By the year 2031, 2.2 million Canadians will be living with cancer, with 40 per cent between the ages of 20 and 65 — the typical working years, according to Maureen Parkinson, provincial rehabilitation counsellor at B.C. Cancer Agency and co-director of Cancer and Work.
In a session at Benefits Canada’s 2020 Employers Cancer Care Summit on Mar. 3, she said 63 per cent of working-age individuals will return to work within their first year of a cancer diagnosis. Further, 26 to 53 per cent of cancer survivors will lose their jobs or quit working after treatment, and 57 per cent of these individuals will reduce their hours by at least four per week.
A vocational model considers all factors that influence return to work, said Parkinson, noting when it comes to biopsychological factors, people with more extreme prognoses are less likely to return to work, but those in remission are more likely to do so.
Person-centred factors also have an influence. For people coping with cancer, or for those you have survived, working may no longer hold the same meaning, and expectations for recovery are also influential, she said. “If someone’s thinking they’re not going to be able to return to work, it seems to correlate with not returning. And attitudes towards work, whether people see work as good or bad, whether they fear work or feel like stress causes their cancer, can impact returning to work too.”
Many influences, including those pertaining to familial and financial matters, are also factors, noted Parkinson. Families that are overprotective or think it’s bad for their loved one to return to work following a cancer diagnosis may negatively prevent that person from going back. Also, the effects of financial support can go both ways. “Having enough financial support may postpone someone’s return to work, but for those who don’t have this type of support or have lost benefits, they might come back to work before they’re ready.”
As for workplace considerations, there’s no question that employer support and co-worker attitudes help a cancer survivor when returning to work, she said. “The accommodations that employers are willing to put in place significantly influence the likelihood of a cancer survivor returning to work.”
Another concern for a cancer survivor returning to work is stress, but research on this is conflicting, noted Parkinson. On one hand, stressful life experiences and personality, poor coping skills and quality of life lead to higher incidences, poor survival and mortality. “However, it’s also similarly been found that returning to work does provide emotional stability and survivors report that work maintains their cognitive ability.”
Indeed, brain fog following chemotherapy affects 40 per cent of patients and involves the working memory, speed of processing and psychomotor skills, she said. But learning compensatory strategies for memory, organization and time, stress and fatigue management is one way to assist with “chemo brain.” In addition, workplace accommodations like reducing auditory or visual distractions, using minutes for meetings and recapping conversations are also helpful, she added.
While it’s very important for employers to establish return to work procedures and policies, they need to be flexible, advised Parkinson. And the more an employee can disclose, the easier it will be for an employer to understand and make accommodations. “Managers can be fearful about asking and respecting privacy, but at the same time there’s concern that survivors may withhold information helpful for accommodation.”
So how can employers help cancer survivors determine whether they’re ready to return to work? Parkinson suggested starting with a work simulation, where possible. “It’s amazing how [these individuals] are theoretically worried about fatigue, but task and job analyses help them look at things they might not have considered. Job analyses help those who don’t think they can do anything and remind them they can do a lot in terms of function.”
It’s also crucial to create a supportive workplace, which includes discussing disclosure and privacy, guiding health-care providers and offering employees job demand analyses and improved access to work-focused assessments. “I would encourage employers to consider a longer graduated return-to-work protocol, monitor return to work and support sustained employment,” she said. “You need to keep an eye on people after they’ve come back because they may still be struggling.”
Read more coverage from the 2020 Employers Cancer Care Summit.