Returning to work is getting harder for cancer survivors yet more could done
Dr Tyna Taskila
02 May 2013
The difficulties faced by cancer patients who are returning to work have rightly been under the spotlight this week. Today (03 May), Macmillan Cancer Support published research which shows almost four in ten people (37%) who return to work after cancer treatment experience some kind of discrimination from their employer or colleague, compared to just under a quarter (23%) in 2010. The findings are shocking and as an article in The Guardian earlier this week shows (including further research from Macmillan), earnings are directly affected. A third of cancer patients lose an average of £860 a month as they are unable to work or have to reduce their hours.
Our recent report, Returning to work: Cancer survivors and the Health and Work Assessment Service echoes these findings and our recommendations, if implemented, would help more survivors to remain in work. If healthcare professionals introduce work as a clinical outcome early on in treatment and employers make workplace adjustments (such as flexible working), cancer survivors are better equipped to deal with the challenges of returning to work. Employers are not always aware that for many who are returning to employment after an extended period, the mental strain can be highly stressful. As one survivor remarks in our report:
“I would gladly have given my job to someone younger. It scares me to return to work, because I've been absent for over a year. What frightens me most is how my colleagues are going to take my return. I guess they never expected me to return to work. Too much has happened over the past year. Mentally I haven't been able to keep track of things. First I prepared myself for dying – now I have to re-orientate myself into work life.”
- 53-year old breast cancer survivor
Compounding these psychological difficulties are the physical strains. Chronic fatigue in particular is very common amongst cancer survivors. This can often be as disabling as the condition itself and without proper support, many feel compelled to give up their jobs. If we want employers to make adequate adjustments we need to start by ensuring government policy is focused on supporting people with cancer back to work.
Although policymakers have increasingly recognised the need to better support people with long-term conditions to enter and remain in the workplace, the level of support available to people under the Health and Work Assessment Advisory Service (HWAAS) is not yet clear. Recently introduced, the HWAAS has the potential to really improve employment outcomes of people with long-term conditions such as cancer. But it needs to consider the needs of patients with long-term fluctuating conditions. This is especially important for cancer survivors, as a 12-month period of absence from work is not uncommon. The service needs to be carefully designed to recognise the challenges faced by each individual. But it is not clear when, or if, work will be introduced as a potential outcome for patients on long-term sick leave.
What needs to change? Firstly we need to challenge prejudice and assumptions in the workplace and amongst healthcare professionals. Unfortunately, there is a perception amongst GPs and other healthcare professionals that cancer survivors are incapable of - and ultimately unwilling to - return to work. Unless employment is seen as a clinical outcome, there is a possibility that the referral of cancer patients (and other people with chronic conditions) will become a random process based on a GP’s personal assumptions and perceptions of their patients’ needs. If the service is expected to have a positive impact it must be offered systematically to everyone who may need it.
Secondly, referral routes for those who do wish to return to work should be clearly signposted and considered as a routine aspect of care. Fitness for work: the Government response to health and work – an independent review of sickness absence suggest GPs act as the main referral route to the service, primarily because they are responsible for managing sickness absence.
Thirdly, we need to improve the assessment process itself. There are lessons to be learnt from the Work Capacity Assessment around the assessment of people’s support needs on returning to work and job retention. The HWAAS assessment process should take account of potential problems that might occur with each individual worker. These difficulties are often dependent on the type of work someone undertakes, the kind of contract a patient has with an employer and a patient’s financial circumstances.
To ensure the HWAAS is offering the best support, the following four questions should be asked by healthcare practitioners during assessments:
- How likely is it that there will be financial problems for an individual and their family if a patient is not at work andshould financial support be signposted?
- Is the current job suitable for the patient or would it be necessary to consider other types of work?
- How mentally and physically demanding is the job and is there a need for workplace adaptations?
- What is the relationship with the supervisor and is the patient confident about discussing his/her condition at the workplace with a reasonable expectation that such adaptations will be considered?
The HWASS could help more people to remain in work. Ultimately, its success or failure will rest on the quality and the practicality of the advice it gives and the extent to which this can be applied within each individual’s workplace. A coordinated approach is key. Employers and healthcare specialists in both primary and secondary care have an important role to play. A carefully designed service which accounts for individual needs will surely have a positive economic impact on individuals who would otherwise have left the workforce. More importantly, it will transform the lives of many cancer survivors who wish to work.