Abstract
Background
Return to work (RTW) is a critical aspect of recovery and social reintegration for cancer survivors. With increasing survival rates, understanding the research landscape in this field has become essential.
Objective
This study aims to systematically identify research hotspots, emerging trends, and development directions in the field of return to work among cancer patients through bibliometric analysis.
Methods
Relevant literature published between January 1, 2004, and May 31, 2024, was retrieved from the Web of Science （WoS） Core Collection. Bibliometric analysis and knowledge mapping were performed using CiteSpace for visualization.
Results
A total of 1370 relevant publications were retrieved, with 767 English articles included in the visualization analysis after screening. These publications originated from 54 countries, with more than 30 articles from 10 countries or regions. The top three countries in terms of publication volume were the Netherlands, the United States, and Australia. The leading institutions were the University of Amsterdam, Vrije Universiteit Amsterdam, and Academic Medical Center Amsterdam. The most prolific author was Frings-Dresen, M.H.W. The top five keywords were “Return to work,” “Breast cancer,” “Survivors,” “Quality of life,” and “Employment.” Keyword cluster analysis revealed 15 clusters, divided into four major categories: Population and Disease Types (cancer survivorship, cancer patients, head and neck cancer, colorectal cancer, breast cancer survivors), Health Promotion and Work Ability (return to work, work ability, health promotion, functional outcome), Health Economics and Injury Compensation (supervisor, health economics, disability pension, sick leave), and Research Types (scoping review). An emergent analysis of keywords indicates a shift from early terms like “quality of life,” “rehabilitation,” and “sick leave” to “needs,” “burden,” “impairment,” and “management.”
Conclusion
Breast cancer is the most common focus within studies on cancer patients returning to work, with colorectal and head and neck cancers gaining attention. Research is increasingly focused on the economic burden's impact on cancer survivors. Effective interventions could include employer-level initiatives, vocational counseling, patient education, psychological support, and multidisciplinary measures combining biofeedback-assisted behavioral training or physical exercise.
Keywords
Introduction
With the rapid advancements in medical technology, the survival rates of cancer patients have significantly improved, with an average 5-year survival rate approaching 46% to 60%. 1 This, coupled with a relatively high incidence rate, has led to a large population of cancer survivors. In recent years, the issue of cancer patients returning to work post-treatment has garnered increasing attention and has become a research hotspot in academia. This shift reflects society's growing concern for the quality of life and comprehensive rehabilitation of cancer patients. As the number of cancer survivors rises, returning to work has become an inevitable trend, bearing substantial significance for the patients, families, and society. From an individual perspective, being employed is a crucial factor affecting the quality of life. Studies have shown that employment affects various aspects of health and quality of life for patients.2,3 For cancer patients, undergoing disease treatment and recovery may affect their physical, psychological, and social functions to varying degrees. 4 However, returning to work not only provides an opportunity to reintegrate into daily life and social rhythms, but it also serves as an essential chance for patients to regain confidence and self-esteem. Return to work is a key component of survivorship care, integrating medical, psychological, social, and economic dimensions. Similar multidimensional processes are reported in other occupational health contexts. 5 More importantly, returning to work may indirectly contribute to improved survival outcomes in cancer patients, as alleviating the economic burden of cancer can reduce financial barriers to adherence to recommended treatments. 6 A longitudinal study conducted in Taiwan over 11 years revealed that returning to work significantly reduces the risk of all-cause mortality in cancer patients. 7 From a societal perspective, encouraging patients to return to work has economic implications. 2 Most patients diagnosed with cancer are at critical stages of their family and career lives, causing significant losses to family functions and the workforce. Returning to work can alleviate the economic burden on families and society to some extent, especially for those who are main breadwinners or live independently. Therefore, encouraging and supporting cancer patients in returning to work is not only a personal concern but also reflects societal progress and inclusivity.
