Working after cancer can be difficult for a number of reasons. Cancer and its treatment may lead to physical illness and emotional distress that may interfere with the ability to carry our work tasks. Treatment for cancer may be time consuming and undertaken far away from home leading to extended absences from work. Cancer patients and their employers may be concerned about the impact on cancer on a person’s ability to work leading to a sense of frustration and isolation. Inability to work may amplify the social isolation and a sense of loss of identity and purpose.
There are a number of barriers for individuals seeking to work following the diagnosis of cancer. These can be considered under three principle headings.
Physical issues
Individuals are often deconditioned and their muscles and cardiorespiratory systems fatigue more quickly than prior to the diagnosis and treatment. Poor sleep may contribute to this state. There may be physical consequences as a result of surgical intervention or lingering effects from chemotherapy. Their physical issues may be further complicated by an ongoing need for treatment in the form of regular but intermittent therapy which may leave them temporarily tired or nauseated.
Psychological issues
The psychological challenges posed by a diagnosis of cancer cannot be under estimated. The diagnosis can make individuals re-evaluate their whole lives including the relevance of work in their lives. This re-evaluation may make individuals quite ambivalent in their attitude towards work and at times demotivate them so that attempts to return are half hearted and result in failure. Without strong motivation the likelihood of successful work rehabilitation declines dramatically. Complicating this may be underlying (and sometimes under recognized) anxiety and depression which can contribute to this loss of motivation. Again, poor sleep or the effects of chemotherapy may contribute to a psychological state which can interfere with a successful return to work.
Social issues
There are numerous social issues which can conspire against individuals attempting to resume work. Firstly, well meaning (but ultimately unhelpful) friends and family may discourage individuals to continue or resume work. Secondly, the workplace itself may present problems. Work colleagues may be anxious about how to react with someone following the diagnosis of cancer, and managers may have concerns about the individual’s ability to perform their work, or have safety concerns related to the return of the individual. Employers may have an expectation that an individual should be able to perform all their pre-illness activities without restriction (no “light duties”) and be unable or unwilling to accommodate scheduled or unscheduled time off work for medical appointments. The regulations around return to work from illness in many jurisdictions are different from return to work following work injury, where employers have legal obligations to provide suitable alternative duties where it is practical to do so.
Other work related issues include the rapidly changing nature of modern employment, and a contracting labour market can be a barrier to resuming employment if an individual is out of the work force for a prolonged length of time. The age when cancer most commonly manifests itself may be close to retirement age, making efforts at a successful return to work more challenging.
Social security and insurance or superannuation schemes can paradoxically act as a barrier to a return to work. The requirement that permanent or long term impairment be certified in order to access some of these schemes can run counter to the notion of encouraging or certifying capacity to work. This promotes disability over ability to work.
Special challenges are faced by individuals who are self-employed, the very young, those living in remote and rural environments, and those of culturally and linguistically diverse background (below paras on each which should be linked to each item).
Self-employment – poses unique challenges to work after cancer. While self-employment offers flexibility, there is the social isolation of working alone and the responsibility for the business which often cannot be passed on to someone else. Sometimes, there is no income protection insurance to cover loss of income and a pressure of urgent work commitments.
The very young employees and trainees. There is a number of issues that young people with cancer might experience in relation to studying, training and work. For example:
For more information and help for young people with cancer please visit Redkite, a charity organisation providing essential help to young people with cancer and their families, at https://www.redkite.org.au/
Living in rural Australia. Distance is a particular challenge, especially in Australia. Returning to work may be difficult if you’ve been away for a long time to receive cancer treatment, the job availability may be limited in the place of residence as would the opportunities for re-training. In small communities, it may be hard to maintain privacy regarding one’s employment issues.
Culturally and Linguistically Diverse (CALD) Background. Language and communication barriers are a particular challenge for people who speak other than English languages. They may not be familiar with cancer services and with services available to support employment. They are more likely to live in the setting ore socioeconomic disadvantage where limited resources and lack of transport may limit access to cancer and employment support. Their cultural beliefs about cancer may lead to fatalistic view about cancer outcomes and thus lack of motivation to work as well as sense of stigma and isolation.
For further reading see:
Cancer Council Australia- Cancer, Work and You booklet