Conversations: Living and working with cancer
BACP Workplace, October 2021

It’s a figure that’s hard to ignore and one that’s often repeated by cancer charities: according to the Office for National Statistics (ONS), one in two people will be diagnosed with cancer at some point in their lifetime.¹ With 46% of those people being of working age,² it’s useful to consider what impact this might have on clients, employees and the wider organisation. As with most things in life, it’s impossible to completely separate what will impact on us at a personal level from our working lives – which makes it all the more vital for line managers and employers to have the appropriate skills to support employees and colleagues, and recognise what they might be experiencing and how this may affect them at work.

Employers that have made good progress in this area, work hard to create an open workplace culture where cancer is both discussed and included in a long-term ill-health policy, which helps to make it easier for employees who are diagnosed with cancer, and for their managers and colleagues, to approach a subject that many are likely to fear.

What happens after diagnosis?

After a cancer diagnosis, people’s reactions can vary widely. While one person will want to tell as many people as possible, to help them to manage expectations and allow for open dialogue, another person will decide not to tell anyone unless, or until, they absolutely have to, preferring to act – and be treated – in the same way that they have always been. Fear and uncertainty about the future, as well as having worries about long-term health, and concerns of a financial nature, are not uncommon. While statutory sick pay (SSP) (at £95.85 per week) can be claimed for up to 28 weeks, organisations might also have occupational or company sick pay, which might be more generous than SSP, or be paid on top of SSP.³ As a manager or colleague, knowing what your organisation provides, and ensuring that others know this too, could help to alleviate worries and be one less thing that someone with a new diagnosis of cancer needs to find out about.

One of the common feelings after being diagnosed with cancer is anger, with questions arising such as: ‘Why me?’ and ‘Why does my life have to change?’. This anger might be masking fear, or it could be a manifestation of the concept that life isn’t fair, or that there is a strong feeling that individual autonomy needs to be retained. Exercising regularly, practising breathing and/or relaxation exercises, and talking about or writing down how you feel, are some of the suggestions often made for dealing with this anger. If anger becomes a constant feeling and is affecting someone’s life on a daily basis, then talking to a counsellor or psychologist can help, as experiencing a life-threatening illness is a major life transition.³ Often those with a cancer diagnosis are advised to save their emotional energy for themselves, rather than expending it protecting and supporting loved ones. For close friends and family, managing their own emotions around the fear and upset of someone dear to them receiving a diagnosis of cancer, can be hard, and might affect the amount of support that they can give. This means that managers or work colleagues, who may not be so close, can sometimes provide a more objective type of support than loved ones, as expressed by one of the people I spoke to for this article:

‘The first thing I noticed was the consistent support that came from my husband and parents, but also from a couple of people I hardly knew. They were literally on the perimeter of my network. They weren’t close emotionally but they had the strength to support all my emotional needs without offloading on me.’

Undergoing treatment

There is no one way to respond to cancer treatment, and everyone reacts differently, with some people having far more side effects than others. The most common physical impacts of cancer and its treatment are: tiredness and fatigue, pain, nausea, infection, trouble sleeping, hair loss, breathlessness and bladder or bowel problems.³ Planning work days around treatment and ensuring that work is not stressful or physically demanding for the few days around the treatment, can be really helpful. Some people find that short breaks or naps are necessary, and they might need to have rests after any physical activity.

Keeping a diary of physical and emotional responses can help people to notice if there is a pattern, which, in turn, can help with planning workload and managing tasks. If someone suffers particularly from fatigue, it is useful for managers to be aware of an appropriate space where employees can go for rest and recovery. Having conversations with colleagues and managers about these physical effects can help increase understanding and support, and may enable people to adjust their work situation, including working from home, prioritising tasks and delegating workload.

After treatment/returning to work

Cancer survivors and working carers are protected against discrimination in the workplace, and the former must be offered reasonable adjustments to return to work.⁵ It’s worth being aware that employees often have up to a year off from work due to treatment, and therefore flexibility is important. After treatment, it can take another year for people to ‘get over the treatment’, and recovery can be both physical and psychological, with simple daily tasks such as having a shower being enough to result in exhaustion. One workplace therapist told me: ‘I will often see clients referred by their employer once they’ve had ‘the all clear’, and the process of healing internally can only start once the immediate threat is over. At
that point, clients are seeking a space to work out what’s just happened to them, what does it all mean, who was I before the cancer, and who am I now? One of the recurring themes is often how to face the future with the risk of the cancer returning and an increased sense of one’s mortality.’

I was interested to listen to an interview with Liz O’Riordan, a consultant breast surgeon, who talked to Barbara Wilson, the founder of Working With Cancer, about her experience of returning to work after her own cancer treatment.⁴ Liz O’Riordan explains how unsettled she felt by not knowing whether or not she would be able to return to work part time, but how she found it empowering to learn that she now had disability status because it meant, ‘I knew what I could ask for’. She urges others who find themselves in a similar situation at work, to inform work colleagues about the situation, rather than assuming that they all know – and she explains how this can help if someone’s appearance is changed as a result of having chemotherapy, or if they want to request to work different hours. Sharing her experience of how some people behaved when she returned to work, not knowing what to say, or how to behave and even becoming nervous when discussing cancer patients when she was in the room, she says: ‘I had to learn to act so that they wouldn’t walk on eggshells around me, and just treat me like a normal doctor, whereas inside I was wobbling’. She explains that she found having one person who knew what she was going through was key so that she could just say: ‘I need to take a moment, I’m having a wobble’, and they wouldn’t need any further explanation.

I spoke to Isabel van der Ven, an Associate of Working With Cancer, and she described how, often, people who have gone through treatment can have a feeling of being lost and vulnerable – as if ‘the rug has been pulled from under them’ – partly because they are no longer into the routine of regular treatments.

Although they might look completely fine, there can be ‘invisible struggles’ – worry about recurrence of the disease or dealing with fatigue, for example – and that others often think or say, ‘You look all right, so you must be OK’. After treatment, people returning to work can find that, initially, colleagues are delighted to have them back but, quite quickly, it can be as if they’ve forgotten that they have ever been sick and off work.

Closing thoughts

Working on the basis that ‘we’re all different’, it’s important for line managers and employers to know how to behave towards employees with cancer, to feel confident in finding out what kind of support each person wants/needs, by simply asking them. It can be helpful to have regular check-ins, while respecting that some will want to carry on with their working lives as if nothing has happened and be able to tune in to work as a place of ‘normality’. It’s helpful not to make assumptions about what people may/may not want at work, whether they want to carry on with their job in exactly the same way, or thinking you know about their hopes for promotion/ next career steps. Giving time, space and support to those people who’ve returned to work after cancer is within the power of many employers
and managers and is arguably the greatest gift they can give.