Return to work in young and middle-aged colorectal cancer survivors: Factors influencing self-efficacy, fear, resilience, and financial toxicity

Table 1 Characteristics of young and middle-aged colorectal cancer survivors, n (%)

Variable	Total (N = 209)	Non-RTW, n = 118 (56.46%)	RTW, n = 91 (43.54%)
Age (years), mean ± SD	50.55 ± 7.67	50.97 ± 7.46	50.01 ± 7.95
Gender
Male	148 (70.81)	78 (66.10)	70 (76.92)
Female	61 (29.19)	40 (33.90)	21 (23.08)
Education
Junior high school or below	102 (48.80)	69 (58.47)	33 (36.26)
High school or above	107 (51.20)	49 (41.53)	58 (63.74)
Health insurance
Employee health insurance	109 (52.15)	50 (42.37)	59 (64.84)
Other	100 (47.85)	68 (57.63)	32 (35.16)
Family monthly income per capita (RMB), n (%)
≤ 2000	99 (47.37)	76 (64.41)	23 (25.27)
> 2000	110 (52.63)	42 (35.59)	68 (74.73)
Job type
Blue-collar	106 (50.72)	82 (69.49)	24 (26.37)
White-collar	103 (49.28)	36 (30.51)	67 (73.63)
Nature of work
Physical labor	93 (44.50)	69 (58.47)	24 (26.37)
Cognitive labor	116 (55.50)	49 (41.53)	67 (73.63)
Employment contracts
Non-long-term contracts	66 (31.58)	54 (45.76)	12 (13.19)
Long-term contracts	143 (68.42)	64 (54.24)	79 (86.81)
Site of cancer
Colon	99 (47.37)	49 (41.53)	50 (54.95)
Rectum	110 (52.63)	69 (58.47)	41 (45.05)
Comorbidity
No	162 (77.51)	97 (82.20)	65 (71.43)
Yes	47 (22.49)	21 (17.80)	26 (28.57)
Cancer stage
I or II	122 (58.37)	59 (50.00)	63 (69.23)
III or IV	87 (41.63)	59 (50.00)	28 (30.77)
Tumor differentiation
Low or high	26 (12.44)	12 (10.17)	14 (15.38)
Medium	183 (87.56)	106 (89.83)	77 (84.62)
Postoperative chemotherapy
No	61 (29.19)	25 (21.19)	36 (39.56)
Yes	148 (70.81)	93 (78.81)	55 (60.44)
Stoma
No	150 (71.77)	75 (63.56)	75 (82.42)
Yes	59 (28.23)	43 (36.44)	16 (17.58)
Total hospitalization cost (ten thousand yuan), mean ± SD	6.79 ± 1.99	6.97 ± 2.16	6.54 ± 1.74
RTW-SE, mean ± SD	45.12 ± 10.45	37.92 ± 7.96	54.45 ± 3.73
The eHL, mean ± SD	24.10 ± 9.70	22.39 ± 9.50	26.32 ± 9.55
FR, mean ± SD	106.22 ± 12.08	98.79 ± 7.92	115.87 ± 9.45
FoP, mean ± SD	26.91 ± 7.14	30.98 ± 5.51	21.64 ± 5.35
FT, mean ± SD	19.67 ± 10.02	15.55 ± 9.21	25.00 ± 8.42

RTW: Return to-work; RTW-SE: RTW self-efficacy; eHL: eHealth literacy; FR: Family resilience; FoP: Fear of progression; FT: Financial toxicity.

Table 2 Cox univariate analysis of return to work in young and middle-aged colorectal cancer survivors

