The Cancer and Work Scale (CAWSE): Development and Validation of a Return to Work Assessment for Cancer

Background: Returning to and sustaining employment after cancer presents significant challenges for individuals touched by cancer (ITBC). While vocational rehabilitation and workplace accommodations are critical, existing return to work (RTW) assessments lack cancer-specific considerations, limiting their clinical and occupational utility. Purpose: This study aimed to develop and validate the Cancer and Work Scale (CAWSE), a psychometrically robust tool designed to assess RTW likelihood and employment sustainability among ITBC, while also providing avenues for targeted interventions. Methods: A two-phase cross-sectional study was conducted. Study I (n = 130) assessed content validity and construct development, leading to a refined 43-item CAWSE. Study II (n = 216) employed exploratory and confirmatory factor analyses to establish structural validity, reliability, and responsiveness. Additional validation included correlations with fatigue, cognitive difficulties, depression, and anxiety. Results: Factor analysis supported a seven-factor structure with 31 final items. The CAWSE demonstrated strong internal consistency (α = 0.787), construct validity, and moderate responsiveness (AUC = 0.659). High sensitivity allowed for accurate identification of RTW difficulties, with an established cut-off score of 123.5 on the total CAWSE scale. Implications: The CAWSE fills a critical gap in oncology-specific vocational rehabilitation, offering healthcare providers a validated tool for targeted interventions to enhance RTW outcomes and long-term employment sustainability for ITBC.