Return to work for women with cognitive changes following breast cancer treatment: Implications for assessment and the role of occupational therapy

Abstract

While survival rates for women with breast cancer have improved, many experience persistent cognitive challenges that hinder return to work. This thesis examines the impact of breast cancer on workforce participation, focusing on cancer-related cognitive impairment and its implications for employment outcomes. Despite growing recognition of these changes, structured assessment and support remain limited in Australia’s healthcare and employment systems. Guided by the question, “How do cognitive changes associated with breast cancer influence women’s work participation and performance, and how can these effects be measured?”, the research explores four areas: evidence of reduced work participation, the impact of cognitive changes on work performance, specific cognitive domains affected, and the effectiveness of PRPP-A (PRPP@WORK) in assessing workrelated cognition. Using a mixed-methods approach, the study combines a longitudinal analysis, a scoping review, qualitative interviews, and pilot testing of PRPP@WORK. Findings confirm breast cancer significantly reduces workforce participation, with many women moving to part-time roles or leaving employment. Cognitive impairments, particularly in attention, planning, and executive functioning, emerge as key contributors. PRPP@WORK demonstrates strong ecological validity and predictive value, correlating with neuropsychological assessments and identifying women at risk of not returning to pre-illness roles. The research highlights systemic gaps, including missed opportunities for early cognitive screening, limited survivorship support, and fragmented referral pathways. Occupational therapists are critical in bridging these divides yet remain underutilised. The thesis advocates for integrated survivorship care, policy reform, and cancer-specific employment support, introducing PRPP@WORK as a novel tool and underscoring work as both a meaningful occupation and a form of cognitive rehabilitation.