Fitness for work : the medical aspects

A general framework for assessing fitness for workHealth problems and employmentImpairment, disability, and handicapPrevalence of disability and its impact on employmentThe Equality Act 2010The 'fit note'The ageing workerOccupational health servicesContacts between the patient's medical advisers and the workplaceConfidentialityMedical reportsAssessing fitness for work: general considerationsWhy an assessment may be neededWhen an assessment of medical fitness is neededRecruitment medicalsRecruitment and the company pension schemeSpecial groupsYoung peopleSeverely disabled peopleThe assessment of medical fitness for workA general frameworkFunctional assessmentRequirements of the jobFactors influencing work performanceObjective testsMatching the individual with the jobPresentation of the assessmentRecommendations following assessmentWork accommodationAlternative workEarly medical retirementRecent developments and trendsGovernmental initiativesMaintaining fitness for workConclusionsReferencesLegal aspects of fitness for workCommon lawCommon law duties of employersStandard of care of occupational physiciansDuty to inform and warn of risks to health and safetyBalancing the riskThe state of the artGreater duty of care: 'eggshell skull' principleDuty owed in mental illnessEmployees' dutiesStatute lawHealth and Safety at Work etc. Act 1974Employers' statutory dutiesEmployees' statutory dutiesThe institutionsEmployment protection legislationGrounds for dismissalRight of representation'Capability': ill health casesLying about previous health conditionsMedical evidence and medical reportsStatus of statements of fitnessNot all duties are suspended when an employee is off sickNeed for an up-to-date medical reportData Protection Act 1998Access to Medical Reports Act 1988Conflicting medical adviceConsultation with the employeeSeeking suitable alternative employmentPermanent health insurance benefitsEarly retirement on medical groundsManagement's role in sickness decisionsPre-placement medical assessmentsDuty of care in writing pre-employment reportsDuty to be honestConfidentialityExpert evidencePregnancy, discrimination, and the lawEuropean lawWorking Time DirectiveOther health and safety directivesReferencesDisability and equality law'Medical' model of disabilityCourt judgmentsThe Codes of Practice and GuidanceDifferent forms of disability discriminationRole of the occupational physicianEthical considerationsDisability considerationsProtected characteristics EqA S4Definition of 'disability' EqA S6Normal day-to-day activitiesDetermination of disabilityShowing an impairmentCovert surveillanceWhat is an 'impairment'? EqA Sch1 S1 & 6Long-term effects EqA Sch1 Part 1, S 2Severe disfigurement EqA Sch1 S3'Substantial' EqA Sch1 S4Effect of medical treatment EqA Sch1S5Progressive conditions EqA Sch1 S8Direct discrimination EqA S13Positive discriminationCombined discrimination EqA S14Discrimination 'arising from disability' EqA S15JustificationIndirect discrimination EqA S19Duty to make reasonable adjustments EqA S20What is reasonable?What is unreasonable?Sickness absenceRedeployment and relocationLifestyle reasons for disabilityIrrelevance of alleged discriminator's characteristics EqA S24Harassment EqA S26Victimization EqA S 27Employees and job applicants EqA S39Employees and job applicants: harassment by a third party EqA S40Enquiries about disability and health EqA S60Positive action EqA SS158-9Lack of knowledge of disability EqA Sch 8 S20Health and Safety Law EqA Sch 22A right to work?Exemption certificates and 'disability clashes'Fitness standardsArguments of fitness in dismissal casesWorking abroadPoliciesReferencesSupport, rehabilitation, and interventions in restoring fitness for workChallenging conventional assumptions: health problems, sickness, and disabilityThe relationship between work and healthCommon health problemsDisability benefits and common health problemsModels of disabilityThe medical modelThe social model of disabilityThe economic modelIndividual perceptionsOrganizational policy, process, and practiceThe biopsychosocial modelThe contemporary biopsychosocial modelWorkplace managementVocational rehabilitationConcepts of rehabilitationThe evidence for vocational rehabilitationCognitive-behavioural and talking therapiesSocial and occupational interventionsEducational interventions—the role of health services and healthcare professionals'Pathways to Work' pilotsSummary and conclusionsReferencesEthics in occupational healthGovernanceProfessional standardsCommercial occupational healthProtecting health and promoting