Variable	β	SE	Z	HR (95%CI)	P value
Age	-0.01	0.01	-1.03	0.99 (0.96-1.01)	0.303
Gender (with male as reference)
Female	-0.32	0.25	-1.30	0.72 (0.44-1.18)	0.194
Education (with junior high school or below as reference)
High school or above	0.74	0.22	3.37	2.09 (1.36-3.21)	< 0.001a
Health insurance (with employee health insurance as reference)
Other	0.82	0.22	3.72	2.28 (1.48-3.52)	< 0.001a
Family monthly income per capita (with ≤ 2000 as reference)
> 2000	1.32	0.24	5.43	3.73 (2.32-5.99)	< 0.001a
Job type (with blue-collar as reference)
White-collar	-1.34	0.24	-5.63	0.26 (0.16-0.42)	< 0.001a
Nature of work (with physical labor as reference)
Cognitive labor	1.16	0.24	4.81	3.19 (1.99-5.12)	< 0.001a
Employment contracts (with non-long-term contracts as reference)
Long-term contracts	-1.43	0.31	-4.61	0.24 (0.13-0.44)	< 0.001a
Site of cancer (with colon as reference)
Rectum	0.44	0.21	2.10	1.56 (1.03-2.35)	0.036a
Comorbidity (with no comorbidity as reference)
Yes	-0.28	0.23	-1.22	0.75 (0.48-1.19)	0.224
Cancer stage (with I or II as reference)
III or IV	0.59	0.23	2.59	1.80 (1.15-2.81)	0.010a
Tumor diferentiation (with low or high as reference)
Medium	0.39	0.29	1.36	1.48 (0.84-2.62)	0.175
Postoperative chemotherapy (with no as reference)
Yes	-0.68	0.21	-3.14	0.51 (0.33-0.78)	0.002a
Stoma (with no as reference)
Yes	0.81	0.28	2.93	2.25 (1.31-3.86)	0.003a
Total hospitalization cost	-0.108	0.063	-1.70	1.00 (1.00-1.00)	0.089
RTW-SE	0.19	0.02	8.85	1.21 (1.16-1.26)	< 0.001a
The eHL	0.04	0.01	3.38	1.04 (1.02-1.06)	< 0.001a
FR	0.11	0.01	10.14	1.11 (1.09-1.13)	< 0.001a
FoP	-0.16	0.02	-8.90	0.85 (0.82-0.88)	< 0.001a
FT	0.07	0.01	6.62	1.08 (1.05-1.10)	< 0.001a

^aP < 0.05.

β: Regression coefficient; SE: Standard error of the regression coefficient; Z: The ratio of the estimated β to its standard error; HR: Hazard ratio; CI: Confidence index; RTW: Return to work; RTW-SE: RTW self-efficacy; eHL: eHealth literacy; FR: Family resilience; FoP: Fear of progression; FT: Financial toxicity.

Table 3 Cox multivariate analysis of influence on return to work in young and middle-aged colorectal cancer survivors

Variable	β	SE	Z	HR (95%CI)	P value
Education (with junior high school or below as reference)
High school or above	0.02	0.30	0.07	1.02 (0.56-1.86)	0.94
Health insurance (with employee health insurance as reference)
Other	-0.40	0.31	-1.32	0.67 (0.37-1.22)	0.188
Family monthly income per capita (with ≤ 2000 as reference)
> 2000	1.04	0.42	2.49	2.83 (1.25-6.42)	0.013a
Job type (with blue-collar as reference)
White-collar	-0.82	0.27	-3.04	0.44 (0.26-0.75)	0.002a
Nature of work (with physical labor as reference)
Cognitive labor	0.27	0.33	0.83	1.31 (0.69-2.49)	0.404
Employment contracts (with non-long-term contracts as reference)
Long-term contracts	-0.31	0.38	-0.81	0.74 (0.35-1.55)	0.418
Site of cancer (with colon as reference)
Rectum	-0.43	0.28	-1.54	0.65 (0.38-1.12)	0.123
Cancer stage (with I or II as reference)
III or IV	-0.18	0.28	-0.64	0.83 (0.48-1.46)	0.524
Postoperative chemotherapy (with no as reference)
Yes	-0.49	0.26	-1.92	0.61 (0.37-1.01)	0.055
Stoma (with no as reference)
Yes	0.28	0.37	0.77	1.33 (0.64-2.73)	0.442
RTW-SE	0.15	0.03	5.10	1.16 (1.10-1.23)	< 0.001a
eHL	0.01	0.02	0.04	1.00 (0.97-1.03)	0.965
FR	0.08	0.02	5.13	1.08 (1.05-1.11)	< 0.001a
FoP	-0.03	0.03	-1.19	0.97 (0.92-1.02)	0.233
FT	-0.03	0.02	-1.18	0.97 (0.93-1.02)	0.236

^aP < 0.05.

β: Regression coefficient; SE: Standard error of the regression coefficient; Z: The ratio of the estimated β to its standard error; HR: Hazard ratio; CI: Confidence index; RTW: Return to work; RTW-SE: RTW self-efficacy; eHL: eHealth literacy; FR: Family resilience; FoP: Fear of progression; FT: Financial toxicity.

Table 4 the receiver operating characteristic curve results of return-to-work self-efficacy and family resilience

Variable	AUC	Optimum cut-off value	Sensitivity	Specificity	Cut-off
RTW-SE	0.963	0.832	0.934	0.898	48
FR	0.899	0.718	0.879	0.839	104

AUC: Area under the curve; RTW-SE: Return to work self-efficacy; FR: Family resilience.