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The number of people living with and beyond cancer is growing and people are now living with cancer in different ways.
The effect a cancer diagnosis and treatment will have on a person and their ability to work will vary widely. It will depend on the type of cancer, its stage (the size of the tumour and whether it has spread), any symptoms the cancer might be causing, the cancer treatment and side effects, and how the person copes when faced with a traumatic situation.
Some people welcome work as a way of helping them to feel ‘normal’ and in control. Carrying on with or returning to work can help some people emotionally while they’re waiting for a diagnosis, having treatment, or caring for someone with cancer. For others, working is a financial necessity and they can’t afford to be away from work for long.
Some people give up their jobs because their cancer is advanced or the symptoms make it impossible to work. Side effects of treatment leave some people unable to work. Others may resign because their self-esteem or confidence has been damaged. Carers may need to reduce their hours or give up work to care for someone with cancer.
As a manager, you may be one of your employee’s most important sources of support. You don’t need to be a medical expert, but a basic understanding of cancer and its treatment can help you in that role. This knowledge will also help you to plan for and recognise issues that may emerge at work.
The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. There are more than 200 different types of cancer, each with its own name and treatment. Some causes are known, but often the doctors simply can’t say why a person has cancer.
Normally, cells divide in an orderly and controlled way. But if for some reason the process gets out of control, the cells carry on dividing and develop into a lump called a tumour.
Tumours are either benign (non-cancerous) or malignant (cancer). Cancer cells have the ability to spread beyond the original area of the body. Without treatment, cancer may spread into surrounding tissue. Sometimes cells break away from the original cancer and spread to other organs in the body through the bloodstream or lymphatic system. When the cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or a metastasis.
We have information about most cancers| and their treatment.
The aims of cancer treatment| will depend on the type of cancer|, its stage and a person’s general health. Treatment may be given to cure a cancer, to slow its progress and to help relieve symptoms.
The most common treatments are surgery, radiotherapy, cytotoxic chemotherapy, hormonal therapy and targeted therapy. Sometimes a person may have more than one type of treatment.
Surgery| may aim to remove all or part of a tumour. Some operations may be carried out as day surgery, so a person only needs to take a short time off work. Other operations are much larger and may mean spending a few weeks or even months away from work.
Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. For most types of curative radiotherapy treatment, a person will need to go to the hospital each weekday, Monday–Friday, for between 2 and 7 weeks.
Chemotherapy| drugs interfere with the process of cell division, but affect normal cells as well as cancer cells. The drugs are usually given as a liquid through a drip into a vein (intravenously). Some chemotherapy drugs are taken as tablets or capsules, which can be taken at home.
Chemotherapy is usually given in cycles of treatment. Usually 4–6 cycles of treatment are given, which take 4–8 months. Some treatments for particular types of cancer last much longer than this, while others may be shorter.
Hormonal therapies| stop or slow the growth of cancer cells by either changing the level of particular hormones in the body, or preventing the hormones affecting the cancer cells. Most hormonal therapies are given as tablets, but some are given as injections every few weeks or months. This kind of therapy can continue from a few weeks to a number of years.
Targeted therapies are a newer group of treatments that work by targeting the growth of cancer cells. They generally have little effect on normal cell growth, so they usually have less troublesome side effects than chemotherapy drugs. Targeted therapies may be given as a drip (intravenous infusion) or as tablets. This kind of therapy can continue from a few weeks to a number of years.
Side effects will depend on the treatment being given but will also vary from person to person. Some people will be able to work during their treatment, while others will need to be off for a few weeks or months.
Side effects of treatments| can include:
Your employee’s medical team should go through the possible side effects and how best to manage them before they start treatment. Some side effects can be easily managed with medicines.
Some people are surprised to find they have few problems with treatment. Other people may have significant symptoms from their cancer or side effects from treatment.
Some people find that side effects build up during the treatment so they may be able to work at first, but then need more time off as treatment progresses.
You can try to make it easier for your employee to cope with side effects of cancer treatment| at work. For example, allowing frequent breaks, access to a fridge or an alteration to their uniform may make life easier.
Fatigue can affect people in different ways and may persist long after treatment is over. It may mean your employee:
Fatigue, together with the other effects of cancer and its treatments, may mean that your employee is unable to work for long periods. Tiredness can also make people irritable and affect how they relate to other people.
You can help your employee to cope with fatigue by offering various adjustments. Flexible working, working from home, reduced hours or lighter duties are a few of the options outlined later in this guide. Simple steps like rest breaks or a short walk outdoors can really help.
If your employee is caring for someone with cancer, that person’s fatigue can have an impact on them too. It can increase their need for time off so they can attend to caring responsibilities.