well-beingOrganizational healthHealth promotionPre-employment assessmentHazard controlImmunizationHealth screeningHealth surveillanceDrug and alcohol testingGenetic testing and monitoringHealth and workSupporting the sick workerRecommending adjustmentsTermination of employmentHealth-related pension benefitsInformationCollection of informationStorageRetention and transfer of recordsDisclosureConsentSocial mediaCovert surveillanceWorking with othersClinical and non-clinical teamsOther health professionalsOthers in the workplaceOthers outside the workplaceOccupational health researchReferencesNeurological disordersSize of the problemOccupational causes of neurological impairmentClinical assessmentThe impact of prognosis and rehabilitation on workHow neurological illnesses may influence workHigher cerebral functionsCognitive function and psychometricsBehaviour and impulse controlDisturbances of arousal and consciousnessSleepPain disordersSpeech, language, and communicationEmotional stateSymptoms related to cranial nervesMotor symptoms related to the trunk and limbsUpper motor neurone lesions, extrapyramidal disorders, and hypertoniaAtaxia and incoordinationLower motor neurone lesionsDisorders affecting the neuromuscular junctionsSomatosensory impairmentsLoss of sphincter controlFatigueDrug managementDrivingFactors affecting neurological functionTemperature and humidityLightChemical factorsToxic neuropathiesHeavy metal toxicity and organic solventsOrganophosphate pesticides and sheep dipsIdentification and prevention of occupational neurotoxicityAssistive technologySpecific neurological disordersHeadache disordersDisorders of awareness and sleepRisk factorsRisk of recurrence/incapacitationMedicationFunctional deficitsCerebral tumoursParkinson's diseaseEnvironmental neurotoxicity hypothesesOccupational considerationsEssential tremorDystoniaReturn to work after traumatic head and brain injuriesApproving return to work after concussion and minor brain injurySymptomsSignsCognitive functioningVocational rehabilitation after moderate-severe brain injuryMeningitis and encephalitisAlzheimer's disease and other pre-senile dementiasNeurological disorders of childhoodSpinal cord injury and diseaseMultiple sclerosisMiscellaneous genetic disordersMotor neurone diseasesPeripheral neuropathyNeuromuscular junction diseaseMuscle diseasesEntrapment neuropathiesChronic fatigue syndromeReferencesMental health and psychiatric disordersThe extent of the problemThe economic burden of mental illnessSome definitionsPrimary prevention of mental health disorderSecondary prevention of mental health disordersTertiary preventionHow mental health problems might interfere with workImpaired concentration and attentionImpaired motor skillsImpaired communication and social skillsRisk to self and othersThe effects of abnormal illness behaviourWhy work matters: the psychosocial benefitsObstacles to employmentFit for work? Assessment for employmentBack to work: reintegration into the workplaceRecovery and return to workWork schemes and sheltered employmentModelsUser employment programmesCommon psychiatric disordersAdjustment disordersDepressionPost-traumatic disorders including post-traumatic stress disorderChronic fatigue syndromeChronic mixed anxiety and depressionBipolar affective disorder (also known as manic depression)SchizophreniaAcute psychotic disordersPersonality disordersConclusionsReferencesEpilepsyDefinitionsEpileptic seizuresEpilepsyClassification of epilepsyFocal seizuresGeneralized seizuresIncidence and prevalenceCauses of epilepsyRecurrence of seizuresChances of remissionWithdrawal of antiepileptic drug treatmentPrevention of epilepsy in the workplacePrimary and secondary preventionShift workStressPhotosensitivity and visual display equipmentOther types of reflex epilepsyAlcohol and drugsResponsibility of the physician in the workplaceConsideration of potential new employeesSensible restrictions on the work of people with epilepsyLifting of restrictionsEffect of antiepileptic drugs on work performanceSpecial work problemsDisclosure of epilepsy to employersAccident and absence records of those with epilepsyCurrent employment practicesGetting employers to understand about epilepsyMedical services and opportunities for sheltered workNHS medical servicesResidential careEpilepsy charitiesResidential centres and schools for people with epilepsySpecial assessment centresRelationship between the occupational physician, neurologist, and general practitionerExisting legislation and guidelines for employmentThe driving licence regulations and their effectsConclusions and