Cancer treatment is largely shifting from inpatient infusion therapy to outpatient treatment with oral medications, but the impact of these new therapies on lost productivity and time away from work is unknown. In addition, an emphasis on early detection has led to younger individuals being diagnosed and treated for cancer.
Survivors are living longer, which has resulted, in part, in longer and often more aggressive treatments, and in turn, has increased the number of survivors returning to the workforce. Cathy J. Bradley, PhD, MPA, Associate Director of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, discussed this topic at the 2018 Cancer Survivorship Symposium.
Cancer therapies come at a high price, resulting in an even greater incentive for maintaining an income and health insurance coverage, but patients still face a multitude of barriers when returning to work after a cancer diagnosis. According to Dr Bradley, these factors underscore the need for effective interventions—at the patient, provider, and workplace levels—to minimize the effects of cancer and its treatment on returning to work.
Shifting Trends in the Workforce
Patients with cancer have a strong intrinsic desire to remain in the workplace. It provides a sense of normalcy and self-worth, as well as a distraction from treatment.
“For many of us, it defines who we are,” said Dr Bradley. “It’s also an important signal about recovery; saying ‘he’s back to work’ means something to us; it’s different from saying ‘he’s doing better.’”
Growing Disparities in Survivorship
The US workforce is now trending toward more freelance and contract work, leaving this growing sector of workers without benefits such as health insurance and paid sick leave. People are also remaining in the workforce longer, increasing their probability of becoming working cancer survivors.
Widening disparities are becoming more common in the workforce, with low-skilled workers tending to work fewer hours, cutting costs by removing healthcare coverage, or withdrawing from the labor force altogether.
African Americans, Hispanics, and rural workers with cancer are more adversely affected than others, raising concerns about the widening disparities in cancer survivorship. Workers in more cognitively demanding jobs tend to have a more difficult time returning to work because of the effects of treatment, and face the risk of depression and adverse psychosocial outcomes.
Low-wage workers are particularly vulnerable, because of nonaccommodating employers and no paid sick leave, often resulting in a loss of a job or staying in the workplace regardless of how sick people are, thus jeopardizing their health and well-being.
This all adds up to a substantial hit on the US economy.
“Cancer survivorship doesn’t take place in a vacuum. We have to think about what trends are going on around us,” Dr Bradley advised. “This changing workforce dynamic is going to have critical implications for cancer survivors in needing healthcare coverage and flexibility following diagnosis and treatment.”
What Do Your Patients Need?
According to Dr Bradley, patients with cancer who are returning to the workforce need symptom control, rehabilitation if treatment has created a deficit, and retraining if getting back to the same role is no longer a possibility.
Oncologists should understand the potential impact of a certain treatment on a patient’s job, and incorporate that knowledge into their decision-making and patient education. Patients should have reasonable expectations of how much time they will miss from work, how they can plan for that time away, and whether the treatment they select will affect their functional status.
In addition, oncologists should make treatment decisions that will maximize a patient’s ability to work: supportive therapies such as cognitive reconditioning and physical therapy can be very effective, whereas sleep aids and antidepressants may interfere with the patient’s ability to function in the workplace.
Helping Patients at Work an Important Aspect of Recovery
“When I talk to members of patient advisory boards who are going back to work, they repeatedly report that well-meaning employers do the wrong thing,” she said. “So this is a big area of education—to be able to inform both survivors and their employers about what’s needed, and what can be done—that’s not just well-intentioned, but also effective.”
Workplace-related accommodations should be offered to patients (ie, flexible schedule, telework, fewer hours without jeopardizing benefits), and also help to ensure patients don’t face discrimination for having been diagnosed and treated for cancer.
“If survivors want to get back into the workforce, the workforce needs to meet them somewhere in the middle, with accommodations that help them stay attached to their job, especially during long treatment regimens,” she said.
According to Dr Bradley, work ability after cancer diagnosis and treatment is currently not integrated into clinical practice, nor is it handled well at the worksite. This translates to a survivorship environment that has not caught up with the recent advances in cancer.
“But returning to work is a tangible signal, and an important one in a patient’s recovery and survivorship,” Dr Bradley said.