Back to Work Within a Month: What Helps Lung Cancer Patients Return to Their Jobs After Surgery

When a young or middle-aged adult undergoes surgery for lung cancer, one of the most pressing questions is not only whether they will survive but whether they will return to the life they had before, including their job. A new prospective cohort study from Shanghai Chest Hospital, published in Supportive Care in Cancer, has now quantified how quickly working-age patients resume employment after minimally invasive lung cancer surgery and identified the psychological and social factors that appear to drive that early return. The findings suggest that the road back to work begins before patients even leave the hospital.

The research team, led by Jie Yang and Li Jiang of Shanghai Jiao Tong University School of Medicine, recruited 160 young and middle-aged adults who underwent minimally invasive lung cancer surgery at a tertiary hospital in Shanghai between June and December 2024. Before discharge, each participant completed a battery of validated assessments measuring three dimensions of early recovery: the quality of their in-hospital recovery, their confidence in managing their own cancer care, and the level of social support they perceived around them. One month after surgery, the researchers assessed whether participants had returned to work and, crucially, at what stage of readiness they stood.

The headline result is striking: 88 of the 160 participants, or 55 percent, had already returned to work within a single month of undergoing lung cancer surgery. This is a remarkably rapid reintegration for a population recovering from a cancer diagnosis and a thoracic operation. Yet the study also revealed a sobering nuance. Of those who had resumed work, 53 were categorized in the uncertain maintenance stage of return to work, meaning they had gone back to their jobs but remained unsure whether they could sustain it. Only 35 had reached the proactive maintenance stage, in which they felt confident and in control of their working lives again.

The remaining 72 participants, 45 percent of the cohort, had not yet returned to work at one month. The researchers mapped these individuals across the stages of the Readiness for Return-to-Work model, a framework originally developed for patients with musculoskeletal disorders and adapted here for cancer survivors. Nine were in the precontemplation stage, not yet thinking about resuming work. Fifteen were in the contemplation stage, aware of the need but not yet committed. Twenty-two stood in the prepared for action self-evaluative stage, weighing whether they were ready, while 26 had reached the prepared for action behavioural stage, actively making plans to go back.

Using binary logistic regression, the team examined which baseline factors predicted early return to work. Three variables emerged as significantly associated with a greater likelihood of resuming employment within one month: higher quality of in-hospital recovery, greater cancer self-management self-efficacy, and stronger perceived social support. In other words, patients who recovered better during their hospital stay, who felt more capable of managing symptoms, medications, and follow-up care on their own, and who perceived more support from family, friends, and their community were more likely to be back at their desks or workplaces within weeks of the operation.

The measurement of in-hospital recovery relied on the Quality of Recovery-15 scale, or QoR-15, a psychometrically validated instrument developed by anaesthesiology researchers to capture the multidimensional nature of postoperative recovery, including physical comfort, emotional state, psychological support, and independence. The self-efficacy dimension was assessed with the Strategies Used by People to Promote Health scale, rooted in Bandura’s social cognitive theory, which holds that a person’s belief in their own capability is a central determinant of whether they will attempt and sustain a behaviour. Perceived social support was measured with a Chinese version of the Perceived Social Support Scale, capturing the support patients feel from significant others, family, and friends.

The theoretical scaffolding of the study draws on the biopsychosocial model of health, which argues that outcomes after illness and treatment cannot be understood through biology alone but must incorporate psychological and social dimensions. This perspective has gained traction in return-to-work research across orthopaedic trauma, hand injuries, and cardiovascular disease, and the Shanghai team extended it to the specific and understudied context of lung cancer surgery in working-age adults. Lung cancer is among the most common malignancies in China, and a substantial proportion of patients are diagnosed at ages when they remain economically active, making the question of work reintegration both a clinical and a societal concern.

The study’s clinical implications are considerable. Rehabilitation nursing, the authors note, plays a critical role in supporting postoperative functional recovery and facilitating reintegration into daily life and work. If the quality of recovery during the hospital stay is already associated with return to work one month later, then interventions delivered in the immediate perioperative period, consistent with enhanced recovery after surgery protocols for lung surgery, may have downstream effects on employment outcomes. Similarly, if self-efficacy and perceived social support predict early return, then nursing programmes that build patients’ confidence in self-managing their cancer care and that mobilize family and community resources could be designed with return to work as an explicit goal.

However, the authors and the broader literature caution that early return is not the same as sustainable return. The fact that most patients who resumed work within a month remained in the uncertain maintenance stage suggests that many were pushing themselves back to employment before they felt fully confident they could stay there. Prior research on cancer survivors has documented work withdrawal behaviour, fear of failure at work, financial toxicity, and the mediating role of self-efficacy between social support and work outcomes. The Shanghai findings align with a growing body of evidence from colorectal, kidney, breast, and head and neck cancer survivors showing that psychological readiness and social resources are as important as physical recovery in determining whether patients return to work and remain there.

The study also contributes to a wider conversation about what work means after cancer. Recent grounded theory research has argued that survivors often reconceive the purpose of work following a diagnosis, sometimes abandoning conventional career ambitions in favour of work that feels meaningful or manageable. The Shanghai cohort’s distribution across readiness stages captures this psychological complexity: even among those who had not yet returned, many were actively evaluating their capacity or making concrete plans. For clinicians, the message is that return to work should be assessed not as a binary event but as a staged process, and that tailored support, whether building self-management skills, strengthening social networks, or optimizing perioperative recovery, may help patients move through those stages more confidently. For working-age lung cancer patients facing surgery, the evidence now suggests that the journey back to the workplace is shaped as much by what happens in the hospital and in the mind as by what happens in the operating room.

Subject of Research: Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study

Article Title: Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study

Article References: Yang, J., Jiang, L., Ge, L., Shi, Y., Ju, X.-X., & Liu, X.-X. (2026). Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study. Supportive Care in Cancer, 34(11), Article 1107. https://doi.org/10.1007/s00520-026-11305-6

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11305-6

Keywords: Associations, in-hospital, recovery, cancer, self-management, self-efficacy, perceived, social, support, early, return, work