recommendationsReferencesVision and eye disordersIntroduction—vision, perception, and workThe effect of vision on workThe effect of work on visionPerception and ergonomicsMatching visual capability to the task requiredVision and drivingAims of this chapterSymptoms and signs of visual dysfunctionDisturbed visual acuityDisturbed colour visionDisturbed visual fieldsDisturbances in binocularityVisual discomfort or glareSomatosensory discomfort or painCommon eye disorders and their effects on visual functionRefractive errors and their correctionRefractive surgeryExternal eye diseasesOcular hypertensionPrimary open-angle glaucomaNormal tension glaucomaAngle-closure glaucomaRetinal disordersRetinal vein occlusionPosterior ciliary artery occlusionTime off work after surgeryVisual ergonomics—lighting, display screens, visual fatigue, and employment of people with visual impairmentLighting and visibilityLighting in the workplaceDisplay screen equipmentVisual fatigueEmployment of people with visual impairmentOcular hazards, toxicology, and eye protectionHeatLightLasersRadiationElectrical shockChemicals, particles, fibres, allergens, and irritantsOccupational injuries and eye protectionCorneal abrasionCorneal foreign bodiesSubtarsal foreign bodiesChemical burnsBlunt injuryPenetrating injuryIntra-ocular foreign bodyCompressed air injuriesEye protectionOcular first aid at workPlanningAssessmentIrrigationEye shieldsMedicationsReferencesHearing and vestibular disordersEpidemiology of hearing loss and tinnitusMethods of assessing hearing disabilityClinical aspects affecting work capacity including accidentsManagement: hearing aids and other assistive technologyEpidemiology of balance disordersMethods of assessing balance problemsManagement: vestibular disordersClinical aspects of vestibular disorders affecting work capacitySummaryReferencesSpinal disordersNon-specific low back painPrevalence and natural historyDisability and sickness absenceTime trendsRisk factorsAssessing back pain and disabilityTriage assessment and investigationOther issues in assessmentManaging the worker with a fresh episode of low-back painKeeping activeKeeping active at workManaging the worker who still has problems after 1-3 monthsActive rehabilitationPre-placement assessmentInvestigations and clinical testsOther guidelinesPrevention and risk managementNeck painPrevalence and natural historyOccupational and personal risk factorsAssessing and managing the patient with neck painSpinal surgerySurgery for lumbar nerve root compressionProlapsed lumbar intervertebral discConservative managementSurgical managementLumbar spinal stenosisSurgery for low back painSpinal fusionTotal disc replacementThe cervical spineOther spinal conditionsAnkylosing spondylitisScheuermann's diseaseFracturesThe thoracolumbar spineThe cervical spineSpinal cord injuryReferencesOrthopaedics and trauma of the limbsThe principles of managing musculoskeletal problems at workErgonomic principlesPsychosocial factorsReturn to driving post musculoskeletal surgeryWork-related musculoskeletal diseasesThe size of the problemOccupational musculoskeletal disordersMusculoskeletal disorders of the upper limbsDisorders of the shoulderSteroid injectionsSubacromial decompressionAcromioclavicular joint painGlenohumeral joint stabilizationDisorders of the elbowElbow replacementEpicondylitisDisorders of the wrist and handTenosynovitis of the finger flexor and extensor tendonsUlno-carpal abutmentScaphoid non-unionScapho-lunate ligament insufficiencyDisorders of the handDigital arthritisDupuytren's diseaseTrigger digitDisorders of the nervesCarpal tunnel syndromePronator syndromeCubital tunnel syndromeMusculoskeletal disorders of the lower limbsGeneral workplace adaptations for lower limb problemsConditions of the hipHip osteoarthritisHip replacementConditions of the kneeKnee osteoarthritisSurgery for knee osteoarthritisKnee replacementMeniscal tearsKnee arthroscopyThe anterior cruciate ligamentConditions of the footAnkle osteoarthritisAchilles tendinitis (non-insertional)Plantar fasciitisTibialis posterior tendon dysfunctionBunions/hallux valgusHallux rigidusMetatarsophalangeal fusionMorton's neuromaTraumaFracturesRemoving metalworkAvascular necrosisPathological fracturesDislocationsLigament injuriesTendon injuriesNerve damageCold intoleranceAnkle sprainAchilles tendon ruptureFractured calcaneusAmputationLower limb amputationUpper limb amputationReturn to workReferencesRheumatological disordersWork-related upper limb disordersDisorders of the neck and upper limbCervical spondylosisDisorders of the shoulderPreventionEpicondylitis of the elbowCarpal