You are here
Many patients do well following their treatment. However, some survivors may experience ongoing side-effects or negative outcomes from the disease or the treatment received [ 3 , 4 ] which have continued impact on everyday functioning, including work. For many survivors, returning to work is an important part of social reintegration and a sign of return to normality [ 5 ].
Cancer survivors have been found to have raised disability ratings [ 10 ] and are more likely to report problems with working [ 11 ] including changes in functional ability and negative or misinformed attitudes of co-workers and employers [ 12 ].
Work in cancer survivors: a model for practice and research.
Some cancer survivors also report lower productivity levels in comparison to their healthy counterparts [ 13 ]. Despite this many survivors report a successful and productive return to the workplace [ 9 , 14 ]. A non-supportive work environment has been shown to negatively affect return to work among cancer survivors [ 12 ]. Type of cancer is important due to the associated side-effect and disability profiles of different cancer types and treatment. For example, survivors of central nervous system, head and neck and lung malignancies have been shown to have a greater risk of not returning to work or of experiencing greater difficulties in the workplace [ 7 , 14 ].
In addition, breast cancer patients have reported apprehensions about returning to work, related to concerns about the effect of ongoing treatments and concerns about their level of physical fitness [ 15 ]. Treatment type has also been shown to be of importance with patients undergoing chemotherapy reporting greater difficulties with returning to work [ 16 , 17 ] and a greater need for practical support on returning to work [ 18 ].
Organizations also have a key role to play in the transition back to the work environment [ 14 , 19 ] yet there is less research into their role in the return to work process.
How can cancer survivors best be supported to return to work?
A good employee—employer relationship is associated with a positive return to work experience [ 19 ]. However, some employers express concern about the ability of cancer survivors to meet the demands of the workplace [ 20 ]. There is also evidence, from across a range of chronic illnesses, that employer-made work adjustments to accommodate functional limitations ensure that employees not only maintain their employment but also that they are better able to manage their work [ 10 , 18 ].
More recently, the patient's perception of their employer's accommodation for their cancer and treatment and the patient's own illness perceptions have been shown to be predictive of return to work [ 21 , 22 ]. Currently, little is known regarding patient's beliefs about how their cancer and treatment might impact on their return to work or of the beliefs of organizations about the impact of cancer on work. The aim of this study was to determine the beliefs of patients and organizations regarding the impact of cancer on returning to work and to identify differences in the beliefs held by patients and organizations.
The study was approved by the local research ethics committee. The study was part of a larger UK-based study investigating the organizational perspective of the return to work of cancer patients [ 21 ]. This paper presents a series of questions focussing on perceptions of the impact of cancer on work and compares the responses of organizational respondents with a sample of cancer patients. Medium 50— employees to large-size over employees companies across a range of sectors were randomly identified stratified for location and size of company and their details e-mail, telephone and postal address provided through a marketing company Electronic Marketing.
Companies were telephoned to confirm the contact details were correct; 36 companies were not contactable and were excluded. Named individuals within human resources or occupational health departments were sent an information sheet, questionnaire and freepost envelope. Non-responders were sent a reminder e-mail and an e-mailed version of the questionnaire within 2 weeks and a further reminder phone call 1 week later.
Survivors of head and neck, gynaecological, urological or breast cancer were eligible for inclusion providing they were aged under 60 years, had no evidence of advanced disease or recurrence and were in paid employment prior to diagnosis and were yet to return to work.
Patients were approached on average 1. Patients were approached in outpatient clinics within a large London teaching hospital or were sent a letter, consent form and reply slip. Non-responders received a 2-week reminder call, followed by a final postal reminder. The first section of the questionnaire focussed on the perceived impact of cancer and its treatment on work. Items were developed following a qualitative exploratory study with 40 cancer patients 12 months post-diagnosis. These interviews explored facilitators and barriers to the return to work process.
The most common barriers and facilitators were identified and were used to form the items for this subscale all questionnaire answers were provided on a seven-point scale. Patients were asked how easy or difficult each of nine factors would be in their return to work. The organizational respondents were asked how easy or difficult they thought each factor would make it for a cancer patient to return to work.
The Brief IPQ assesses the cognitive and emotional representations of illness. Causal and identity items were excluded as these were not felt to be applicable to return to work. This adapted eight item scale assessed beliefs about the effect of cancer on work see Table 4. All answers were provided on seven-point scales. The resulting questionnaire was piloted on 15 cancer survivors and eight organizational participants who provided feedback on individual items and the comprehensibility of the questionnaire.