However, the current situation of cancer patients returning to work is far from ideal. Substantial evidence indicates that cancer and its treatment adversely affect survivors’ employment, work ability, performance, and job satisfaction. 8 We realize that relying solely on medical treatment is insufficient for helping patients fully recover and rejoin the workforce. Instead, a more comprehensive and integrated intervention strategy is needed to address the physical, psychological, and social challenges faced by patients. 9
Previous studies on cancer patients returning to work have deepened, covering various aspects such as the current status, influencing factors, experiences and perceptions, and intervention programs. However, due to the heterogeneity and dispersion of research data, effectively integrating and analyzing this vast information poses a major challenge for researchers. Knowledge Graphs, as an emerging technology for data integration and knowledge representation, can structure and semantically process heterogeneous data, displaying the development of scientific knowledge through visual graphs. This provides possibilities for the integration and analysis of complex information, presenting the structural context, social networks, and other complex relationships between knowledge modules. 10 Bibliometrics, as a discipline for quantitatively analyzing literature data and revealing trends in scientific activities, can quantify the impact of research outputs by statistically analyzing academic papers, monographs, and patents. 9 The Web of Science is the world's largest and most discipline-inclusive English database, making it the preferred choice for bibliometric investigations due to its broad coverage of academic publications. 11
This study aims to conduct a bibliometric and visualized analysis based on the Web of Science database to examine research on cancer patients returning to work over the past two decades. By integrating fragmented findings through knowledge mapping, this study seeks to identify research hotspots, emerging trends, and key development directions, and to provide a comprehensive overview to inform future research.
Materials and methods
Source of literature and search strategy
The Web of Science Core Collection database served as the data source for this study, with the search strategy defined as TS = (Tumor* or Neoplasia* or Neoplasm* or Cancer* or Carcinoma or Malignanc* or Oncolog* or Oncoma or Tumour) AND TS = (“Return to Work” or “Work, Return to” or “Back to Work” or “Work, Back to” or Back-to-Work or Return-to-Work). The search period was set from January 1, 2004, to May 31, 2024. Inclusion criteria required that study subjects be cancer patients and the study variable focus on returning to work. Only “Article” and “Review” literature types in English were included. Exclusion criteria ruled out conference proceedings, book chapters, revised literature, letters, news articles, and duplicated reports. The selection process entailed deduplication, as well as reviewing titles, keywords, abstracts, and full texts to exclude any literature that did not meet the inclusion criteria. The screening and selection of studies (including title/abstract and full-text review) were conducted independently by two researchers. Any discrepancies were resolved through discussion until consensus was reached.
Data visualization process
Selected documents were saved in full record and cited reference formats as plain text and imported into CiteSpace (version 6.2.R3) to create a new project. The time span was set from January 1, 2004, to May 31, 2024, with one-year time slices. Node types were selected according to standard bibliometric frameworks and the objectives of this study, including country, institution, author, co-cited references, and keywords. Countries and institutions were used to describe the geographical and organizational distribution of research. Authors were analyzed to identify influential scholars and collaboration patterns. Co-cited references helped reveal the intellectual base and foundational studies in the field, while keywords were used to identify research hotspots and evolving trends.
For network construction, cosine similarity was applied to measure the strength of relationships between nodes, and the within-slice linking method was used to restrict connections to the same time slice, thereby improving the clarity and temporal consistency of the network. The g-index (k = 25) was used to select representative nodes, balancing highly cited studies and overall publication volume, which helps focus the analysis on the most influential contributions. Pruning algorithms were applied to simplify the network by removing redundant links, making the visualizations easier to interpret without losing essential information.
Network indicators were used to evaluate structure and reliability. Centrality reflects the importance of nodes within the network. Modularity (Q value) indicates how well the network can be divided into distinct clusters, with higher values suggesting clearer structure. 12 Silhouette (S value) was used to assess the consistency of clustering results, with higher values indicating better reliability. The Log-Likelihood Ratio (LLR) algorithm was used to generate cluster labels, improving the interpretability of thematic groupings. Burst analysis was conducted to detect keywords with sudden increases in frequency, which helps identify emerging research frontiers. 13 In addition, Microsoft Excel was used to analyze annual publication trends and summarize contributions from countries, institutions, authors, and keywords.
Results
Following the established search strategy, a total of 1370 documents were retrieved. After applying the inclusion and exclusion criteria, 767 English articles were finally selected for further analysis. The screening process is illustrated in Figure 1.
Flow chart of literature screening and selection process.
Publication volume and trends
The research on cancer patients returning to work has shown a continuous upward trend in publication volume (see Figure 2). However, there was a brief decline in the number of publications from 2020 to 2022, likely due to the profound impact of the global COVID-19 pandemic on research activities across various fields. Despite this, by 2024, within just the first five months, there have already been 34 publications, indicating an ongoing and increasing level of interest in this topic within the academic community. It should be noted that the increase in publication numbers may be partly influenced by the overall growth of scientific output. Therefore, the observed trend should be interpreted with caution.
Trends in the publication of research on cancer patients returning to work.
