Return to work experience on structural constraints and gendered differences among nasopharyngeal carcinoma survivors: a qualitative study

Purpose: Working-age nasopharyngeal carcinoma (NPC) survivors frequently resume employment while contending with weak labor protections and latent gender norms. This study aims to explore how NPC survivors navigate the return to work (RTW) process beyond binary aspects, with a focus on the dynamics of structural constraints and gendered experiences.

Methods: This study employed a qualitative design, conducting semistructured interviews with 32 working-age NPC survivors in China (aged 30 to 45 years, 56.2% male). Data were analyzed with thematic analysis.

Results: The findings reveal two overarching themes, with six subthemes. (1) Structural constraints: NPC survivors are encountering reduced sick leave pay, disruption of social insurance, and housing insurance. A cancer diagnosis puts pressure on working performance, but there is limited support for remote work and opportunities for promotion. The coping strategies include optimizing insurance reimbursement with commercial insurance, crowdfunding, applying for leaves, and welfare schemes. (2) Gendered coping strategies on RTW: NPC survivors tend to limit disclosure of their diagnosis to avoid labeling and stigma. Male survivors consistently emphasized breadwinner-related financial toxicity, while female survivors more frequently reported role conflict, indicating a paradox of caregiving and RTW.

Conclusion: The RTW trajectory of NPC survivors is a complex and multifaceted process, navigating multiple significant challenges that are deeply entrenched in structural constraints and gendered expectations, resulting in a dynamic phenomenon. The existing coping strategies might not fully address the identified challenges. Institutional reform should involve standardized sick leave pay, ensuring continuity of social insurance, antistigma practices, and providing support for flexible working arrangements.