The cancer survivor—Manager dyad during the return‐to‐work process: An introduction with theoretical, conceptual, and methodological considerations

There is a need for tailored interventions aimed at promoting the sustainable return to work (RTW) of cancer survivors. As managers have a primary role in supporting cancer survivors to return to work, a better understanding of the “cancer survivor‐manager” dyadic process is much needed. The aim of this paper is to introduce the cancer survivor‐manager dyad in the context of RTW of cancer survivors, and to inform future studies by presenting theoretical, conceptual, and methodological considerations.


Key points
� The success of the implementation of managerial actions supporting the cancer survivor's return to work depends on the manager's and cancer survivor's willingness and ability to act as a unit.
� Studies focusing on the cancer survivor-manager dyad are needed and a specific conceptual model would be useful to conceptualize the interpersonal dynamics.
� It is important to identify determinants of the quality of the cancer survivor-manager relationship, and their effect on the return-to-work process.
� To study the cancer survivor-manager dyad, the use of the actor-partner interdependence model and prospective longitudinal studies are recommended.
� For the recruitment of cancer survivor-manager dyads, it is recommended to employ a cancer survivor-focused approach involving a trustworthy third party.

| INTRODUCTION
Approximately 40% of cancer survivors (i.e., every person who has been diagnosed with cancer at some point in their life and is currently still alive) are not able to return to work (RTW) within a year of diagnosis, 1 as the RTW of cancer survivors is a multifactorial process that can be complex. 2 When focusing on the workplace, managers (i.e., direct supervisors, human resource managers/directors) are usually the first interlocutors for cancer survivors, and they have a primary role in supporting cancer survivors to RTW. 3 Although several managerial actions (e.g., practical or emotional support, communication) have been highlighted as being vital for a successful RTW, 4 their success depends on the willingness and ability of the manager and the cancer survivor to act as a unit. 3,5 Such a unified entity could be referred to as a "dyad". 6 To date, dyadic studies in oncology have mainly concerned the cancer survivor-partner dyad. Only one study has focused on the relationship between the cancer survivor and the manager in a dyadic manner. 6 We know that the relationship between the cancer survivor and the manager involves both individual and joint emotional dynamics that can impact the chances of a successful RTW for the cancer survivor. 7 A better understanding of the "cancer survivor-manager" dyadic process is much needed and would facilitate the development and implementation of tailored interventions aimed at promoting the sustainable RTW of cancer survivors. On the other hand, to operationalize dyadic studies with the cancer survivormanager dyad is not methodologically easy. 6,8 We aim to introduce the cancer survivor-manager dyad in the context of RTW of cancer survivors, and to inform future studies by presenting theoretical, conceptual and methodological considerations.

| THEORETICAL AND CONCEPTUAL CONSIDERATIONS
Interventions to support the cancer survivor-manager dyad should be based on a theoretical model explaining their dyadic adjustment. A good dyadic adjustment refers to some form of attachment and satisfaction between the two members of the dyad, good communication and problem-solving skills in the dyad, and consideration of the characteristics, personality, and feelings (positive or negative) of each member of the dyad. 9 The explanatory models of dyadic adjustment are numerous, are generally referred to as dyadic coping models, and built on the knowledge of the patient-partner dyad. [10][11][12] The cancer survivor-manager dyad is specific and integrates the respect of privacy, 4 implying from the outset a different approach compared with that relating to the couple. Indeed, the cancer survivor is concerned with maintaining their own health even while returning to work, whereas the manager is responsible for maintaining the well-being and productivity of the entire team.
Throughout the cancer survivor's RTW process, a shared stressor for both parties of the dyad is to identify the appropriate balance between the cancer survivor's productivity within the team, which is crucial for renewing their self-confidence and feeling useful within the company, and the preservation of his/her health. This balance is crucial to endorse the sustainability of the RTW. [2][3][4] However, the simultaneous consideration of these individual and shared stressors can pose a complex challenge for all parties involved in the RTW of cancer survivors, including occupational health professionals. A model specific to the cancer survivor-manager dyad would be useful to conceptualize the interpersonal dynamics between the two parties and to frame interventions aimed at supporting cancer survivors and managers throughout the entire trajectory from diagnosis until sustainable job retention.
Interpersonal issues in a dyadic relationship may depend on the emotional experience of the stressful situation, the ability of each member of the dyad to be able to work as a team to cope with this stressful situation, and on the quality of the relationship. 6,7,13 The latter can be defined in three fundamental dimensions: (i) availability, (ii) relationship intensity, and (iii) perception of interpersonal conflict. 13 It is not easy for cancer survivors and managers to always establish a good relationship in practice. This may be due to positive or negative emotions experienced on an individual or shared basis due to the cancer diagnosis. 7 In addition, cancer survivors and managers often have a common pre-cancer history (positive of negative). Their respective perception of the quality of their precancer relationship could well influence the implementation of 1360 -GREIDANUS and PORRO managerial actions from the beginning of the return-to-work process. 2,3 Remarkably, no study has yet defined what a good relationship between a cancer survivor and his/her manager is, nor investigated its determinants. We therefore encourage further investigations to identify: (i) determinants of the quality of the relationship perceived individually by the cancer survivor and the manager; and (ii) their effects on the RTW process. 6

| METHODOLOGICAL CONSIDERATIONS
Dyadic studies require specific analysis models and research aimed at studying the cancer survivor-manager dyad in the context of the RTW of cancer survivors are subject to many limitations and/or biases regarding study design and recruitment method. A strategy in which consent of the cancer survivor was sought first, followed by recruitment of the manager by the cancer survivor him-or herself, may also be unappropriated. 15 This approach comes with serious selection bias toward cancer survivor with a proactive attitude and assumedly a good relationship with their manager. 15 These biases do not facilitate the identification of negative elements in the cancer survivor-manager relationship, which are very important for an intervention aimed at improving this relationship. 6 Alternatively, we propose to involve a trustworthy third party (TTP). He/she can consecutively: (a) recruit the cancer survivor, (b) ask the cancer survivor if he/she agrees with the invitation of his/her manager, and (c) recruit the manager. This third party should preferably be an acquaintance or confident of the cancer survivormanager dyad, for example, an occupational health or reintegration specialist, depending on the respective countries legal and supportive system. This strategy complies with all ethical standards and the abovementioned additional principles. Bringing in an independent third party may also make managers less fearful of violating privacy rules, thus making them more likely to participate. 8 When employing this strategy, we encourage researchers to exclude cancer survivors who have not informed their manager about their diagnosis of cancer yet, so that the study procedures do not put them under unintended pressure to make that disclosure. 15

| CONCLUSION
Investigations studying the cancer survivor-manager dyad are necessary to understand, in more detail, the interpersonal relations between these two stakeholders, which are at stake in the process of the RTW and job retention of cancer survivors. We have addressed different theoretical, conceptual and methodological aspects that open new perspectives in this area. Among the theoretical and conceptual aspects, we highlighted the interest of developing a dyadic coping model specific to the cancer survivor-manager dyad, and of studying in more detail the quality of the relationship between the two actors, including its impact on the work-related outcomes of the cancer survivor. Methodologically, we encouraged the use of the APIM and prospective longitudinal studies, and we proposed a recruitment strategy of the dyad by a TTP. This strategy respects the ethical framework, and the privacy and voluntary choice of cancer survivors.