National/regional collaboration network analysis
Based on the results observed in Figure 3, which illustrates the map of publication volumes by region, a total of 54 countries have contributed to the relevant literature. The Netherlands leads with 137 data points, indicating the highest volume of publications. The United States follows in second place with 121 data points. Other notable contributors include Australia (66), England (64), Canada (64), Germany (63), France (61), Sweden (45), Denmark (42), and China (31). These top 10 countries account for 82.1% of the total publication volume. From the regional collaboration map shown in Figure 4, countries with a betweenness centrality greater than 0.1 include the Netherlands, the United States, Australia, England, Spain, Brazil, and Belgium. This suggests that these countries have high levels of collaboration and influence in the field. The United States, which ranks second in publication volume, has the highest centrality value at 0.36. In network analysis, centrality measures the extent to which a node serves as a bridge connecting different research groups or countries; a higher centrality value indicates that the United States plays a key intermediary role in facilitating collaboration across the international research network，indicating strong collaborative ties with other leading countries. Figure 5 presents the institutional collaboration network within this field, where 398 institutions have been extracted, with 972 connections and a network density of 0.0123. Among the top 10 institutions conducting research on cancer patients returning to work, six are based in the Netherlands, contributing a total of 294 publications, accounting for 38.33% of the total publication volume. The largest collaboration network centers around institutions in Amsterdam, Netherlands, highlighting their leadership in this research area.
Map of publication volumes by country/region.
Collaboration map by country/region.
Institutional collaboration co-occurrence map.
Author analysis
The analysis of authors included in the literature comprises 378 authors. Table 1 lists the top five authors by publication volume. The top four authors all hail from the same country and institution. The leading author, Frings-Dresen, M.H.W., has published 30 articles in this field, with her first contribution dating back to 2009. Her research primarily focuses on occupational health, exploring ways to improve work participation for cancer and chronic illness patients. The second-ranking author, Angela G. E. M. de Boer, also from the Netherlands, began her research in this area in 2012, focusing similarly on occupational health and improving work participation among cancer and chronic illness patients. See Table 1 for more details.
Analysis of authors by publication volume.
Citation analysis
In the citation analysis, the node type “Reference” was selected to identify the top 10 highly co-cited references in this research field, as shown in Table 2. Among these, seven are systematic reviews or meta-analyses. The most frequently cited paper is by Mehnert, A., published in Critical Reviews in Oncology Hematology. This review, which addresses employment and work-related issues among cancer survivors, has been cited 56 times. Nine of the papers analyze factors influencing the return to work, while one systematic review summarizes interventions for returning to work.
Top 10 highly co-cited publications in cancer return-to-work research over the past 20 years.
Keyword network analysis
Keyword co-occurrence analysis
Using Citespace software, a keyword co-occurrence analysis was conducted to identify the top 15 keywords by frequency in the research field. These keywords include “Return to work,” “Breast cancer,” “Survivors,” “Quality of life,” “Employment,” “Return,” “Cancer survivors,” “Impact,” “Diagnosis,” “Health,” “Women,” “Predictors,” “Experiences,” “Work,” and “Cohort.” These terms highlight the central themes and focus areas, as illustrated in Figure 6.
Keyword co-occurrence network diagram.
Keyword clustering analysis
In CiteSpace, keyword clustering analysis was conducted using the LLR algorithm, which groups frequently co-occurring keywords into thematic clusters. This algorithm was chosen because it provides more accurate and distinctive cluster labels compared to other methods (e.g., mutual information), as it emphasizes terms that are uniquely characteristic of a cluster. The keyword cluster map revealed 326 nodes and 607 links, resulting in 15 cluster labels. The clustering modularity value (Q) is 0.7841 (greater than 0.3), indicating that the network structure of the clustering results is significant. The average silhouette value (S) of the clustering is 0.857 (greater than 0.7), suggesting that the clustering results are reliable. There is an overlapping phenomenon among clusters, indicating close connections between them. The 15 major clusters, as reported in Figure 7, are numbered starting from 0 and include: #0 “disability pension,” #1 “cancer survivorship,” #2 “cancer survivor,” #3 “supervisor,” #4 “cancer patients,” #5 “head and neck cancer,” #6 “health promotion,” #7 “return to work,” #8 “colorectal cancer,” #9 “work ability,” #10 “health economics,” #11 “scoping review,” #12 “functional outcome,” #13 “breast cancer survivors,” and #14 “sick leave.” Cluster #0 is the largest cluster, followed by cluster #1, and so on.
Keyword clustering diagram.
