Evaluation of the Socio-Medical Assessment of Work Capacity in Patients with Colorectal Cancer in German Rehabilitation Clinics: Its Diagnostic Accuracy for Actual Return to Work and the Physician’s Views on Potential Changes in Current Practice

In Germany, physicians assess the work ability of colorectal cancer patients at the end of a usually 3-week stay in a rehabilitation clinic. This study evaluated the diagnostic accuracy of this assessment for return to work and the open-mindedness of physicians towards changing their current assessment practice. We conducted an online survey with physicians and followed up colorectal cancer patients for 9 months after rehabilitation. Although 97% of the patients were judged to be able to work by their physicians, only 70% actually did 9 months after rehabilitation. The majority of physicians at least partly agreed that a standardized checklist is needed to help them with the work ability assessment (73%), and almost all (95%) said that they would use it. The diagnostic accuracy of the current work ability assessment for colorectal cancer patients in Germany is limited, and a checklist could help physicians in their judgments.

Background/Objectives

Return to work (RTW) is a goal of many patients with colorectal cancer (PwCRC) attending inpatient rehabilitation. In German rehabilitation clinics, physicians conduct the socio-medical assessment of work capacity (SMWC) with the aim of assessing the current ability to work. We tested how well it also predicts the actual RTW of PwCRC.

Methods

This study combined a nationwide physician survey (N = 38) with longitudinal data from a cohort study of PwCRC (N = 172) aged 65 or younger who were employed prior to CRC diagnosis. Physicians were asked about their use of validated tools for the SMWC and their attitudes towards a standardized assessment checklist. PwCRC completed baseline and 9-month follow-up questionnaires about their employment status. SMWC results of the cohort study’s participants were extracted from rehabilitation discharge reports.

Results

While 97% of PwCRC were predicted to be capable of working ≥ 6 hours/day, only 70% actually returned to work 9 months after rehabilitation. The SMWC showed high sensitivity (98%) but low specificity (6%) for predicting RTW, with a positive predictive value (PPV) of about 70%. Most physicians (73%) at least partly saw the need for an evidence-based structured checklist for an improved SMWC, and almost all (95%) would use it if it did not take more than 10 minutes to apply it.

Conclusions

The SMWC for PwCRC in German rehabilitation clinics is not standardized and overestimates the return-to-work rate. There is a need for a standardized checklist, and most physicians would be willing to use it.