Due to improvements in cancer survival the number of people of working age living with cancer across Europe is likely to increase . It is estimated that more than 500,000 people in the UK under the age of 65 years have been diagnosed with cancer during their working lives . Every year in Scotland around 27,400 people are diagnosed with cancer, 52% (n = 14,300) of whom are women . Breast cancer is the most commonly diagnosed cancer in Scottish women and incidence has increased by 8% over the past decade attributed, in part, to earlier detection due to mammography screening programmes. In 2007 over half (55%) of all women diagnosed with breast cancer in Scotland were of working age (i.e., between 18 and 65 years): around 1 in 20 were under 40 years, and 1 in 5 were under 50 years . Despite notable variation across countries,  breast cancer mortality rates are decreasing across Europe[6, 7]. In a recent comparative analysis of 30 European countries, England and Wales, Scotland, and Northern Ireland had the second, fourth and fifth largest overall decline in mortality between 1989 and 2006 of 35%, 30% and 29%, respectively . There is evidence that the trends of increasing incidence  and decreasing mortality will continue . Remaining in or returning to work will therefore be increasingly important for women living with breast cancer in Scotland and across the UK and Europe.
Dame Carol Black's recent review of the health of Britain's working age population recommended a multi-agency and partnership approach to supporting people to remain in or return to work and highlighted the role of line managers, general practitioners (GP) and vocational rehabilitation (VR) services. UK governments have made commitments to reduce the number of working days lost to ill-health and to improve access to VR services. In Scotland, the Scottish Centre for Healthy Working Lives (SCHWL) has established pilot VR services in National Health Service (NHS) Tayside and NHS Lothian. These services support people to remain in or return to work by providing fast-track care and services such as physiotherapy, counselling and occupational therapy to employees from small- to medium-sized companies with less than 250 employees, where occupational health support services are not available. The Scottish Government has recently identified return to work for people living with cancer as a priority .
People with cancer can often experience changed workplace relations or employment status following diagnosis or during treatment, with negative financial and psychosocial consequences. It is known that individuals change jobs, leave paid employment or experience a decline in earnings . Individuals may also experience discrimination from employers or colleagues . However, a recent review has identified that there are few services to support people to remain in or return to work after cancer and no associated trials to assess their impact .
The SCHWL and Macmillan Cancer Support are developing plans to expand VR services to people with cancer. The establishment of pilot VR services across Scotland may provide an opportunity to conduct a large randomised controlled trial to evaluate their effectiveness for people living with cancer. However, there are several uncertainties that must be addressed including an assessment of the feasibility of such a trial and the acceptability of the intervention among people with cancer. Given increasing incidence and survival of people living with breast cancer, it is both timely and appropriate to determine the feasibility of this definitive trial through a pilot randomised controlled trial (RCT) of VR services among women following surgery for breast cancer. A study design incorporating a pilot RCT was selected to refine, and assess the feasibility of, trial processes (including, recruitment, randomisation and follow-up) and estimate the likely effect size in advance of a larger, more definitive, future trial.