Working with Cancer states that there are approximately 900,000 people of working age living with cancer in the UK, a number, which is expected to increase to 1,150,00 by 2030 with Healthy working lives stating an extra 130 000 people are likely to want to return to work by then.
Work can be really important for those who have cancer as it can restore a sense of normality and help with financial wellbeing. However, the symptoms and effects of cancer and treatment can have a impact on the workability of individuals. Employers can do a lot to support individuals who are going through this, whether remaining at work or becoming absent. For those becoming absent, keeping in touch is of most importance (NICE guidance), but it is equally important to keep checking in on those that remain in work (HealthyWorkinglives). Feeling isolated from the workplace or feeling unsupported can lead to difficulty in returning to work or remaining in work (DWP 2013).
Support with cancer needs to be truly person-centred as every cancer and treatment is individual and affects people differently. The starting place is for managers to chat with the employee, which may be difficult for both parties. However, a manager’s confidence can be built by undertaking the Cancer and Work eLearning from Macmillan, as this enables the manager to become better informed. Occupational Health can also be a support mechanism for those at work or absent due to cancer and a far more in-depth, 3 hour, e-learning module for health professionals, is also available, to support the knowledge they already have.
Having an employee who develops cancer is a strong possibility in any workplace and therefore a really useful tool for employers to have is a cancer support policy. This should provide a framework for managers on how to proceed when an individual is diagnosed. Occupational Health is a great resource for managers when ascertaining adjustments due to the biopsychosocial model of assessment that is undertaken, encompassing all these factors and more.
As per NICE guidance, psychological health for any long-term health condition, especially cancer, must be considered and this should be part of any good OH assessment with clinicians usually using validated assessment tools such as the brief PHQ4 unless symptoms indicate the more indepth PHQ9 & GAD7 is required. Another validated assessment tool that can be really useful is the Fatigue Assessment Scale (FAS) as fatigue is a common symptom caused by cancer treatment. OH, should also be able to assess what signposting may be useful depending on the concerns the individual may have.
Policy to include, for example:
- Risk assessing the role and environment
- Respect for the employee’s dignity and privacy
- Maintaining employee involvement and engagement in work with a diagnosis
- Ensuring the employee suffers no financial detriment
- Continuing to provide employment benefits
- Adopting a flexible approach
- Continuing to provide access to development opportunities
- Providing the employee with information and support
- Supporting the team affected by the employee’s situation.
Every experience is different and depends on the type of cancer, the type of treatment, other health issues the individual may have, the support they have at home, their coping strategies and their health beliefs.
Some symptoms and issues which need to be explored and taken into account when considering adjustments:
- Fears over the uncertainties surrounding the future even after successful treatment
- Mood reduction and/or anxiety
- Concerns over how others might react either due to unfamiliarity with cancer or because they might need to undertake more of the workload
- Worry over which of their colleagues should be informed and when?
- Time off to accommodate consultations and treatment
- Being more prone to infection as aside effect of cancer treatment
- Extreme fatigue may last months or years or fluctuating fatigue
- Other side effects of treatment may include feeling sick, sore mouth, hair loss, diarrhoea or constipation and numbness in the hands
- Trauma symptoms
- Possible changes in eating or toilet habits following surgery or with medication to take into consideration
- The rapid development of menopause symptoms in some circumstances, depending on the cancer type and treatment including surgery.
Examples of reasonable adjustments:
- More flexible hours to avoid travel to and from work at busy times
- Redeploying from any risks associated with their treatment or reduced immunity (such as hazardous substances or infections)
- Time to attend appointments and/or treatment sessions
- Asking colleagues to be supportive and to help with some of the workload
- Allowing short breaks to rest or lie down
- Allocating a parking space near to the building entrance
- Allowing work to be done from home if feasible
- Finding lighter work if the job involves physical exertion and/or heavy lifting
- Respecting any wishes for privacy and confidentiality
- Arranging for a colleague to be a work ‘buddy’ responsible for keeping an employee up to date with key developments during any temporary or extended absences for treatment
- Scheduling regular consultations with the line manager to discuss work issues
Making any reasonable adjustments to premises, equipment, travel arrangements and provision of support workers in line with the Equality Act (2010) must be considered, as cancer is an automatic disability.
Sometimes it may not be clear that an employee has cancer related to the Equality Act. In the case of Lofty vs Hamis, the employee had a precancerous skin condition that initially was not deemed a disability, a decision that was overturned by the Employment Appeal Tribunal. This makes it even more important for employers to seek advice and to consider adjustments even if they are not sure, as mentioned in Thrive’s article on Reasonable Adjustments in this publication.
The role of Occupational health is not only to tailor advice for the individual on adjustments but also to signpost to resources.
Although most individuals should be able to receive psychological support via their oncology department, signposting to the Employee Assistance Program (EAP) for benefits advice and psychological support could be helpful but also wellbeing services for nutrition and lifestyle advice, local cancer support centres or Maggies.org a support service for those with cancer and perhaps Access to Work depending on the person’s needs. It is possible that individuals may need longer-term management of their health and a WAP (Wellness Action Plan) may be appropriate for them to discuss and agree with their employer. Although designed for mental health this could be useful for any chronic health condition. A reduction in resilience to usual workplace stressors is also a possibility and therefore managers may wish to use the HSE stress risk assessment (SRA) or their organisations SRA to help the individual feel supported but also to pick up any issues quickly.
Another supporting role OH can play is in the individual risk assessment for COVID 19. Individuals who have been diagnosed with cancer are considered at a higher risk of severe ill-health with COVID. OH, generally use the ALAMA tool to calculate the individual’s COVID age, which takes into account several risk factors to calculate the overall risk. Diagnosis of cancer in the last year increases the risk quite considerably due to a reduced immunity level and therefore any return into the workplace does not only need to take into account the individual’s symptoms and function but also their COVID 19 risk. The Society of Occupational Medicine (SOM) has published a good general guide on factors to take into consideration, however most OH professionals will be able to match their advice to the role and tasks required of the individual.
NICE psychological support for cancer
Working with cancer
DWP telephone assessment 2013
NICE long term sickness absence
Equality Act 2010
Society of Occupational Medicine
Healthy Working Lives Cancer
HSE stress risk assessment
Clinical Nurse Director PAM Director iOH