Psychosocial factors associated with return-to-work in breast cancer survivors: a systematic review

Abstract Background Breast cancer (BC) is one of the most frequently diagnosed cancer types, with severe consequences impacting almost every sphere of an individual’s life. Returning to work (RTW) is a crucial element in regaining a sense of normalcy; however, it remains a major challenge for the BC population due to a number of factors impacting employment outcomes. While the clinical impact of BC on RTW is well acknowledged and investigated, the psychosocial aspects of it have often been overlooked. Thus, the aim of this systematic review (SR) is to identify and systematically summarize the psychosocial factors associated with RTW in the BC population. Materials and methods Three scientific databases (PubMed, Embase, and Scopus) were searched to identify studies investigating psychosocial factors associated with RTW published from 2015 to 2025. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). The methodological quality of the included studies was assessed using the modified Downs and Black checklist. Results Sixteen studies were included in this review. Our analysis identified a number of psychosocial variables significantly associated with work reintegration for this population of cancer survivors. More specifically, anxiety and depression emerged as the most prominent barriers to successful RTW. Other major determinants hindering RTW were fatigue (particularly mental and emotional) and impaired quality of life domains in emotional and social well-being. Factors positively associated with RTW included resilience, motivation, greater RTW self-efficacy, perceived support, and positive body image. Conclusion This SR highlights that psychosocial factors play a crucial role in RTW outcomes among BC survivors. The findings underscore the need for a coordinated, multidisciplinary approach to optimize RTW outcomes, integrating oncological treatment, mental health support, and occupational rehabilitation in the cancer care pathway. Early psychosocial assessment within oncological care will enable the identification of vulnerable domains and guide the development of individualized survivorship care plans, tailored to optimize not only physical functioning but also psychological recovery and occupational reintegration.