We need more support systems for people who want to work during and after cancer treatment

By Bogda Koczwara

14 Nov 2016

Work is good for your health. Not only because it provides income but because it preserves a sense of identity and purpose if you are going through a hard time. It provides social interaction and, especially in the case of someone battling through cancer, a sense of normality.

But coming back to work after cancer treatment, or working during, will not come as easy as before diagnosis. And in Australia, there is no system to support people returning to work after cancer treatment – or to provide advice to their doctors or employers on how to help them.

Work and cancer

Cancer and its treatment can have a profound impact on the patient’s ability to work. A recent Australian study of 255 cancer patients showed 67% changed their employment after cancer and for 63%, the household income had reduced since diagnosis.

People who have, or are, undergoing cancer treatment, experience physical changes such as fatigue or nausea; emotional issues including self-consciousness about hair loss; and practical issues such as fitting in medical appointments around work responsibilities.

The cancer diagnosis itself can lead to a change in life priorities, and work may drop down the list. Equally though, despite not being fully able to manage work demands, cancer patients may feel pressured to work to meet their financial needs.

Cancer patients are at greater risk of unemployment than the general population. That risk is higher for those with few work skills, blue collar workers who are already more financially vulnerable and those who live in areas of limited employment opportunities.

The ability to work after cancer treatment is further impacted by the economic environment and job market. Some countries like the Netherlands and Germany consider rehabilitation after cancer, including work rehabilitation, part of the standard management of cancer patients. But this approach is not currently adopted in Australia.

Financial toxicity

Being unable to work during cancer can make it difficult for the patient to meet the costs of treatment. The so called “financial toxicity”, or difficulty paying for cancer treatment, has been associated with distress, bankruptcy and in some cases, earlier death.

The impact of cancer treatment costs on patients and their families is increasingly recognised in Australia and the world. But the indirect effect of a patient being unable to work as a contributor to financial toxicity, has attracted much less attention.

A recent study in the Lancet medical journal found during the global economic downturn, cancer patients who were unemployed had lower survival rates. This was especially the case in countries where patients have to pay full price for treatment, which authors suggested could be due to being less able to afford cancer treatments.

More cancer treatments in Australia require some form of user-pay arrangements; from self-funded chemotherapy and higher co-payments, to escalating parking and travel costs.

There have been calls in Australia for doctors to openly disclose the extent of financial toxicity associated with the patient’s treatment, as part of the informed consent process.

But although doctors can tell patients what their treatment will cost, most health professionals don’t routinely provide advice about the impact of cancer and its treatment on work; nor are they trained in assessing a patient’s work ability.

It’s not routine practice to refer patients to an occupational physician for this kind of assessment.

Australian state-based schemes, such as WorkCover and WorkSafe, offer support when a work injury prevents people from working. But neither of these have a scheme for those who can’t work as a result of cancer.

How we can help

Doctors routinely recommend short-term absences from work to allow for recovery from surgery. But similar discussions and advice relating to the long-term impact of cancer treatments like chemo and radiation therapy are often lacking.

This is partly because, unlike the well documented surgery recovery time, the impacts of the other treatments are hard to predict and quantify. They depend on many factors including individual tolerance to treatment and the nature of the patient’s job.

Further, those undergoing treatment may be too focused on getting through their cancer ordeal to be aware of the risks of impaired work ability. And employers may not know how to support someone going through cancer treatment. They may be more comfortable getting with the employee not working at all.

Patients, health professionals and employers, need support to help people return to work after cancer. We have developed a web resource to help with various needs in this area.

The website includes links to informative Australian and international resources. It also has a list of questions patients should ask their doctors and employers, assessments on their ability to work, resources on legal rights and obligations, and personal perspectives of cancer survivors.

It aims to provide information on not just what to expect but what could be done and by whom. For instance, it provides a template for a return-to-work plan and a checklist – developed by an occupational physician – for doctors of items to examine to assess a patient’s ability to work.

Researchers need to start measuring the impact of cancer on employment at both the individual and social level and develop strategies to manage it. We shouldn’t forget the more than a million cancer survivors in Australia, many of whom are young enough to continue working after cancer.

The author is presenting the web resource workaftercancer.com.au at the Clinical Oncology Society of Australia’s Annual General Meeting this week.

This article was originally published on The Conversation. 

About the author: is a Senior Staff Specialist, Medical Oncology, National Breast Cancer Foundation Practitioner Fellow, Flinders University

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