Keyword burst analysis
Keyword burst refers to the phenomenon where a particular keyword appears frequently over a period, indicating the research focus during that time. The burst intensity and timing are important attributes, highlighting research hot spots and development paths in the field, helping infer the frontier progress and research trends. This study conducted keyword burst analysis on 767 English articles, detecting the timing, frequency, and increase of burst keywords. We identified 37 keywords showing the most significant burst values from January 1, 2004, to May 31, 2024, to explore the trends and advancements related to the return to work for cancer patients. Notably, “prospective cohort,” “return,” and “education” garnered attention as early as 2007, reaching peak burst intensity in the same year. Recently, keywords such as “impairment,” “burden,” “needs,” “distress,” “of life,” “management,” and “head and neck cancer” have emerged as research hot spots, reflecting a growing focus on the psychological state of cancer survivors and issues related to employment obstacles(as shown in Figure 8).
Keyword burst diagram.
Discussion
This study provides a comprehensive overview of research on return to work among cancer survivors over the past two decades using bibliometric methods. The findings indicate a steady growth in research output and reveal the multidimensional nature of this field. Keyword co-occurrence and clustering analyses identified several major thematic domains, including population and disease characteristics, work ability and health promotion, economic burden, and research methodologies. In addition, keyword burst analysis suggests a shift in research focus from early topics such as rehabilitation and sick leave toward more recent concerns related to psychosocial needs, burden, and management. These findings contribute to a clearer understanding of the evolving research landscape and may help inform future studies and practice.
Research areas and trends
This bibliometric analysis identified key trends and distributions in the global literature on return to work among cancer patients between 2004 and 2024. The overall volume of publications showed a continuous upward trend, with a phase of rapid growth from 2017 to 2019. Research in this field started earlier in Western countries, notably in the United States in 2004 and the Netherlands in 2006, with the Netherlands emerging as the most productive country and its institutions and researchers acting as core contributors. In contrast, research in China only began in 2017 and remains at an early stage, contributing just 4.0% of all publications, yet it has established close international collaborations that support its academic influence. This upward trend, particularly after 2017, may be associated with improved cancer survival rates and a growing recognition of survivorship as a distinct phase of care. As more patients live longer after diagnosis, attention has shifted from survival alone to functional recovery and social reintegration, including return to work. In addition, policy developments in occupational health and increasing awareness of work participation as a key component of quality of life may have further driven research growth in this area.
Hotspots and frontier analysis
An analysis of keywords from 20 years of English literature concerning cancer survivors returning to work provides an objective view of research hotspots and frontiers in this field. This analysis also serves as a resource for guiding future studies.
Targeted groups
Research hotspots initially concentrated on female breast cancer survivors, which is reflected in the high frequency of related keywords in earlier periods. Literature indicates that early-stage breast cancer patients generally have an easier time returning to work compared to those with late-stage cancer. Treatment types (such as surgery, chemotherapy, and radiation) and their side effects also significantly impact this return.23,24 lymphedema and cognitive impairment) can hinder patients’ work abilities.9,14,22 Due to unique physiological traits and familial responsibilities, women often experience anxiety, depression, and fear post-cancer, affecting their quality of life and complicating their return to work. 9 Recently, focus has shifted to colorectal and head and neck cancers. Postoperative complications are common in colorectal cancer patients, increasing their economic burden and extending their return-to-work times. 6 Although attention to head and neck cancer began only in 2018, it has quickly become a priority. High-impact studies indicate that functional impairments following treatment can influence survivors’ abilities to return to work and daily life, adding to their economic burdens. 25 Overall, this shift in targeted populations suggests a transition from a single-cancer focus to a more diverse and comprehensive research scope. It reflects an increasing recognition that return-to-work challenges vary substantially across cancer types, treatment modalities, and functional impairments, thereby requiring more tailored research and intervention strategies.
Intervention hotspots and trends
Studies indicate that support from employers and colleagues is a key factor influencing successful return to work among cancer survivors. Such support facilitates adaptation to the work environment and reduces psychological stress, thereby improving return-to-work outcomes. 26 Conversely, perceived discrimination is negatively associated with successful reintegration. Positive employer attitudes and a better understanding of survivors’ needs are essential, particularly given variations in health status related to cancer type, treatment, and recovery stage, which may require flexible arrangements such as adjusted workloads or rest periods. 15 Workplace accommodations, including job modifications and paid sick leave, further mitigate economic burden and improve quality of life.16,27 Evidence also shows that disability benefits and sick leave increase substantially within the first year after diagnosis and decline by the third year, reflecting dynamic return-to-work trajectories.28,29 Beyond workplace support, multidisciplinary interventions play an important role. 12 Approaches combining vocational counseling, patient education, behavioral training, and physical exercise have been shown to effectively promote return to work. 7 Psychological factors, including anxiety and depression, as well as treatment-related physical limitations, remain critical barriers that should be addressed in future interventions. 30 Recent evidence further highlights the complexity of these needs. A scoping review by Mollet et al.dentified diverse information and support needs across personal, workplace, healthcare, and policy systems, emphasizing the importance of coordinated, multi-stakeholder interventions to support sustainable return to work. 31 Overall, these findings suggest that return to work is shaped by the interaction of individual, workplace, and systemic factors, highlighting a shift toward more holistic and work-oriented rehabilitation strategies.
