Cancer recovery and return to work: An integrated approach.
By Julie Denning, PhD. CPsychol, Managing Director at Working To Wellbeing.
In 2014 there were 360,000 new cancer diagnoses with a predicted rise to 422,000 by 2022. Data suggests around 60% of people survive cancer (Seifart & Scmielau 2017).
As increasing numbers of people are living with and beyond cancer, it is time to start addressing their needs on a larger and more inclusive scale. Whilst advances in medical interventions are staggering, support for the sequelae of those treatments is often lacking.
People in our service often report a “black hole” post treatment or as if they are falling off a cliff. They may still have links to their oncology or surgical team but still experience physical and psychological difficulties. They also may be unsure about what to do about work. Indeed post treatment, many people do not return to work because of emotional difficulties and many report that physical difficulties are an obstacle to return.
Mood and physical issues
Early intervention support should be provided to help people have a smooth recovery post cancer diagnosis. Evidence has shown that people benefit from vocational rehabilitation support. This can come in the form of supporting the engagement in exercise and activity throughout treatment and afterwards. Just providing reassurance that it is OK to exercise can be enough to get people moving and becoming active again. We know that people often need a graded exercise programme to increase strength and stamina and also to enable functional activity and recovery.
People also need to have the opportunity to talk about the impact their diagnosis has had and to express their feelings about their situation with someone who is outside their social sphere so that they can have the ability to talk without guilt or worry. As an example, I once called a patient for a review and found out that he was in hospital again. I said I would call back another time, but he was insistent we have the call. He wanted to talk through how he was feeling with me rather than upsetting and worrying his wife when she arrived later that day to visit him.
Furthermore, it is important to discuss people’s fear of recurrence and changes to their ‘normal’ lifestyle. Early conversations mean that worries don’t balloon into panic and generalized anxiety. It is important to note too, that people won’t necessarily need CBT as an intervention, they may just need the opportunity to talk and process what has happened to them.
An integrated service model that provides both physical and mental health support is key. By ‘joining the dots’, such a model helps people to focus on their recovery, improve their functioning and when ready, rehabilitate back into work.
Practical considerations for return to work and employer support
It is important to understand the impact of symptoms in relation to returning to work. Clinicians have a vital role to understand this so they can help someone return to everyday functioning. Employers need to adhere to the Equality Act and make reasonable adjustments to support their returning employee, so it is important that they also understand how someone’s symptoms may impact on them returning to work.
For example, if someone is experiencing fatigue this may affect their concentration, focus, communication and mental processing. Neuropathy in one’s hands or feet can affect dexterity for typing and writing and difficulties in walking. Anxiety and/or low mood can impact on concentration, productivity can cause a lack of focus, relationship difficulties and lethargy. Pain can result in difficulty sitting for long periods at a desk.
Knowing what their colleague is going through post cancer diagnosis and treatment can help employers to best support them. Indeed, they have a crucial role to play. Often this comes down to a line manager level, but having helpful, proactive policies in place at an organisational level and creating a culture of support for return is essential. If employers see that work is a key part of recovery for someone and clinicians see work as a health outcome, then there would be greater impetus to create a supportive work environment.
The third sector is noticeably engaging in the work conversation. Macmillan is spearheading the way forward not only with their plethora of information booklets and online information but also more recently with their work support service helpline where people can be offered advice as to return to work planning. Anthony Nolan have gone a step further and provides a brief intervention service supporting patients post-transplant with their work plans as well as providing emotional support and guidance as to exercise and activity.
Conclusions: more VR needed, more integrated support
In conclusion, support is urgently needed for a growing body of people who are living with and beyond cancer. They may have been cured or told they are in remission, but their story continues as they are often facing other challenges, both physically, emotionally and vocationally.
Their needs must be met and their voice must be heard.
We must ensure that they have access to early intervention services to meet their physical and mental health needs so that they are able, when ready, to return to the workplace. Providing early integrated vocational rehabilitation services must move higher up the agenda at both a government, clinical and employer level.