Return to work after breast cancer: Women’s experiences of encounters with different stakeholders Marie Nilsson a, * , Mariann Olsson b , Agneta Wennman-Larsen a , Lena-Marie Petersson a , Kristina Alexanderson a a Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden b Division of Social Work, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Keywords: Breast cancer Oncology Sick leave Return to work Encounters Focus group abstract Objective: Long-term sickness absence is common among women with breast cancer and more know- ledge, from the individuals’ perspective, is needed regarding factors that influence their return to work (RTW). The aim was to gain knowledge about women’s experiences of encounters regarding RTW after breast cancer surgery. Methods: Qualitative content analysis was applied to data obtained in four focus group interviews with 23 women treated for breast cancer regarding aspects of RTW. Results: The women talked about encounters regarding RTW they had had with the following stake- holders: social insurance staff, employers, colleagues, healthcare personnel, family, and friends. Three categories of such encounters were identified, involving: (i) adjustments associated with the women’s needs (e.g., at work, handling sickness benefits, or care), (ii) information shared with the women (e.g., concerning sickness insurance or side effects of treatment), and (iii) attitudes perceived and appraised by the women, respectively. The third category comprised two subcategories of stakeholders’ attitudes: those concerning work adjustments or being sickness absent, and those directed towards the women themselves, respectively. Conclusions: Women with breast cancer experience that encounters with many different types of stakeholders affect their RTW. Important aspects of the encounters are what attitudes the professionals convey, what information the women receive, and whether adjustments of relevance are discussed. A mutual knowledge about other stakeholders involved in the RTW process and how the women are encountered by others, may be useful for each stakeholder to facilitate a closer collaboration in order to find flexible solutions and adjustments for individuals which in turn may facilitate RTW. Ó 2011 Elsevier Ltd. All rights reserved. Introduction Breast cancer is the most prevalent malignancy among women globally, with approximately 1.38 million new cancer cases yearly (WHO, 2008). Of these, several are in working ages, and e.g. in Sweden 54% of all women diagnosed with breast cancer are below 65 years of age (National Board of Health and Welfare, 2007). Both the number of women diagnosed and the survival rate are increasing; the 5-year survival rate now is 89% in Western countries (Parkin et al., 2005). Accordingly, a vast number of young and middle-aged women in the workforce already have, or will get, breast cancer, and hence most of them face the issue of return to work (RTW) during or after treatment. Several studies have focused on quality of life of women with breast cancer (Ganz et al., 2002; Ahles et al., 2005), and in some studies attention has also been given to the process of RTW among survivors (Maunsell et al., 1999; Drolet et al., 2005a; Main et al., 2005; Bouknight et al., 2006; Fantoni et al., 2010; Johnsson et al., 2010). Work is an important factor in the lives of individuals, providing not only financial security, but also health, social contacts, and a sense of contributing (Ferrell et al., 1997; Friesen et al., 2001; Holland-Elliot, 2004). It has been shown that having gainful employment has a positive influence on the quality of life and that women with cancer describe work as a normalizing factor (Bowling, 1995; Kennedy et al., 2007; Rasmussen and Elverdam, 2008; Frazier et al., 2009; Johnsson et al., 2010). However, some studies have shown RTW after breast cancer to be associated with * Corresponding author. Tel.: þ46 8 524 83217. E-mail address: marie.i.nilsson@ki.se (M. Nilsson). Contents lists available at ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon 1462-3889/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejon.2011.03.005 European Journal of Oncology Nursing 15 (2011) 267e274