Aptitud sobrevenida tras incapacidad laboral prolongada por cáncer

Abstract

[ES] El número de supervivientes al cáncer con capacidad de trabajar va en aumento gracias a los avances diagnósticos y terapéuticos, pero la reincorporación al trabajo del trabajador que ha padecido cáncer se produce tras un largo periodo de incapacidad laboral y tras haber sufrido un tratamiento agresivo que hacen que el retorno se realice con una aptitud sobrevenida. Dicha aptitud es entendida como la condición del trabajador que tras un periodo de incapacidad en que perdió capacidades, se recuperaron al alta (no incapacidad, alta médica de la baja), pero se reincorpora con una nueva situación de salud (capacidades) y adquiriendo el trabajador y el trabajo nuevos riesgos para su salud y nuevos riesgos frente al trabajo. Se realiza estudio de las bajas por cáncer que duraron más de 365 días, y se realiza un seguimiento de las recaídas que existieron en los seis meses siguientes a la reincorporación. Y se realizan propuestas para garantizar un retorno saludable y eficaz. Material y método: Con el fin de buscar los artículos sobre el retorno al trabajo tras cáncer, las barreras que se presentan y las propuestas para facilitar el retorno efectivo, se revisaron hasta mayo de 2019 las siguientes bases de datos bibliográficas: SciELO, PUBMED. Se realizó también un estudio de los procesos de cáncer que mantuvieron baja prolongada que alcanzó los 365 días, y se analizó cuántos finalmente concluyeron en alta médica, cuántos de estos procesos de alta tuvieron recaídas en los seis meses siguientes y porqué, y cuántas de las recaídas concluyeron en incapacidad permanente. Conclusiones: En estudio efectuado sobre trabajadores con bajas por cáncer que alcanzaron o sobrepasaron los 365 días, se comprueba que el 81% de los casos se incorpora al trabajo con disfunciones que configuran la aptitud sobrevenida y que son estas disfunciones las que causan en un 75% las recaídas en incapacidad en los seis meses siguientes, haciendo fracasar el retorno laboral. Las disfunciones más predominantes y de mayor impacto son la astenia/fatiga, los trastornos psicológicos (incluyendo ansiedad, bajo ánimo, síntomas depresivos, deterioro cognitivo tipo déficit de atención, concentración o memoria), las disestesias /parestesias, y las artralgias. [EN] Thanks to the diagnostic and therapeutic advances, the number of cancer survivors able to work is increasing. Nevertheless, the return to work of the worker who has suffered cancer takes place after a long term work incapacity and after having undergone an aggressive treatment causing the return to be made in sudden circumstances. These are understood as the condition of the worker who after a disability period in which he lost capabilities, he received the medical discharge (not disability, medical discharge of the loss), returning to the job in a new health situation (capacities) and facing the worker and the work new risks for his health and new risks at work. A study of more than 365 days sick leave due to cancer was made as well as a six-months-follow-up of the relapses after the returning to work. Proposals are made to ensure a healthy and effective return.Material and method: In order to search not only the articles about the return to work after cancer but also the barriers that may arise and the proposals in order to facilitate an effective return, the following bibliographic databases up to May 2019 were revised: SciELO, PUBMED. A study of cancer processes that kept prolonged sick leave within a 365-day period was carried out, analyzing how many of them did eventually end in medical discharge, how many of these processes had relapsed in the following six months and why had it taken place, and how many of the relapses ended in permanent disability.Conclusions: In the study carried out on workers with cancer sick leaves that reached or exceeded 365 days, it has been verified that 81% of its cases have been incorporated to work with dysfunctions configuring such sudden circumstances. These dysfunctions are precisely the cause of 75% of the disability relapses in the following six months, causing a failed attempt to return to work. Asthenia / fatigue, psychological disorders (including anxiety, low mood, depressive symptoms, cognitive impairment type attention deficit, concentration or memory), dysesthesias / paresthesias, and arthralgias are the most predominant and most impacting dysfunctions. Supervised aptitude modifies its previous functional capacity undergoing new risks for his health and his work. The following issues should be taken into account: A compulsory adaptation period to facilitate the labor recovery with no risk factors and in a healthy and continuous way; to address the partial discharge in this initial stage reducing the workloads, as well as a psychological support for those cancer workers in order to face the return to work; to support policies in the company protecting and supporting the reincorporation as well as to establish fiscal measures that incentive them; to improve the disability assessment criteria / ability to work, as well as the knowledge of work by using occupational worksheets; to take as well into consideration those preventive returning-to-work decisions; to consider the improvement of the communication between the agents involved in the health care, managers of disability and of the world of work; to prepare a strategic plan for the comprehensive protection of the cancer survivor; to draw up an Occupational Disability Map in Spain in order to carry out the analysis of work incapacity and its economic, social and health impact, as well as to evaluate the management policies.