With earlier diagnosis of cancer and improvements in treatment survival rates, there are more cancer survivors returning to work. While they may have conquered the disease, they still face many challenges once they return to the office, such as increased stress or fatigue or reduced confidence.
“It’s a problem that’s not going to go away and it’s an issue that really does need more of a focus because there are going to be larger numbers of people affected by this,” said Alethea Cooper, research fellow at the Biomedical Research Centre in the department of public health sciences at King’s College London in the United Kingdom.
Further complicating the situation are variations in perceptions by the cancer survivors and their employers. Organizations consistently have more negative beliefs about the impact of cancer on work than the returning employees, found a study co-authored by Cooper based on interviews with 252 organizations and 274 patients in the U.K.
Employers rated nine factors as having a greater impact on work than cancer survivors: fatigue, emotional distress, physical symptoms, low confidence, lower concentration, unpredictability of cancer, level of performance, lack of colleague understanding and hospital appointments. (See chart.)
“Such a discrepancy could potentially be detrimental to a constructive dialogue between the employer and employee, interrupting a smooth transition back to work,” said the study Cancer Survivors’ and Employers’ Perceptions of Working Following Cancer Treatment. “It is important that both employers and employees have realistic expectations of working both during and post-treatment and that there is awareness and acceptance of individual differences.”
The same differences in opinion were evident when the two sides were asked about issues such as how long work would be affected by cancer or the degree of control an employee has over the effects of cancer at work.
“The difference in the scores reflects that organizations are obviously and understandably very cautious and concerned about individuals coming back and feel there is a large impact,” said Cooper. “And, in a way, that’s a good sign — they are looking to be supportive.”
Patients, on the other hand, don’t see it as a big issue.
“It could (be) there’s a little bit more reality coming from the organization than perhaps the patient or employee. That requires very careful handling,” said Cooper. “There has to be room for some negotiation and review.”
But the study does not suggest survivors are overestimating their abilities, said Lucie Kocum, an assistant professor in the department of psychology at St. Mary’s University in Halifax who has done preliminary research on breast cancer survivors.
And false assumptions can be a problem because the work role is really important to cancer survivors, she said.
“It’s dangerous to a woman’s well-being to assume that holding back on important tasks will do her good,” said Kocum. “It’s very, very important that the person still feel autonomous, still feel related to people, still feel competent in the role.”
These days, patients are able and encouraged to go back to work sooner but with new treatments, there are potentially new side effects, so sometimes it isn’t always clear how somebody’s going to recover, said Maureen Parkinson, a vocational rehabilitation counsellor at the BC Cancer Agency in Vancouver who co-authored the paper Cancer and Work: A Canadian Perspective. And if it’s a really new treatment, there’s always a research lag in understanding how people will be affected.
“There’s been a dearth of research in terms of work and functioning,” she said.
As a result, a non-supportive work environment can include false assumptions about the effects of cancer and its treatment.
“Not all cancers are the same, treatments are very self-specific and even people are very individual in terms of their reactions to treatment and the disability,” said Parkinson. “So generalizations about recovery from cancer are not helpful.”
Unrealistic expectations are also a challenge, since recovery can take some time. Some workplaces might be supportive at first but that kind of dies down, she said.
“Fatigue, for example, is one big issue… so there needs to be ongoing support,” said Parkinson. “Sometimes, employers want a very fast graduated return to work and I don’t think that that always fits for somebody who’s recovering from cancer treatment.”
HR’s role: Assessments, policies, training
A proper return-to-work assessment that takes into account the survivor’s and employer’s perceptions is key when a cancer survivor is returning to work, said the U.K. study. A lot of people are advised to go back to work when they feel up to it but they often cannot judge that properly, said Cooper. They could be bored at home, feel they’ll be perceived as malingerers or want to get back to normality but, ultimately, find the fatigue too hard for such a schedule. So a phased return, with a review after a few weeks, is recommended.
But if an occupational assessment for a person returning to work is done too soon, it is a source of stress for survivors, said Kocum.
“It’s very important that it be done at the point where the person is actually well enough so it sets them up for proper accommodation and is not setting them up to fail,” she said. “It’s just (about) understanding, communicating.”
While a staggered return to work might be appropriate for one person, it might not be for another, said Kocum.
“What’s most important is that each person be treated as an individual and their accommodation be what they need.”
And while many companies have implemented a return-to-work policy, few have a cancer-specific policy, said Cooper.
“So what’s different is looking at the individual treatment regime the patients are going through but also their perceptions of what they can do,” she said. “It really needs to be very focused on their own viewpoint and understanding and beliefs about what they’re able to do but also taking into account the fact that that may be overly ambitious.”
Employers generally know the law and their duty to accommodate but the support is less evident when it comes to colleagues, said Parkinson. So it’s up to HR to educate colleagues through sensitivity training that looks at perceptions and assumptions. While confidentiality around the employee’s ailment is a challenge, an aging population means there will be more health issues in the workplace, so sensitivity training can still apply, she said.