Once you’re back in society people don’t realise that you’re still dealing with medical stuff. You come back to work and it’s like “welcome back, here’s a bunch of work” and you think ” I don’t know if I can deal with all of that, just help me back in and ease back in a bit.

 – Jim, leukemia survivor.

The ability to return to work after a cancer diagnosis varies considerably among people with cancer. Working after cancer may be difficult for some, 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 out some work tasks. Treatment for cancer may be time consuming and undertaken far away from home leading to extended absences from work.  People with cancer 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 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. On the other hand returning to work may be the very motivation needed to finish treatment and a person may be more than ready to return to work or only need a little flexibility to return to their role.

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.