Cancer survivorship in Covid-19: A blind-spot for employers?
On World Cancer Day it is quite appropriate for much of the attention to be on the thousands of cancer patients whose cancer has not been diagnosed promptly or whose treatment has been delayed during the pandemic. For most of these patients the anxiety and distress of having cancer is being compounded by the fear that a delay in treatment risks a more gloomy prognosis.
But Covid-19 seems to be masking another problem. Working age cancer survivors seem to be slipping down the priority list for employers, with many finding it harder to get support to remain in or return to work (RTW) and others feeling that working from home is making them less visible to their bosses, and access to support, workplace adjustments and vocational rehabilitation more difficult. So why is this important?
Globally the incidence of cancer is in excess of 14 million and this number is forecast to increase to about 25 million new diagnoses a year by 2025. Because of changes to retirement ages — the peak age for a diagnosis is between 65 and 69 — around half of those diagnosed with cancer are of working age. This, together with improved survival rates, means that employees who want or need to continue working after a diagnosis will be more common in workplaces of the future. Yet the data tell us that achieving and sustaining a successful return to work is much harder than it ought to be. Shockingly, fewer than two-thirds of employees with cancer have returned to work or are still working a year after getting a diagnosis.
Some of the barriers patients face are clinical. Profound fatigue, lack of stamina, side effects of chemotherapy or radiotherapy treatment, frequent follow-up appointments and the need to avoid infection, for example, can impede regular attendance at work and make sudden and unpredictable absences from work common. Some barriers are psychological. A lack of confidence — even among once confident high performers — or low self-esteem, a fear of what the next CT scan (‘scanxiety’) might reveal and a worry that colleagues see you as a burden or ‘flaky’ and unreliable. Anxiety about being shunned at work or colleagues not knowing how to talk to you are other common experiences. Others are barriers which employers can influence. These include providing access, usually on a temporary basis, to flexible working, regulating workload and work intensity, making sensible workplace adjustments and taking care over setting performance targets. Many cancer survivors look very well on the outside. But the psychological effects of cancer and cancer treatment, or body image anxiety because of scarring or hair loss, can disguise a sometimes crippling fear of work and the workplace when, for many, they cannot afford to stop work or even to reduce their hours.
Among many cancer survivors there appear to be a number of other cultural or ‘hidden’ barriers which may also inhibit successful RTW, for example, cancer still carries a stigma in some European countries including those with efficient, modern health systems. For some cancer survivors, financial distress can be a major part of the anxiety and stigma they experience. In addition to concerns over the financial implications of job loss or underemployment, some financial institutions can penalise cancer survivors long after their treatment has completed, especially in the field of pensions, debt, mortgages and insurance. This has led some to call for the ‘right to be forgotten’ being formalised in regulation.
Despite this, it seems that the number of employed cancer survivors feeling supported and connected at work during Covid-19 has declined appreciably. Barbara Wilson, CEO of the social enterprise Working with Cancer told me that many cancer survivors have struggled to get support from their employer as they deal with a recent diagnosis or as they start their journey back to work. ‘This may be less to do with a lack of compassion or concern among employers than reduced managerial ‘bandwidth’ during the pandemic’, said Barbara. Whatever the reason, this is just another example of the way that cancer patients may be dropping down the list of the priorities of some employers just at the time when they need this support most.
Being at work is a social as well as an economic act and it is important for employers to recognise that work can have therapeutic benefits for people living with chronic health conditions. For cancer survivors like myself the physical and emotional effects of both the symptoms and treatment need special care from employers. Getting it wrong can exacerbate the discomfort and uncertainty. But getting it right can — especially during a period of elevated anxiety such as a pandemic — be liberating and open up new opportunities for both employee and employer.
Stephen Bevan and Barbara Wilson will be presenting at the Health and Wellbeing at Work Conference on 16th March and 4.25pm. Their presentation is entitled: Cancer Survivors at Work — The Unspoken Truths.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.