Each item was examined individually. Responses of the cancer patients and organizational respondents were analysed using a multivariate general linear model between subjects. Separate analyses were conducted for each scale. Bonferroni adjustments were carried out and adjusted P values obtained. Alpha was set at 0.
Analyses were conducted with SPSS Non-responders cited lack of time or company policy as reasons for non-completion. No significant differences emerged between responders and non-responders for job-role or organizational sector. There were no significant differences between the responses of those who reported a personal history of cancer either self, family member or friend and those who had no personal history of cancer. Reasons for non-participation included feeling too unwell, too busy and preferring not to discuss their cancer.
There was a problem providing the content you requested
Demographic and clinical characteristics of the patients are listed in Table 2. The median duration from start of treatment to completion of the questionnaire was days and the median number of days off work to the time the questionnaire was completed was days. Organizational respondents consistently rated seven of the nine factors as more difficult Table 3.
Respondents were asked to indicate the degree to which each factor would impact on returning to work. The higher the score the greater the belief that the factor would have a negative impact of returning to work. There were no statistically significant differences between the organizational respondents when analysed according to department, industry or geographical reach. Among the cancer survivors, older participants 50 years and over rated four of the factors as more difficult than younger participants Table 4.
Female participants rated three of the factors as more difficult than male participants. Differences emerged between the breast and urology patients. There were no significant differences between patients who had received radiotherapy and those who had not. Significant differences were observed between organizational respondents and cancer patients on all eight statements of the adapted Brief IPQ Table 5. There were no differences between the responses of the organizational respondents when analysed according to industry or geographical reach.
No significant differences emerged between patients who underwent radiotherapy or not or between the different tumour groups. In this study, the organizational respondents reported more negative beliefs about the impact of cancer on work than the patient respondents. The employers of patients who have had myocardial infarction have also reported negative perceptions regarding their return to work due to the extra support required to facilitate the return and a perceived reduction in occupational functioning [ 24 ]. Among patient respondents, there were some differences in beliefs across age groups, cancer types and treatment received.
However, it should be noted that some patients underwent multiple treatments for example, radiotherapy and chemotherapy, in addition to surgery. Therefore, conclusions drawn on the basis of responses analysed according to treatment type should be taken with the caveat that there is a potential confounding factor related to the combination of treatments received. The patients in this study were perhaps overly optimistic about the impact of cancer and treatment on their work.
It has been suggested that there may be a mismatch between expectations and ability to perform in the workplace [ 25 ]. Employees may experience difficulties due to residual symptoms such as continuing fatigue and indeed there is evidence to suggest that survivors who try to return to work too soon may experience greater fatigue [ 19 , 25 ]. Therefore, in some cases, there may be a mismatch between cancer survivors' expectations of returning to work and the actual process.
Some survivors may feel distressed that they are not able to perform at their pre-diagnosis level [ 14 ]. There are currently about , people of working age with cancer.
This represents over a third of the 2 million people living with cancer — and with survival rates improving and people retiring later, the numbers are likely to increase. Many cancer patients struggle to return to work, however. When I was diagnosed with breast cancer in , it was still assumed that, after cancer, those of us in remission would want to spend more time with the family or go round the world ticking off items on our bucket list. Most of us want to return to work, however. Work contributes to financial independence, provides a sense of purpose, gives you identity and self-esteem, creates structure and order in our lives, is an important source of friendship and social interaction, and is a lifeline back to normality, wellbeing and recovery.
There is comprehensive legislation in place to support a successful return to work.
- Work in cancer survivors: a model for practice and research.?
- Factors affecting cancer survivors' employment and work ability.!
- Work after cancer: what are the options and how can employers help?!
Together the Equality Act and the Disability Discrimination Act provide protection from discrimination. Everyone with cancer is classed as disabled from the point of diagnosis for the rest of their life, and their employer or a prospective employer must not treat them less favourably for any reason relating to their cancer. All areas of employment are covered including recruitment, promotion, training, pay and benefits. So, what is happening and why? Every case is different but there are some common issues employers and those with cancer need to be aware of, such as dealing with the side effects of treatment, which can be both physical pain, fatigue, loss of bladder control, impotence and psychological depression, lack of confidence , and can begin long after treatment has finished.
Employers need to understand that recovery is a process and that it takes time.