tunnel syndromeTenosynovitis of the wristNon-specific diffuse forearm painOther management pointers in upper limb disorderOsteoarthritisRisk factors for osteoarthritisOccupational risk factors for osteoarthritisAssessment of osteoarthritisManagement of osteoarthritisManagement of osteoarthritis in the workplaceInflammatory arthritisRheumatoid arthritisManagement of rheumatoid arthritisManagement of rheumatoid arthritis in the workplaceAnkylosing spondylitisSeronegative arthritidesReactive arthritisPsoriatic arthritisConnective tissue diseasesSystemic lupus erythematosusRisk factors for systemic lupus erythematosusSystemic lupus erythematosus in the workplaceManagement of systemic lupus erythematosusManagement of systemic lupus erythematosus in the workplaceChronic widespread pain and fibromyalgia syndromeRisk factors for fibromyalgia syndromeManagement of fibromyalgia syndromeManagement of fibromyalgia syndrome in the workplaceConclusionReferencesGastrointestinal and liver disordersInflammatory bowel diseaseUlcerative colitisCrohn's diseaseExtra-intestinal manifestations of inflammatory bowel diseaseFunctional limitationsAdjustments at workEmployment issues for workers with intestinal stomasIrritable bowel syndromeDefinition, prevalence, and natural historyManagementFunctional limitationsAdjustments at workGastrointestinal infectionsDistinguishing infectious and non-infectious diarrhoeaFunctional assessment and exclusion from workFood handlersPrevention of microbiological contamination of foodExclusion from workInfections with special occupational implicationsSalmonella infectionsHepatitis AViral hepatitisHepatitis BHepatitis CCirrhosis of the liverPrevalence and prognosisManagement and functional assessmentAdjustments at workLiver transplantationGuidelines for employees handling hepatotoxinsObesityPrevalence and definitionsTreatmentPrevention and treatment of obesity in the workplaceFunctional limitationsAdjustments at workReferencesDiabetes mellitus and other endocrine disordersClassificationRecent advances in diabetesInsulin-infusion therapy ('insulin-pumps')Islet cell transplantationDiabetes diagnosis by HbA1cType 2 diabetes and the incretin systemDiabetes and employmentPrevalence, morbidity, and mortalityDiabetes epidemiologyMortality and morbidityDiabetes treatmentType 2 diabetesType 1 diabetesControl monitoringGlycaemic and risk factor controlGlycaemic targetsRisk factor targetsSpecial work problems caused by diabetesThe work record of people with diabetesWorking patterns and diabetic treatmentComplications of diabetesChronic complicationsAcute complicationsDiabetic hypoglycaemiaDiabetes, pregnancy, and employmentPensions, insurance, advisory services, etc.Pension schemesDiabetes in employer-sponsored health insuranceAdvisory servicesGuidelines for employmentConclusions and recommendationsEndocrine disordersHyperthyroidismHypothyroidismThyroid eye diseasePituitary diseaseReferencesHaematological disordersHaemoglobinopathiesSickle cell diseaseThalassaemiaImmune cytopaenias (AIHA, ITP)Coagulation disordersTherapeutic anticoagulationInherited clotting disorders: haemophilia and von Willebrand's diseaseThrombophiliaMalignant haematological disordersEpidemiologyClinical features and recent advancesAdjustments to work in malignant haematological diseasesGeneric issuesImmunity and infection riskStem cell transplantationIndications for stem cell transplantation and survivalFitness for work in stem cell donorsSplenectomy and hyposplenismRepeated transfusionAnaemiaFatigueBleedingPsychosocial aspectsConclusionsReferencesFurther readingCardiovascular disordersEpidemiologyClinical featuresAssessmentManagement strategies: medicalCoronary angioplasty and stenting (percutaneous coronary intervention)Coronary artery bypass graftingReturn to work after developing coronary heart diseaseCardiac rehabilitationReturn to workPsychological factorsScreening for coronary diseaseCongenital and valvular diseaseCardiac arrhythmiasSyncopePacemakers and implantable devicesPacemakersImplantable cardioverter defibrillatorsHypertensionOther circulatory disordersSpecial work issuesPhysical activityLifting weightsDrivingWork stressShift workHazardous substancesHot conditionsCold conditionsTravelElectromagnetic fieldsPhysical hazardsThe future of workLegal aspectsReferencesRespiratory disordersMethods of assessing respiratory disabilityGeneral considerationsMeasurements of lung functionScreening questionnairesChest radiographyClinical conditions and capacity for workAsthmaStatements and strength of evidenceChronic obstructive pulmonary diseaseInterstitial lung diseaseRespiratory