21% and 15% respectively)
R. R. Bouknight et al, 2006, Journal of Clinical Oncology	USA	Cancer survivors enrolled: N = 443, completed study 12 months patients: N = 416, mean age 50.8 years completed study 18 months patients: N = 407, mean age 50.9 years	Prospective longitudinal study, assessment was done at 12 & 18 months of cancer diagnosis	Younger age good health, early tumor stage workplace accommodation	older age, black race, low health status advanced tumor stage heavy lifting work, perceived employer discrimination	Chemotherapy had no effect on return to work
A. Johnsson et al, 2011, Work	Sweden	Cancer survivors : N = 102, female age 35 - 63 years	Cohort study, assessment was done at 6 weeks, 6 & 10 months after surgery	Higher life satisfaction with life as a whole (satisfaction with vocational situation, somatic health and psychological health)	Low satisfaction with vocational situation irradiation to breast/ chest wall, and regional nodes Chemotherapy** axillary node dissection	Age, educational level, marital status, manual work were not associated with RTW
V.S. Blinder et al, 2012, Cancer	USA	Low income Latinas and Non-Latina white breast cancer survivors: N = 290, Latina survivors: N = 179, age 32-65 years & Non-Latina Whites survivors: N = 111, age 26-85 years	Longitudinal study, assessment was done at 6, 18, & 36 months of cancer diagnosis	More no of children at home to help with daily tasks, social support	**Low income Manual work, chemotherapy & higher comorbidity	Neither low-income Latinas nor non-Latina Whites approached the 80% rate of RTW seen in rich white cancer survivors
R. M. Villaverde et al, 2008 Occupational Medicine	Spain	Cancer survivors: N = 96, mean age 47 years (range 22 - 65 years)	Cohort study	Self-employed helpful co-workers and employers	Fatigue lymphodema, comorbidity, advanced stage disease	None reported job discrimination
E.Hedayati et al, 2012 Scand J Caring Sci	Sweden	Cancer survivors: N = 44, women age 40 - 64 years	Cohort study	Other adjuvant therapy except for chemotherapy	*chemotherapy advanced disease stage, lymph node involvement, positive Her2 status	Cognitive function do not predict RTW
B. Hauglann et al, 2012, J Cancer Surviv	Norway	Breast cancer case: N = 1548 and cancer free controls : N = 1548, age <50 -≥50 years	Cohort (National register based controlled cohort study)	Not described	Reduced income, reduce work ability early disability pension	At the end of the observation period, employment rates were higher in non-disabled patients than in non-disabled controls (82% vs.77%, p = 0.008)
E. Maunsell et al, 2004, journal of the National Cancer Institute	Canada	Breast cancer survivors: N = 646 comparison group: N = 890, age 18-59 years	Cohort study (population-based retrospective cohort study)	Not belonging to a union, No health insurance coverage among the labour force participants	Own decision to stop working new cancer events job is too difficult	√ Older age did not negetively affect the work situation √ discrimination at work was rare. √ After 3years, slightly more survivors (21%) than women in the comparison group (15%) were unemployed (RR adjusted = 1.29; 95% CI 1.05-1.59)
F. Balak et al, 2008, J occup Rehabil	Netherland	Patients with early stage breast cancer: N = 72, mean age 49.2 years (18-65 years)	cohort study	Patients who did not receive adjuvant therapy	Fatigue, chemotherapy & multimodal treatment	√ Age of women is not related to RTW √ The time taken to RTW after early stage breast cancer was principally determined by the type of treatment.
S. Lillehorn et al,2012, Scandinavian Journal of Caring Sciences	Sweden	Breast cancer survivors: N = 56, mean age 49 years (range 31-60 years)	longitudinal study, repeatedly interviewed over a period of 18-24 months	Willingness/ self-motivation, normalcy, missing work place	Physical sickness, chemotherapy, fatigue, exhaustion, discouraging work environment	Potential interactive relationships between biomedical and psychosocial circumstances affecting the return to work process.