Cancer and its treatment can cause physical changes, so you and your colleagues may need to be prepared for this. Again, it depends on the individual.
Changes can include:
We have information about coping with hair loss| and coping with body changes| after cancer.
People who have finished treatment may find it difficult getting back to normal. They may struggle with their emotions (see below) and fatigue, or need to adjust to changes that treatment has made to their body. Some treatments leave people with long-term side effects. Many people want to get back to work but may have difficulties in returning to their old jobs. They will need your understanding and support to do this successfully.
Some people recover well after treatment and they aren’t ever affected again by the cancer. But some people may be living with the knowledge that their cancer can’t be cured, even though they feel well at the moment. Their cancer may return at some point and they may need further treatment. Some of these people will then have further periods of remission while for others the cancer may be more advanced.
Some people live with cancer for many years without ever developing significant symptoms. However some people may die from their illness within a matter of weeks or months.
Being diagnosed and then going through cancer treatment can understandably have a huge impact on the person concerned, their family and friends and their work colleagues.
Going for tests and waiting to hear results can be an anxious time. Many employees may wish to keep their situation confidential at this point. If they tell you what is happening, you can respond appropriately to their need for time off to attend medical appointments. See section 2 of this guide for employers, for information and advice on talking about cancer.
When someone receives a cancer diagnosis, the shock can make them feel numb at first. Some people can take a while to accept the fact that they have cancer and they may try to carry on as if nothing is wrong. Other feelings people may have include:
If your employee learns that they or a loved one has a cancer diagnosis, they may need time off to be with their family and collect themselves before coming back in to work.
Learning that a cancer has recurred can also be devastating news, particularly if the person needs more treatment or if their medical options are becoming limited.
Uncertainty can be one of the hardest things to deal with when faced with a diagnosis of cancer and can cause various emotional responses. Some people manage this by taking one day at a time and not looking too far into the future. Others want to find out as much as possible to help them regain some sense of control.
Sometimes cancer puts people on an emotional rollercoaster. Distress can hit them out of the blue. If this happens to your employee at work, it might help to offer them a private space for a while. You could suggest they go home for the rest of the day. Ask if they would like you to call a relative or friend to come and travel with them.
You and your colleagues may also have strong feelings and this is only natural.
Don’t hesitate to ask for support in dealing with emotions of your own. Within the limits of confidentiality, it may help to talk to another manager in your workplace.
You can also call our cancer support specialists on the Macmillan Support Line on 0808 808 00 00. We are here to help anyone who is affected by cancer, including you.
We have a booklet called The emotional effects of cancer, which explains more about the different feelings people may have following a cancer diagnosis and what can help.
Watch our video for real examples of how people were supported by their employers when they were looking after someone with cancer.
Becoming a carer is often unexpected and can be one of life’s most emotional and physically demanding roles. Sometimes it’s hard to juggle caring and employment at the same time, but there is support available to help carers remain in work.
Caring responsibilities may cause absences. For example, an employee might take sick or annual leave when a crisis occurs, rather than asking for time off to care for someone with cancer. Often this is because people wrongly believe their caring role isn’t a legitimate reason to request leave or the carer may not feel comfortable disclosing that they are caring for someone.
Being a carer can have an impact on both physical and emotional health and this can affect the carer’s ability to work. They may find it difficult to concentrate or feel tired from lack of sleep. Being a carer can exacerbate existing health problems, such as high blood pressure or back problems.
It will help if, as soon as you are aware of a person’s caring responsibilities, you can go through your organisation’s policies and their rights as a carer, and explain what leave options they have. Letting them know what you need from them will also help you support them.
Cancer can be a fluctuating illness, with long cycles of treatment, often requiring outpatient appointments. Carers may need time off work at short notice. And side effects and symptoms can persist after treatment so the need for flexibility may remain for some time.
Your employee’s commitment to their job and colleagues may cause them to feel guilty if they’re unable to complete their usual work. Caring responsibilities may also affect how an employee views their own career development – they may feel discouraged about seeking promotion or applying for a new job. Being a carer shouldn’t adversely affect an employee’s longer-term job prospects and it will help if you can reassure them about this. Your employee may appreciate it if you explain the options for leave, your organisation’s policies and their rights, for example, flexible working.
Your employee can contact the Macmillan Support Line on 0808 808 00 00 for information and details of local support services. We also have a database of useful organisations|. We also have information for carers about working while caring for someone with cancer| and a booklet written by carers for carers called Hello, and how are you? is available to order from be.macmillan.org.uk|.
Content last reviewed: 1 May 2011
Next planned review: 2013
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
If you have any questions about Macmillan we would love to hear from you| .
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© Macmillan Cancer Support 2013
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