Preparing your patients to return to work

Returning to work has a number of positive psychosocial and economic benefits for the individual and the community as a whole – but, as you will have seen in Martina’s case, it can be overwhelming.

According to a recent report published by the Cancer Council of Australia, an estimated 10–38% of employees do not return to work after finishing their cancer treatment.

These numbers are expected to increase given the growing proportion of cancer survivors in the community, which poses economic challenges as well as individual ones. In this section of the course, we’ll first look at the common reasons why cancer survivors do not return to work, and then consider how return-to-work discussions can help address these.

There are many reasons for a survivor to feel uneasy about returning to work. A cancer diagnosis and its subsequent treatment are emotionally and physically draining, and a patient might feel that returning to work will just be an added challenge. It can take time to get over the side effects of treatment, and making adjustments to your work schedule and environment may make things easier. Some common issues for returning to work are:

• Fatigue and tiredness – Cancer treatment and associated stress can cause patients to feel tired and weary. Factors such as job stress, shift work or standing for long periods may make them feel worse. Many people find that they cannot do as much as they normally would, while others are able to continue their usual activities.

• Concentration and memory – Their job might require them to interact with others, solve problems and concentrate for long periods of time. After cancer treatment, it can be difficult to concentrate. Your patients may feel like they are in a fog. This is sometimes called ‘chemo brain’, but can happen even if patients don’t have chemotherapy.

• Nausea and vomiting – Nausea is best treated early. If patients feel sick, they should be advised to return to the clinic. Anti-nausea medicine can be taken regularly to relieve symptoms.

• Increased risk of infections – When the immune system is affected by cancer treatments such as chemotherapy, there is a need to take precautions against infections. Colds and flu are often passed around in organisations or between people who work closely together. This happens frequently during winter.

• Changes in appearance – Side effects from surgery, chemotherapy or radiotherapy may cause survivors to look different and change the way they feel about themselves. They may feel less confident about who they are and their abilities. Reassurance that it is normal to feel self-conscious when returning to work is advised.

When discussing return-to-work strategies, it is important to consider:

• How your patient is feeling about returning to work?
  • Do they have any guilt regarding their inability to return to work and/or perform their usual role?
  • Are they showing signs of diminished self-esteem and confidence?
• Does their workplace know about their diagnosis?
  • Patients may not wish to disclose their cancer experience when returning to work or seeking new opportunities
• What your patient understands about his or her rights at work?
  • Do they know what to look out for when it comes to potential employer or peer discrimination?
  • How comfortable are they with basic ideas in employment law?
• How would the potential loss of employment demotion impact their situation?
  • What are the potential impacts of a restricted income on their finances? Are they already under financial burden?
• Will their decision impact those around them – be it family members, carers or close friends?
  • Will their decision ask more of families, carers or close friends – and perhaps impact their support network’s careers?

There is a lot to consider when a survivor is looking at returning to work for the first time after a cancer diagnosis.

Have you advised a patient on returning to work? Share what advice you would give to your colleagues when advising a patient on returning to work.