Impact outcome variables
Research hotspots concerning impact outcome variables for returning to work include quality of life, burden, health economics, disability pension, and sick leave. “Quality of life” has been a widely discussed topic since 1999, highlighting its significant effect on cancer patients who return to work. Employment is considered the third most crucial factor affecting quality of life for survivors, following mobility and social activity capabilities. 32 Emergent keywords post-2019, such as “needs” and “burden,” indicate a growing focus on psychological health and economic burdens faced by survivors returning to work. Recent bibliometric analyses further demonstrate an increasing focus on rehabilitation, burden-related factors, and performance-related variables across disciplines. 12 The term “burden” first appeared in 2017, with Seifart, U. et al. noting that cancer patients often prioritize economic stress over physical and psychological side effects. Keywords like “health economics,” “disability pension,” and “sick leave” substantiate this trend. A highly cited 2019 study by Pearce, A. found that cancer survivors unable to return to work experience poorer economic circumstances and diminished quality of life. 33 Employment gaps trigger financial stress, leading to distress, anxiety, and depression, which reduces quality of life. To cope with financial pressures, survivors often cut leisure activities and reduce spending on essentials. 33 Recent studies have also highlighted the increasing importance of recreational and rehabilitation-based approaches for individuals with disabilities, emphasizing inclusive and adaptive strategies. 34 This evolution of keywords indicates a broadening of research perspectives from clinical outcomes to socioeconomic and psychosocial dimensions. It highlights that return to work is not only a marker of recovery but also a determinant of long-term well-being. The growing focus on economic burden and unmet needs further suggests that future research should integrate health policy, social support systems, and individualized rehabilitation strategies.
Limitations
This study has several limitations. First, the generalizability of the findings is constrained by the exclusive use of the Web of Science Core Collection and English-language publications, which may have led to the omission of relevant studies. The predefined time span may have further limited coverage. Second, methodological constraints inherent to bibliometric tools, including limited standardization of data (e.g., case formats and abbreviations) and the use of thresholding and pruning algorithms, may have resulted in partial information loss. Third, reliance on absolute publication counts may be confounded by the overall growth of scientific output; thus, observed trends should be interpreted cautiously. Finally, this study did not examine detailed study-level characteristics (e.g., design, population, or methodological quality), which may limit deeper insights into the structure and strength of the evidence base. In addition, the generalizability of these findings may be influenced by differences in healthcare systems, social security policies, and labor market structures across countries. Variations in workplace environments, such as job security, employer support, and access to occupational health services, may also affect the applicability of RTW strategies. Therefore, the interpretation and implementation of these findings should consider specific national and institutional contexts. Future research should integrate more granular content analyses alongside bibliometric approaches to enhance interpretability and rigor.
Conclusion
This study uses knowledge mapping to examine the evolution of research on cancer survivors returning to work over the past two decades, revealing key themes and shifts in the field. The findings highlight return to work as a multidimensional process shaped by clinical, occupational, and psychosocial factors. By identifying research hotspots and gaps, this study clarifies the field's development and emphasizes the need for more integrative and practice-oriented research to better support sustainable work reintegration.
Footnotes
Abbreviations
Acknowledgements
The authors acknowledge the use of CiteSpace for bibliometric analysis and thank the Web of Science Core Collection for providing access to the data used in this study.
Ethical approval (name of institute and number)
This study does not involve human or animal subjects; therefore, ethics approval is not required.
Authors’ contribution statements
All the authors contributed to study design, interpretation of results, and finalization of the manuscript. Rong Chen and Huiting Zhang are responsible for the first draft of the manuscript. Li Shi are responsible for data summary and analysis. Piao Chen are responsible for literature search and quality assessment. Huiting Zhang，Mengxiao Jiang and Baojia Luo guided and facilitated the study. All the authors commented on the previous version of the manuscript. All the authors have read and approved the final manuscript.
Informed consent
This manuscript has not been published or presented elsewhere in part or in entirety, and is not under consideration by another journal. All the authors have approved the manuscript and agree with submission to your esteemed journal.
Funding
This research was supported by Guangdong Basic and Applied Basic Research Foundation（2025A1515011824）, Guangdong Provincial Nurses Association（GDNSAH2024MS17)
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Availability of data and materials
The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.
