When a 46-year-old woman was diagnosed in early 2016 with stage-two triple-negative breast cancer, she started planning her return to full-time work at almost the same time she began treatment.
“It’s interesting because when we think of return-to-work planning, we think of starting to talk about this toward the end of the treatment phase,” said Dina Linardos, a nurse navigator and the nursing director at CAREpath, during Benefits Canada’s 2021 Chronic Disease at Work conference in late February.
“But for this lady, it was really important to prepare herself. Right off the bat, when she was initially diagnosed before she had even gone to surgery, [we were] really starting to talk about what it would look like, what it would mean to go back to work a year and a half or two years later.”
The patient, a married mother of two who worked full time until her diagnosis, was able to progressively return to work in the fall of 2017 after surgery, chemotherapy and radiation. Returning to work after cancer treatment can be a fraught process for plan members, with several physical and emotional barriers to overcome, Linardos said. It’s something employers increasingly have to be mindful of, as life expectancies for cancer patients improve and even advanced cases — as well as forms of the disease previously considered untreatable — become more manageable.
According to the Canadian Cancer Society, from 2012 to 2014 the five-year net survival rate for all cancers combined was roughly 63 per cent, up from 55 per cent in 1990. Mortality rates have also fallen steadily, Linardos said. She cited the 40- to 59-year-old age group in particular, which had seen mortality rates decline by 2.1 per cent from 1987 to 2013.
In her presentation, Linardos explained the process cancer patients and their nurse navigators go through when preparing a post-treatment return-to-work plan. “One of the things that we want to address is assessing the individual’s work ability. Through formal and informal assessments, it’s important to talk about what changes they’re experiencing and how that will impact them at work.”
She said patients face three types of barriers to returning to work, including physical concerns such as fatigue, insomnia or pain from treatment; emotional challenges like anxiety, confidence, mood swings and depression; and workplace barriers, such as colleague and manager attitudes and flexibility around work hours or job tasks. The goal of nurse navigators is to “empower” patients to “be able to articulate what they’re experiencing and put it into context for their workplace — so communicating effectively and setting realistic goals and expectations.”
One of the first factors in the discussion is whether the patient will be continuing with some form of treatment and how that might impact their return to work. Nurse navigators also help patients undergo an “emotional and psychosocial assessment” at this stage, to determine the biggest emotional barriers they have to returning to the workplace.
Anxiety and body issues frequently come up as areas of concern, Linardos said. She also cited memory and concentration issues post-cancer treatment as common worries for patients, as well as the physical and mental capacity to meet the demands of their job, whether it be long work hours, working over the weekends, or being required to travel.
The second step for return-to-work planning is assessing the workplace itself and what kind of return is possible, such as a slow ramp-up or integrating a remote-working arrangement, as well as how medical appointments and tests can be accommodated. The physical design of the workplace is a key consideration — especially for patients who may still be dealing with side effects like fatigue — from where washrooms are located to how many stairs are in the building and how much walking is involved to get around the office.
Linardos said patients can decrease their anxiety, particularly around body issues, by staying in touch with their teams or manager throughout their absence, as colleagues can see them progressively through their treatment rather than after hair loss, skin changes or weight loss or gain have taken place.
Managers and employers should be thoughtful in their language choices when their colleague returns to work, she said. The term “cancer survivor” is falling out of favour with patients who feel they haven’t overcome cancer and are dealing with tests and doctor’s appointments, while the terms “cancer lifer” and “cancer thriver” are gaining prominence. Linardos also recommended replacing military metaphors such as “battling cancer” with healing-focused language.