Key takeaways
- The right time to return to work after cancer treatment will be different for everyone, but your ability to carry out daily tasks can be a good indicator
- Before returning, it’s a good idea to consider your physical strength, ability to focus and concentrate, and emotional health, as well as your work environment and the best way to talk to your employer
- Physical barriers to returning to work include muscle weakness and fatigue, but can be overcome by building your strength and fitness
- It’s a good idea to allow yourself time to process the emotional impact of cancer, which can be a barrier to returning to work successfully
The majority of people employed when diagnosed with cancer want to continue working, yet most will require time off during and after treatment. How much time you or a loved one need to take is personal to you. This will depend on the type of cancer, stage of diagnosis, treatment plan, financial considerations, emotional and physical wellbeing and other factors. Returning to work is often an important milestone, yet can also present a significant challenge. The barriers to returning are not simply the physical side-effects of treatment, but also changes to memory and concentration. And, while most people understand that they will need to make adjustments in order to return, it can be difficult to know what those adjustments might look like, and how to communicate effectively with an employer.
In this article, we ask occupational therapist Anna Howells, counselling psychologist Dr Lisa Dvorjetz and consultant physiotherapist Louise Malone, for guidance.
Why might returning to work feel like an important milestone?
The predominant reason to return to work is usually financial, but it can also give someone who has been through treatment a sense of identity once again, as well as a feeling of normality and routine. When so much about cancer treatment can feel out of control, returning to work can help a person to feel responsible for their own life. The simple act of surviving and going back to work offers a feeling of resilience. Some people really love their jobs, so returning is a really positive step.
Anna Howells, Occupational Therapist, Perci Health
What’s the right time to return to work after cancer treatment?
Everyone living with cancer is different and treatment side-effects impact people in different ways, so the point at which I’ll start working with someone around return to work will vary. Talking about getting back to work will depend on where you are in your treatment plan; when the side effects are no longer getting worse but starting to plateau, and when you’re out of acute pain. When you’re beginning to regain movement and getting back into regular family or physical activities, and household tasks – that’s the time to make a plan.
Louise Malone, Consultant Physiotherapist, Perci Health
Overcoming barriers to returning to work after cancer treatment
Anna Howells, Occupational Therapist, Perci Health
As an occupational therapist, I support members who are considering or preparing to return to work, in five main areas:
1. Physical strength
To assess this we would typically look at how a person is managing all of their normal activities of daily living, for example, washing, dressing and domestic household jobs. This gives an indication of how that person might manage during a working day. Fatigue also needs to be considered in relation to work and the type of work a person does.
2. Memory and concentration
Cancer treatments can affect your concentration or make you feel more forgetful. This is known as cancer-related cognitive impairment or ‘chemo brain’, although it can affect anyone going through cancer treatment even if they haven’t had chemotherapy. As an occupational therapist, I’ll carry out cognitive assessments to determine whether you have the ability to concentrate on your work, or whether you might need support in the short term.
3. Mental and emotional health
Cancer and its treatment can have a huge impact on self-esteem and someone’s sense of identity. A person might have had surgery – for example a mastectomy – lost their hair or generally feel anxious about returning to work. Identifying these concerns, and having support and practical ways to reduce anxiety around these concerns, can be invaluable when considering returning to work.
4. Working environment
There are a number of things to consider regarding the environment at the workplace or for home working. The work area needs to be set up to support your needs, so it might need assessing and adapting. If you have mobility issues, it’s important to consider things like access to your workplace, if you can’t work from home, as well as parking or transport to and from work. You might need to consider being closer to the bathroom if your continence has been affected. Considering these factors can make you feel so much more comfortable returning to work.
5. Talking to your employer
Making a plan with an employer is an important part of the return to work process. An occupational therapist can speak to your employer on your behalf or help you prepare for these conversations, so it’s clear for both parties what the guidance is around making reasonable adjustments to support you back to the workplace.
Cancer is categorised as a disability, and therefore you have a legal right to reasonable adjustments when you return to work after treatment. The adjustments needed really depend on your job, but could be anything from flexible hours to equipment or extra breaks.
How can an occupational therapist support your return to work?
The huge benefit of working with an occupational therapist is that it’s holistic; we look at your ‘occupation’ in the broadest sense – your work and your life outside work – and all the elements that need to be in balance to get you back into the workplace. Our initial assessment would look at how you’re functioning, and then we’d formulate a plan. We might need to do specific sessions around a particular challenge – fatigue management for instance – before we get to the stage where you feel comfortable and ready to talk to your employer about returning to work.
Overcoming the physical challenges of returning to work
Louise Malone, Consultant Physiotherapist, Perci Health
After cancer treatment, people typically want to get back to their usual routine and think they can jump back into work straight away, but the transition can be a bit wobbly. The strength and resilience to work a full day may not be there initially. The two main challenges are muscle weakness, which impacts a person’s tolerance for activity and work, and fatigue. Around two thirds of people who have had cancer treatment will experience cancer-related fatigue. It’s not just physical but emotional, too, affecting a person’s ability to think and plan.
