In the UK there are currently over 750,000 people of working age living with cancer. This represents over a third of the 2 million living with cancer, and with survival rates improving and people retiring later, that proportion is likely to increase.
More than 40% of people diagnosed with cancer make changes to their working lives, with almost half changing jobs or leaving work altogether. The total loss in productivity of cancer survivors unable to return to paid work in England was estimated in 2008 to be £5.3bn. So, what is happening here, and why? Every case is obviously different, every person unique, but there are nonetheless some common issues here for employers.
After the roller-coaster journey of receiving a cancer diagnosis and treatment, many cancer survivors and their employers believe initially that after a return-to-work plan has been agreed and a few reasonable adjustments made, life will be pretty much back to normal after a few weeks. Indeed, the latest research undertaken by Macmillan Cancer Support shows that 40% of cancer survivors, let alone their employers, are at first totally unaware of the long term side effects of cancer treatment. Yet these side effects can be both physical (pain, fatigue, loss of bladder control, impotence) and psychological (depression, lack of confidence), and they can begin long after the medical treatment has finished.
It is often the case that for those who have cancer, work offers an important lifeline back to normality and wellbeing. But recovery is a process, not an event. It takes place gradually, over time and often takes longer than everybody hoped or expected. Resilience and determination are required as well as patience and understanding.
The first few months after treatment can be a particularly difficult time for those recovering from cancer, often made worse by the feeling (rarely correct) that support is no longer available and that they are now “on their own” to deal with whatever happens next. Many of these difficulties are psychological in nature but are often not mentioned by those recovering from cancer for fear of making things even more difficult at work or of making themselves look weak or needy or over-dramatic.
Cancer treatment is not only profoundly physically traumatic but is also emotionally exhausting as individuals deal with the implications of the diagnosis, the uncertainty, the upheaval, the impact on their family and friends, and the loss of routine. The typical psychological issues that survivors face include feeling:
- abandoned after treatment ends
- afraid of a recurrence – every ache and pain causes anxiety
- a sense of loss – of one’s past life and certainties
- insecure and vulnerable, and not trusting one’s body
- self-conscious about physical changes
- frustrated, annoyed and depressed because of overwhelming fatigue (and fatigue and low mood amplify each other)
- insecure at work because of changes in structure and staffing whilst they were absent on sick leave
Clinicians and employers tend to focus on physical recovery rather than these ‘softer’ issues, and they give very little advice or guidance about when is the right time to return to work, let alone about dealing with feelings or emotions.
So what’s the solution? Getting back to work is only the first step, though an important one, towards mitigating some of the anxieties cancer brings. It requires individuals to think about routine, day to day, external and objective issues – not their cancer. Once they are back at work, however, there are a number of other actions organisations can take to support them, in addition to the standard phased return-to-work plan:
- Regular follow-up with the line manager and/or HR to check all is working well for up to 12 months. Clearly this depends on there being a good working relationship between the individual and his manager and/or HR.
- Understanding within the organisation of the psychological impacts of cancer and how best to support affected employees. Organisations like Working With Cancer run short training events and webinars for line managers and HR professionals
- Coaching/third party/EAP support. Giving individuals time to reflect with a knowledgeable but independent third party about their experience and to integrate it into their post-treatment life – both at work and outside work – often gives them a sense of control that they may have been (or felt) denied during treatment.
- Buddying schemes: increasingly organisations are setting up buddying schemes for employees affected by cancer which enable them to provide mutual support and guidance
- Clear employment policies on the support available to facilitate a return to work after cancer (and other forms of chronic ill health)
- Website links/access to appropriate charities, counsellors and health providers.
None of these ideas is very costly to implement, although they may take a little time and effort to put in place. The saving to employers can’t be quantified exactly but if it saves the time and cost of a managed exit (and remember that the Equality Act protects cancer survivors as “disabled” from the point of diagnosis onwards) and of recruiting and training a new employee, and if it aids recovery as the evidence increasingly suggests, then surely it has to be worth the effort?
Barbara Wilson, Working with Cancer