Managing work with cancer

A cancer diagnosis changes lives irrevocably – for both patients and their carers. The Taking Cancer On initiative is designed to help you cope with and navigate your ‘new normal’. For those who are working, there are many challenges to face in addition to the cancer treatment along with its physical and emotional side effects. You may be asking yourself whether to continue working and what to tell your employer. Or you might be fearful of losing your job as an employee, losing your clients if self-employed or not being able to fulfil your responsibilities as an employer. It’s also important that you understand your employment benefits and rights and how to access social services. We have collated practical advice and guidance to help you cope and find the best way forward for you and your particular situation.

Impact of cancer treatment at work

Introduction

Getting more information from your healthcare team about your cancer and its treatment will help you understand the potential impact on your work life.

It is important to remember that a cancer diagnosis and cancer treatment affects everybody differently. Throughout your treatment, you will need to regularly review your commitments to work. If you undergo certain procedures such as chemotherapy or surgery, you will need to reduce your work hours and responsibilities.

Different treatments (including surgery, radiotherapy, chemotherapy, hormone therapy, targeted therapies and immunotherapy) will have different side effects. It is important to speak with your oncologist about what to expect and to be honest about how you are feeling emotionally and physically.

The most common physical and emotional side effects are listed below.

Physical side effects

• Fatigue: a form of extreme tiredness

• Pain: caused directly or indirectly as a result of surgery

• Peripheral neuropathy: a numbness or feeling of pins and needles in the hands and feet

Emotional side effects

• Anxiety [Link to PA section]

• Depression [Link to PA section]

• Loss of confidence 

• Cognitive problems (‘chemo brain’) including difficulty retaining information, lack of concentration and being less able to deal with pressure or stress

• Fear of recurrence

Most side effects fade with time, but will need to be accommodated at work. Please see our step-by-step guides for nutrition, physical activity and mental health for some useful tips on coping with side effects. [Links]

Continuing to work

There is no right or wrong way to approach your work commitments. A lot of people stop working during treatment and for a period afterwards. Others carry on working to a greater or lesser extent depending on the nature of their treatment.

You may want to continue to work for various reasons: it may help take your mind off your illness; it could give your life focus, purpose and structure; or it might be financially necessary. It’s an individual choice and one you should discuss with your family, line manager or HR.

Returning to work

Returning to work is a process, not a one-off event. Whether you have finished your treatment or are still having treatment, it is very likely you will experience side effects that will impact your return to work for a significant period. As the diagram shows, recovery is not linear and typically takes many months, or sometimes years.

The support you will need: a phased return, flexible adjustments and regular communication

If you have been off sick during your cancer treatment, going back to work might be a major step in your recovery but it may not be straightforward. It is important to set realistic expectations that you review honestly at regular intervals. After being off work for a while, a lot may have changed, such as people, systems or processes.

It is widely acknowledged that, to successfully manage work during or after cancer treatment, you will need to put in place a flexible plan in discussion with your line manager and HR, informed by your healthcare professionals (e.g., oncologist/GP/Occupational Health Advisor). Your plan should have three elements: a phased return, flexible workplace adjustments and regular communication.

A phased return to your role

A phased return is where you gradually increase your workload and your hours over a period of time. For most people this takes at least 12 weeks and sometimes over a year. You may only be eligible to be paid for the hours you work. You will need to speak with your line manager or HR to find out about your employer’s policy.