M.J. Hassett et al, 2009, cancer	USA	Cancer survivors with employed health insurance: N = 3233, age 44-63 years	cohort(population of employed insured women) study	**health insurance	Chemotherapy	Radiation therapy did not influence employment
A. Johnsson et al, 2009, Acta Oncologica	Sweden	Survivors with early stage breast cancer: N = 102, age 35 - 63 years	Prospective Cohort (early stage breast cancer) study	Good self-rated health, Being born in Sweden, high satisfaction with life, low demand in work situation	High demand job chemotherapy axillary lymph node dissection	Age, educational level, living with underage children, marital status, manual work were not associated with RTW
B. Qualitative Study
C. Tiedtke et al, 2012, BMC Public Health	Belgium	Breast cancer participants: N = 22, mean age 46 years (range 40 - 55 years)	Qualitative study	For financial independence, Self-motivation, Normalcy, Good social environment	Anxiety, frustration, Assuming employer will not eagerly welcome, employers negative attitude,	Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job;(ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and(iv) they have doubts about being accepted in the workplace after returning
F. L. Tan et al, 2012, Asian Pacific J Cancer Prev	Malaysia	Cancer survivors N = 40, female age 18 - 60 yrs	Qualitative study	Social Support (More for Malay) regards for financial independence (more among Chinese) support from the employers	Over protective family, tiredness, fatigue, pain depression, worrying, frustrations high physical job demand, fear of potential environment hazards	Health professionals and especially occupational therapist should be consulted to assist the increasing survivors by providing occupational rehabilitation to enhance RTW among employed survivors
V.S. Blinder et al, 2012, J Community Health	U.S.A	Cancer participants N = 23,among them African American = 3 African-Caribbean = 5 Chinese = 5 Filipina = 4 Latina = 3 Non-Latina white = 3; female age range 29 - 63 years	Qualitative study	Normalcy & Acceptance to maintain a normal environment at work, family history of breast cancer social support from friends, family and colleagues	Appearance and privacy lower support from the employers	Financial strain prevent African-American to take more time off from their work African-Caribbean get support from their friends & family Acceptance of cancer is common in Chinese Latina group has more fear of death, Non-Latina white has more family history of cancer which helps them to accept it.
C. Tiedtke et al, 2012, J Occup Rehabil	Belgium	Flemish stakeholders cancer survivors N = 26	Qualitative study	Improve legislation	Varying stakeholder perspective, Belgian legislation which emphasis the patients or disability role	Motivated stakeholders can positively affect RTW
A. Johnsson et al, 2010, Eur J Cancer Care	Sweden	Cancer survivors: N = 16, female age range 44 - 58 years	Qualitative study	Strong wish to stay in the labour market support from the workplace	Change in outlook, Poor social support, Psychological ill health, Diminish work capacity, unclear work roles,	Support from the workplace is of great importance for a successful RTW
S.J. Tamminga et al, 2012, Scand J work Environ Health	Netherland	Breast cancer survivors: N = 12, age 28 - 51 years	Qualitative study	Importance of work support from the supervisors social support	Temperment, feeling guilty treatment itself, having another co-morbidity slow or insufficient recovery over time physical workload, stressful job lack of support from colleagues, employers and/ or occupational physician	During initial RTW, physical & psychological side effect hampered work resumption. In the post RTW stage, work environment is the important factor.
M. Nilsson et al, 2011, Eur J Oncol Nurs	Sweden	Breast cancer survivors: N = 23, mean age 53 years (range 37 - 62 years)	Qualitative study	Support from the friends and family Support from the workplace, healthcare personnel flexibility in the implementation of sick rules	Lack of support from the colleagues and employer Disrespectful attitude of social insurance officers	* Three factors were identified which could be barrier or facilitators for RTW- i. The Adjustment to be arranged according to the survivor's requirements ii. Information (sickness insurance or side effects of treatment, benefit of being employment) sharing to the survivors iii. Attitudes (perceived and appraised) to the survivors by their surrounding people (Family, colleagues)

*RTW-return to work