Other physical side effects include peripheral neuropathy, which is when the nerves close to the surface of the skin are damaged by treatment, particularly chemotherapy. As this can affect the hands and feet it can impact someone’s ability to type, for example, or even get dressed for work. There can be aches and pains from postoperative scar tissue or healing, reduced range of movement, and for some people, difficulty breathing.
How can a physiotherapist support your return to work?
No matter whether you’re returning to work full-time, part-time or flexibly, I always recommend a phased return, as well as reduced hours to begin with. My job is to support you through this transition. When we first meet I start with a detailed treatment and diagnosis history, then it’s about where you are now, including the main challenges you might be experiencing. Next, we’ll talk about where you want to get to. Our ongoing work is about bridging that gap between those two places.
A typical treatment plan includes strength and cardiovascular exercises – likely walking or static bike. Evidence tells us that we need to address both these factors. I might also include some stretches and balance work, as well as guidance around sleep hygiene to help with fatigue, and advice on pacing yourself and prioritising tasks.
Overcoming the psychological challenges to returning to work
Dr Lisa Dvorjetz, Counselling Psychologist, Perci Health
There are a lot of expectations, and therefore pressures, around returning to work after cancer. More often than not this pressure is self-generated. People feel they need to get back to how life used to be before cancer, or they feel guilty about the extra work their team is doing while they’re off. Some people are really mindful of how others are perceiving their return to work, and they don’t want to be seen as lazy. There are also wider cultural and societal expectations to contend with, such as people’s sense of value being dependent on how productive they are. The general public don’t fully understand the impact of cancer treatment; once you’re finished, they assume things will go back to how they were before. This is a huge misconception, and those living beyond cancer can end up pushing themselves beyond their limits.
There are also very practical concerns, of course: sick pay might be ending and you might need to return to work for financial reasons. However, if you do have some flexibility, it can often be sensible to take more time off work than anticipated, to cope with the emotional impact of what you’ve been through. When people get diagnosed and go through treatment, they’re following a plan; the focus is always on the next appointment, the next treatment, the next scan. When this phase finishes or stabilises longer term, it’s common to find that you’ve underestimated how quickly you’ll be able to return to your sense of self and your roles in life and work. You might even start to question whether you want to return to your job at all. This is a really good time to start working with a psychologist, if you weren’t already.
How can a psychologist support the return to work?
Our initial conversations would explore your feelings about returning to work, as well as your values and what’s important to you in your role as an employee and in life more generally. Even if the focus is specifically the return to work, there are likely to be other issues related to this, and there could be longer-term work to be done around the greater impact cancer has had. Giving yourself space to work through these is invaluable.
My work also involves supporting people to communicate with their employers. If you’re able to communicate clearly about what you’re experiencing, you can ask for adjustments. For instance, if you’re struggling with stress, employers can support you through breaks and timeouts, mindfulness and time to attend therapy sessions.
What should be included in a back-to-work plan?
A rainy day scenario
When you return to work after cancer treatment, you just don’t know what each day is going to be like. It’s best to scale up rather than going back at full pace and having to scale back down. I always suggest making a rainy day plan – a plan for a bad day – and sharing this with your employer.
Anna Howells, Occupational Therapist
Daily wellbeing tasks
While you’re going through treatment it’s relatively easy to look after your wellbeing; to have those appointments with your psychologist, eat well, go on a daily walk, etc. But often when you return to work, these things can fall by the wayside; that’s when things go wrong. So remember to factor daily wellbeing into your back-to-work plan.
Louise Malone, Consultant Physiotherapist
Self-compassion and communication
Difficulty concentrating, memory loss and fatigue – lots of side-effects of cancer treatment are invisible, and your employer won’t necessarily spot them. It’s vital to communicate with them, so they can make adjustments. Also, have compassion for yourself. These symptoms can be incredibly frustrating and may take some time to mentally and physically adjust to. Be kind to yourself.
Dr Lisa Dvorjetz, Counselling Psychologist
Making the transition from active treatment, back into the workplace, requires time and support. Perci professionals, including our occupational therapists, physiotherapists and psychologists, are there to help you make this transition successfully. A conversation with one of our Cancer Nurse Specialists is a great place to start, as they can refer you to the right person.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
‘People of working age with cancer’, Macmillan.org, 2017, https://www.macmillan.org.uk/_images/people-of-working-age-with-cancer_tcm9-282791.pdf
Al Maqbali, M., Cancer-related fatigue: an overview. British Journal of Nursing, 30(4), pp.S36-S43. doi 101.12968/bjon.2021.30.4.s36, 2021