Flexible workplace adjustments

Making adjustments to your work is an essential part of working with cancer during or after treatment. If you wish to continue working during your treatment, you should discuss making adjustments with your healthcare professional, your manager and HR as soon as you have your diagnosis. Examples of workplace adjustments are:

• Reducing your duties/responsibilities and changing your performance objectives for a temporary period

• Reducing the onerous aspects of your work (such as by working from home) or changing your role for a period of time

• Reducing your hours or having more flexible hours of work

• Having extra breaks during the day to recover your energy levels

• Having time off to attend medical appointments

• Undertaking a job share to take the pressure off you

• Being given extra time and patience, and given simpler tasks to cope with ‘chemo-brain’

• Making physical changes to your desk, chair or computer software

• Having extra equipment, such as a fan if you suffer hot flushes

• Time-off for any additional therapies (e.g., counselling, yoga, mindfulness, massage, acupuncture), or simply for your ‘down’ days

• Having a parking space at your place of work so you can drive rather than using public transport

Regular communication

Most people worry about telling their employer that they have cancer and need treatment. Many worry about job security, about damaging their career or work relationships, or believe that having cancer is something to be ashamed of.

You do not have to tell your employer about your cancer but unless they know, they cannot support you and help you manage changes to your work life during and after treatment. Also, if you don’t tell your employer and your ability to do your job is affected, it might cause problems later both in terms of your job and in hindering your recovery.

When you should discuss your cancer, why, how and with whom is discussed [here: include links to other sections].

Creating a supportive environment

Introduction 

No one needs to face cancer alone either personally or professionally. For you to have the support you need at your workplace, please talk to people who can help you. This means:

• Speaking to your line manager and colleagues at four key stages during and after your cancer diagnosis and treatment

• (Re)connecting with colleagues

• Building a rich support network of family and friends

Conversations at four key stages

There are four key stages when you should have a structured conversation with your manager to get the support you will need:

• At diagnosis

• At the start of and during treatment

• Before returning to work

• After returning to work

Your conversation should cover your return-to-work plan, requirements for taking care of your health, any ongoing treatment and the support you will need for these.

At diagnosis

• Shortly after your cancer diagnosis, it is advisable that you meet your line manager to let them know. Given that you might be feeling quite upset, this might be easier if you take along a friend, a family member or work colleague

• Ensure you discuss the confidentiality of the conversation and make it clear how much of what you tell your manager can be shared with others

• Try to give your manager as much information as you can about next steps and what time off you will need for medical appointments; let them know if you don’t know this yet

• Discuss to what extent you feel able to work and how your employer could help you. Is there any information you need to know about health benefits, sick leave or other policies?

At the start of and during treatment

• Discuss your treatment as much as you can with your manager. Talk about its probable side effects and how these might impact your ability to work

• If you are taking an extended period of sick leave, how do you want your employer to keep in touch: by email, phone, video call, text message? You may want complete privacy during your treatment, but this can make it difficult for your employer to know what support you will need on your return

• Before you start your sick leave, agree with your line manager what to share with colleagues about your illness. You might want to prepare a short email for your line manager to send out or to send this yourself

• If you choose to continue working during your treatment, discuss with your employer any support or flexibility you might need

• When you start treatment, you may not know what side effects you will experience, although your medical team will try to let you know what you might expect. It’s best to keep things flexible and regularly review with your employer the arrangements you have made

Before returning to work

If you have taken sick leave during your treatment, you should contact your employer three to four weeks before your planned return date to put in place a flexible return-to-work plan. You may also be required to see an Occupational Health Advisor or company doctor to get their advice on returning to work.

Please also see our checklist to help you with returning to work [link to section 3.5].

It is important to be realistic about how much work you will be able to do in the first few weeks and months. Be careful not to overcommit in the early stages, even if you feel fine.

• Share with your manager in confidence details of your current health, the impact of treatment and any significant side effects. Of course, what you share is up to you, and how appropriate you think it is

• Discuss your preferences regarding a phased return and resuming your full job responsibilities. For example, the number and length of the days in the office, options to work from home or undertake hybrid working, and your ability to resume long distance travel

• Consider what you want to tell your colleagues. You could, for example, agree that your manager sends out an email giving a short explanation of your cancer treatment and side effects, with the wording to be agreed with you

• Discuss with your manager what will happen on Day 1 of your return. Much may have changed in your absence such as where you sit, computer systems, processes and your colleagues

After returning to work

It is important to continue to review your progress with your manager:

• Try to meet once every two weeks to review how well any adjustments are working

• Use these meetings to raise any concerns you have about the hours you are working, or your role and responsibilities

• Expect to have good days and bad days. Recovery is rarely linear, and some side effects such as lymphoedema may only begin after the end of active treatment, or arise from the medication you are required to take

• Remember that there is nothing to feel guilty about: you may feel awkward about reducing your hours or workload again after having gradually built them up, but it’s important to remember that this is sometimes necessary

(Re)connecting with colleagues

Keeping connected with colleagues during and after your treatment can be a great source of support and comfort but talking about cancer at work is never easy. It is important to decide what you want to share and with whom.

Initially some colleagues may avoid you because they don’t know what to say or are worried about saying the wrong thing and upsetting you. They may not realise the emotional and physical impact cancer has had on your life. [link to HungerNdThirst ‘Things we hear’ video]

You may not want to mention the word ‘cancer’ but often people jump to the wrong conclusions if given inadequate information. Showing them that you are willing to talk openly about your cancer from the outset may help. For example, providing a short explanation of your cancer and treatment can help to reduce any awkwardness and allow you to then steer the conversation back to your work, where you need help and then back to them and how they are.

Sharing your cancer story can be a way to reconnect with colleagues, but be aware that for some it can feel too personal.

Building a rich support network of family and friends

Following your diagnosis, you will have come across many different people who will be able to help you. It can at times feel quite overwhelming – who do you turn to for what? The picture below captures a few of the different sources of professional and personal support that you may have used or heard others talk about.

Please don’t hold back in asking for support.

Your manager or HR or healthcare professional may also be able to provide you with the help of a specialist coach or counsellor to support your return to work. There are also plenty of other sources of support that can help you [include link to Mental Health section/support].

Coping with cancer, work and COVID-19

Introduction

The COVID-19 pandemic has presented new challenges to all those living with cancer; to those who are temporarily immunosuppressed because of their treatment and to those who are vulnerable now and in the longer term because their type of cancer means their body cannot manufacture the protective antibodies that provide immunity.

We are all different in how we respond to cancer and in our willingness to take risk. Overlaying this, each country has its own set of rules and requirements in relation to the pandemic and each organisation will have its own protocols for employees to follow.

What to consider

Here are some simple and practical points that may help you decide what to do:

1. Make sure you fully understand your country’s rules or guidance about working with cancer or a similar serious illness during the pandemic. If you are uncertain about these, what organisations can you contact to discuss this with (e.g., government department of health, a cancer charity, your trade union)?
2. Make sure you fully understand your employment rights. If not, where might you seek guidance about these? (e.g., your trade union, a government website, a cancer charity)
3. Are you clear about your professional and financial situation and do you need to seek any expert or specialist advice before making any decisions about returning to the workplace? What might be the implications for you, your family or your colleagues?
4. What advice have you received from your health care professionals (e.g., GP, oncologist, Occupational Health Advisor)? You may be required to provide your employer with a medical opinion on returning to the workplace before returning and before any changes are made to accommodate your needs
5. Have you spoken to your employer (your immediate manager or HR) to discuss the situation? You might ask the following questions:

• Will the company/organisation allow me to work/continue to work from home? Will this be possible for some or all of the working week?

• Can adjustments be made for me to work from home/continue to work from home?

• What are the provisions for flexible working hours? If I come into work, can I start later/leave earlier?

• What is being done to make the workplace a safe environment? (For example, glass barriers, face masks)

• What should I do if my colleagues refuse to wear a mask when near me/harass me for wearing a mask/do not keep a social distance?

• Given my circumstances will it be possible to work in an area where I will have less/little/no contact with other people?

• If a colleague I have been in contact with tests positive for COVID-19, will I be allowed to go home/stay at home?

• Rather than use public transport, will the company pay for a cab home if I need one? Or provide a parking space so I can drive to work?

• Who should I contact if I have any concerns about my safety?