infectionsNeoplastic diseaseOther diseases of the pleuraSmokingSpecial work problems and restrictionsReferencesRenal and urological diseasePrevalence and morbidityMortalityPresentationGuidelines for identification of kidney diseaseDiabetesComplications and sequelae of renal diseaseHypertensionCardiovascular diseaseRenal failureEnd-stage renal diseaseDialysisHaemodialysisPeritoneal dialysisWork and dialysisTransplantationHaemodialysisPeritoneal dialysisRenal failure and employmentRenal failure and fitness for workRestrictions and contraindicationsHolidaysShiftworkDriversUrinary tract infectionsUrinary incontinence and retentionProstatic cancerUrinary tract calculiTumours of the renal tractExisting legislation: seafarersConclusions and recommendationsReferencesWomen at workDemographicsConception and fertility issuesEarly diagnosis of pregnancyMiscarriageDeclaration of pregnancy to employerWorkplace hazards to the pregnant workerPregnancy changes that affect fitness to workGynaecological problemsFertility issuesWorking women: other issuesWork-life balanceErgonomic issuesPhysical fitness and injuryConclusionReferencesFitness for work after surgery or critical illnessWhat do patients do in the absence of any advice?Does advice from clinicians have an impact on patients' beliefs and behaviours?The evidence baseWhat do we mean by 'fit for work'?Evidence from wound healing studiesEvidence from use of different closure methods and internal supportDiabetesObesitySmokingAgeThe nature of the operationPsychology and surgeryTime to return to work following surgeryAdvice to employeesSpecific operation sites and proceduresAbdominal surgeryCardiothoracic surgeryVascular surgeryHead, neck and ENT surgeryUrological surgeryBreast surgeryGynaecological surgeryOrthopaedic surgeryReturning to work after critical care treatmentReferencesDermatological disordersPrevalenceAt pre-employmentEczemaOther non-cancerous skin disordersSkin cancerSkin and the psycheInvestigationsRehabilitationSkin careLegal considerationsFinal commentsReferencesHuman immunodeficiency virusEpidemiology of HIV in the UKNatural history of HIV infectionFactors influencing the rate of progression to AIDSMarkers of HIV infection and their clinical relevanceSymptomsPrimary HIV infectionLatent periodOpportunistic infectionsLung manifestationsGastrointestinal manifestationsNeurological presentationsEye manifestationsTumoursPsychiatric morbidityTreatment of HIV infection5*6Commonly used drugsCurrent consensus guidelines relating to HIV treatmentComplications of HAARTAdherence issuesDrug interactionsSecond-line regimens'Salvage therapy'Employment status and barriers to employmentVocational support and rehabilitationUK AIDS charitiesLegal and ethical framework for assessing work fitnessReasonable adjustmentsPre-employment screening, HIV testing, and the Equality ActExposure-prone proceduresEthical frameworkHealthcare workersOccupational risks for HIV-infected workersPotential occupational exposures to opportunistic infectionWorking overseasOccupational immunizationsRisk of transmitting HIV at workTransmission from worker to client/patientOccupational restrictions placed on HIV-infected healthcare workersHIV testing and healthcare workersPatient notification exerciseCare of the HIV-infected healthcare workerConfidentialityRisk of acquiring HIV through workPost-exposure prophylaxisRIDDOR reportingCompensation for HIV infection contracted at workPrevention of occupational HIV transmissionControl of Substances Hazardous to Health RegulationsStandard precautionsSummaryReferencesDrugs and alcohol in the workplacePrevalenceImpactAlcoholDrugsAccidentsAbsenteeismBeliefDrug and alcohol at work policiesImplementation of a new policyTraining for managersReferral to occupational healthAssessment for drug or alcohol misuse and dependencyFeatures of denialAssessment of fitness to workFitness to driveTreatment of dependenceReturn to workDrug and alcohol testing at workEvidence that testing is effectiveWhen to test?Types of testAlcohol screeningDrug testingRole of occupational health departments in a drug and alcohol testing programmeTesting for impairmentConclusionsUseful websitesReferencesMedication and health in the workplaceEpidemiology of medication useMedication prevalence in the workplaceClassification of medicationsReclassificationHarms from medicationsClassification of adverse drug reactionsFrequencies of adverse drug reactions in the workplacePatient informationClinical pharmacology relevant to harmsDrug eliminationDrug interactionsAbuse of medicationsInfluence of legislation/guidanceThe Equality Act 2010 (see also Chapter 3)SEQOHS standardsEffects of medications on performancePerformance testingCircadian rhythmsOccupational exposures and medicationsEffects of medications on specific occupationsDriversDVLA Group 2 driversShift workersPhysiciansOccupational travellersManagement of clinical conditionsCentral nervous systemAntidepressantsHypnotics and sedativesAntipsychotic drugsLithiumAntiepileptic drugsAntihistaminesAntimigraine drugsDrugs for Parkinson's diseaseMedications for multiple sclerosisStimulants and appetite suppressantsAutonomic nervous systemAnaestheticsCardiovascular medicationsAntihypertensive drugsAnticoagulantsAnalgesics and non-steroidal anti-inflammatory drugsHypoglycaemic drugs (see also Chapter 28)Anticancer medicationsAnti-infective agentsTravel medicationsGood occupational health practiceWorkplace solutions and adjustmentsPrescribing in occupational healthSummaryReferencesThe older workerThe demographic backgroundThe United KingdomGeneral age-associated changesAgeingDifferences between younger and older peopleIs the pattern of ageing changing?How old is an 'older worker'?Age-associated changes in functionSpecific age-associated problemsDrug problemsHealth maintenance and service issuesNutrition, diet, and exerciseHealth surveillanceLinks with primary careWorkability and employabilityAgeing and recovery from illness or injuryRetraining and redeploymentEthical issues and retirement: duties to employers, responsibilities to employeesOrganizational issuesManagement and social aspectsShift workHours of workUpstream ergonomics: input into the design of processesOlder workers and younger managersPossible actions and solutionsReferencesFurther readingIII health retirementDemographicsState pensionsOccupational and personal pensionsThe Pensions Advisory ServiceDefined benefit and defined contribution schemesCriteriaEvidenceConflicts of interestCompetenceAppeals and complaintsGuidelinesAuditMedico-legal aspectsInjury awardsLimited life expectancyConclusionsReferencesHealth and transport safety: fitness to driveSafety critical tasksImpairing disabilities and medical conditionsOccupational driving: public highwaysOccupational driving: off-roadMedical aspects of licensingSpecific medical conditionsCardiac events and strokesSeizuresDiabetesVisionSleep disordersPsychiatric illness, drugs, and alcoholFixed disabilitiesThe role of the occupational health professionalReferencesHealth screeningCharacteristics of a screening testSensitivity, specificity, and predictive valueLikelihood ratiosReceiver operating characteristic curvesPractical and ethical aspects of screeningScope of the screening examinationFrequency of examinationAdvantages and disadvantages of health screeningEthical considerationsScreening in occupational health practicePre-placement examinationHealth screening prior to job transfersHealth screening for return to work after illnessSpecific screening testsExecutive health screeningGenetic screeningScreening for drugs and alcoholBiological monitoring and biological effect monitoringHealth surveillanceEvaluation of screening programmesConclusionsReferencesManaging and avoiding sickness absenceEpidemiology of sickness absenceTheoretical models of sickness absence managementPromoting attendanceEngagementManager attitudes and behaviourWhat is good work?Measuring and monitoring absenceTrigger pointsPolicy and procedurePolicy statementKey principlesNotification of absenceEvidence of incapacity'May be fit for some work'Return to work discussionsFormal reviewAbsence due to disability/maternityPrerequisites to interventionsManaging short- and medium-term absencePredicting future absenceLong-term absenceInitial enquiriesDetailed assessmentCoordinating and delivering interventions and servicesTimelinessOccupational health reportsCommunication with other specialistsOccupational rehabilitationPresenteeism and productivityReferencesHealth promotion in the workplaceDefining health promotionHealth promotion and public healthHealth promotion in the workplaceWorkplace health promotion examplesNational campaignsCommunication techniquesExamples of health promotion in the workplaceSummaryReferencesCancer survivorship and workCancer, cancer treatment, and work capabilityDiagnosis and treatment of cancer: functional prognosis and occupational risk assessmentLymphoedemaFatigueImmunosuppressionRadiotherapyHormonal adjuvant treatmentPainOrgan effectsMusculoskeletalPsychological impact of cancerVocational rehabilitationFitness to driveFollow-upHealth promotionEpidemiology of cancerReferencesFurther reading
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