Cancer | Overcoming in-work and return-to-work barriers

Overcoming in-work and return-to-work barriers

There has arguably never been a more urgent need for employers to review the support they provide to employees with cancer: from prevention, pre- and post-diagnosis, to return-to-work planning. We recently brought together cancer and Vocational Rehabilitations experts to discuss the current state of support and what “good” looks like. This article provides an overview. For the full discussion, take a listen to our latest podcast here.

Research published earlier this year found that despite advances in cancer survival over recent years “the proportion of people living with cancer who return successfully to work remains disappointingly low”. 

The research estimated that job loss was experienced by up to 53% of people living with cancer and unemployment can be 1.4 times more likely. Among those who returned to work, knowledge of the Equality Act 2010 “was low at 57%”. 

Cancer is viewed as a protected characteristic under the Equality Act 2010, says Kay Needle, early intervention and rehabilitation expert at Generali UK Employee Benefits. “And unlike other conditions that are expected to endure for at least 12 months to be classed as a disability under the Equality Act, cancer is automatically included within this definition from the first day of diagnosis. This means that there is an obligation on the employer to make reasonable adjustments.”

It’s perhaps understandable that a lot of employers make assumptions about the kind of support people need at this incredibly difficult time. And in the workplace, this can often translate into a very hands-off and long-term absence focused approach. This might work for some employees, but not others. The key is to understand that everyone is different. And everyone’s experience of cancer is very different.
“It is clear that HR and Occupational Health professionals are not doing enough to raise awareness of the obligation to offer reasonable adjustments and a phased return-to-work and wider employment rights,” adds the research referenced earlier. 

For many cancer patients, the risk of losing touch with work and the potential for detrimental impact on their employment status or incomes can be very significant.

“The mental health consequences of a cancer diagnosis and subsequent treatment are considerably worse than the physical effects,” states the report, adding: “work satisfies many more needs for individuals than just being a source of income. It is a way of remaining connected with others, is a source of identity, meaning and purpose and connects people to their community and society as a whole.” 

This matter is ever more urgent

Compounding the existing barriers in the workplace right now, of course, is the fact that pandemic related delays in diagnosis are expected to lead to many more people being diagnosed at a later – more invasive – stage.

Professor Gordon Wishart, Founder and Chief Medical Officer at Check4Cancer as well as visiting Professor of cancer surgery at Anglia Ruskin University, adds: “The Covid-19 pandemic and successive lockdowns have amplified failings in the delivery of NHS cancer services in the UK. And the current backlog of patients waiting to be diagnosed or treated has resulted in the longest cancer waiting times since records began. Furthermore, there is already documented evidence of more patients presenting with advanced bowel, lung and prostate cancer compared to before lockdown.”

Those with advanced cancer reported even lower levels of support for their return to work, according to the research report mentioned earlier.1

So, what does “good” support look like?

Finding out what works best for the individual is paramount, as is keeping in touch, says Dr Julie Denning, Chartered Health Psychologist and Managing Director of Working To Wellbeing and Chair of the Vocational Rehabilitation Association.

“Park all your previous assumptions and judgements. Work with the person in front of you and them only. Ask them what they need, as early as possible, not when they’ve been off sick for some time. And if they’re taking time off for long-term treatment, ask them at the get-go how often they’d like you to be in contact with them, whether they want to still receive the newsletter, for example, and be invited to gatherings – formal or informal. How much do they want to be involved, if at all.

“Remind them about the support services that are available to them, in or out of work. This type of early intervention can make a huge difference. Also, when it comes to return-to-work planning, consider Wellbeing Action Plans; these keep the lines of communication around support needs open on an ongoing basis and, again, can make all the difference.”

This kind of approach to personalised early intervention doesn’t have to be expensive, says Kay. And the same goes for prevention.

“There’s always an opportunity to do something simple; a poster on the back of the bathroom cubicle door, for example, reminding people to check themselves. Make use of awareness days. Use plain language. Normalise by speaking about things like reproductive cancers. Have open discussions.

“Make use of virtual GP services. Also, maybe onsite cancer screening services.”

Professor Wishart adds that cancer screening can become part of employee benefit packages, along with education on the risk factors for common cancers. This might also include access to behavioural change programmes to lower cancer risk by tackling lifestyle factors.

He says: “If employers provide the necessary education to allow employees to understand their personal risk and provide access to screening for those at highest risk, the way that screening is delivered to the workforce can be revolutionised with benefits for both employees and employers.”

The key to all of this is viewing work as a health outcome; in other words, work as part of the early intervention and rehabilitation journey, as opposed to automatically assuming that work is a barrier to recovery and should therefore be avoided at all costs.

Experts suggest that for healthcare professionals “more systematic consideration needs to be given to the possibility that a successful return-to-work may have therapeutic benefits for many patients and should be regarded as a high priority clinical outcome of cancer care”.

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1 Institute for Employment Studies, Cancer & Employment Survey: Summary of key findings, Stephen Bevan and Barbara Wilson, Feb 2022

All information contained herein represents the views and opinions of the author as at the date of writing and is provided for general information only. Nothing herein constitutes or is intended to constitute financial or other form of advice and no individual should rely upon the information provided in making a specific investment decision without first seeking independent professional advice.

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