How cancer affects people
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 can vary widely. It depends 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 its side effects
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 people to cope 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 for long.
Some people give up their jobs because their cancer is advanced or the symptoms make it impossible to work. The side effects of treatment leave some people unable to work. Others may resign because of low self-esteem or confidence issues. Carers may need to reduce their hours or give up work to care for someone.
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. This knowledge will also help you to plan for and recognise issues that may emerge at work.
In a benign tumour, the cells do not spread to other parts of the body and so are not cancerous. However, they may carry on growing at the original site, and may cause a problem by pressing on surrounding organs.
In a malignant tumour, the cancer cells have the ability to spread beyond the original area of the body. If the tumour is left untreated, it may spread into surrounding tissue. Sometimes cells break away from the original (primary) cancer. They may spread to other organs in the body through the bloodstream or lymphatic system.
When cancer cells reach a new area, they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.
Depending on the cancer and where it is in the body, it may cause symptoms such as tiredness, weight loss, breathlessness or pain.
The aim of cancer treatment for many people is to cure the cancer. In some cancers that are very slow-growing or that have spread beyond the original area of the body, the aim may be to control the cancer and delay its progress.
The main treatments for cancer are surgery, radiotherapy and chemotherapy. Other treatments, such as hormonal therapy and targeted therapy, may also be used for certain cancers. Often, a combination of more than one type of treatment is used.
We have more information on our website about different cancer types, treatments and side effects.
Surgery may aim to remove all or part of a tumour. Some operations are done as day surgery, so the person only needs to take a short time off work. Others are more complex and may mean spending a few weeks, or even months, away from work. In some cases, surgery may affect someone’s ability to use a limb.
This treatment uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy that aims to cure the cancer will often mean a person needs to go to the hospital each weekday for several weeks. Each treatment only takes a few minutes. But travelling to and from the hospital and waiting for the treatment may take up a large part of the day.
Some people manage to continue working during radiotherapy, but they may need to reduce their hours. Other people stop working completely while having radiotherapy and for a few weeks afterwards.
Chemotherapy drugs interfere with the process of cell division. They affect normal cells as well as cancer cells. As a result, they often cause side effects.
The drugs are often given as a liquid through a drip into a vein (intravenously). They circulate in the bloodstream and reach the cancer cells wherever they are in the body. Some chemotherapy drugs are given as tablets or capsules, which can be taken at home.
Intravenous chemotherapy may take minutes, hours or a few days to have. The treatment is followed by a few weeks of rest to allow the body to recover from any side effects. Together, the treatment and the rest period are known as a cycle of chemotherapy.
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.
Sometimes, a drug is given continuously into the vein by a small portable pump over the course of a few months.
After their first cycle, a person will have a better idea of how much they may or may not be able to do during treatment. Some people find they can’t work at all. Others are able to keep working or just need to take a few days off after each treatment session. They can then work until the next treatment is due.
These are drugs that can stop or slow the growth of cancer cells by either changing the level of particular hormones in the body, or preventing hormones affecting the cancer cells. Most hormonal therapies are given as tablets, but some are given as injections every few weeks or months. Hormonal therapy may be given for a few weeks or for up to a number of years. They will usually have less of an effect on someone’s ability to work than other cancer treatments, but they do still have side effects.
These are part of a newer group of drug 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. Targeted therapies may be given as a drip (intravenous infusion) or as tablets.
The length of treatment with targeted therapy can vary. It can last from a few weeks to a number of years. Many people are able to carry on working while taking these drugs, but tiredness and other side effects may sometimes make this difficult.
Side effects of treatment
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Side effects – and how long they last – will depend on the treatment being given and 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.
Common side effects of treatments include:
fatigue (see below)
risk of infection
nausea (feeling sick) and vomiting (being sick)
diarrhoea or constipation
numbness or tingling in the hands or feet
body changes (see below).
Your employee’s medical team should explain to them the possible side effects and how they can best manage them before they start treatment. Some side effects can be managed well with medicines.
Some people find they have few problems with treatment.
Others may have significant symptoms due to their cancer or side effects from treatment.
Some people find that side effects build up during their treatment, so they may be able to work at first but then need more time off as treatment progresses.
Fatigue (extreme tiredness) is a common side effect of cancer treatment. It can also be a symptom of some cancers. It can be worse at different stages of treatment, or at different times of the day. Cancer-related fatigue is not like normal tiredness. It can’t be helped by sleep and it can make the simplest tasks feel exhausting.
Fatigue can affect people in different ways and it may persist long after treatment is over.
It may mean your employee:
finds it harder to perform certain tasks
has less strength and energy than before
has difficulty concentrating or remembering things
becomes exhausted during meetings or after light activity
struggles to control their emotions
experiences dizziness or is ‘light-headed’ from time to time.
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 others.
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. These may be temporary or permanent. You and your colleagues may need to be prepared for this. Body changes will depend on the individual’s situation, but changes can include:
changes in complexion or skin tone
altered appearance after surgery
weight loss or gain.
Our section on body image and cancer may be helpful. We also have information about many other side effects.
After treatment is over
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Many people recover well and can return to their normal working life after treatment has finished. But having cancer and recovering from it can have a big psychological impact. Some people find it difficult getting back to normal.
People may struggle with fatigue, their emotions, or changes that treatment has made to their body.
Some treatments leave people with long-term side effects, such as:
tiredness for many months or sometimes years
pain or lack of movement in an arm after breast surgery
only being able to eat little and often after stomach surgery
needing to use the toilet more often after bladder or bowel cancer treatment.
At least one in four people living with cancer experiences a wide range of long-term debilitating health conditions caused by their cancer.
People often want to get back to work but have difficulty returning to their old job. They 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. 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. It can be a shock for people when a colleague dies – especially if it’s soon after a diagnosis.
Emotional effects of cancer
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Being diagnosed with cancer and then going through 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 a very anxious time. Many employees may wish to keep their situation confidential at this point. If they tell you what’s happening, you can respond appropriately to their need for time off to attend medical appointments. We have more 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 they have cancer and they may try to carry on as if nothing is wrong.
Other feelings people may have include:
anger or bitterness
fear – of the disease, treatment and dying
loneliness and isolation.
Someone may also feel relief to have a diagnosis and to be able to find out more about what can be done.
If your employee learns that they or a loved one has cancer, they may need some time off to be with their family and come to terms with it 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 cancer. It 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.
How you can help
Sometimes cancer makes it difficult for people to control their emotions and distress can happen suddenly. 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, or if they want a team colleague to travel with them.
Your own emotions
You and your colleagues may also have strong feelings about a colleague being affected by cancer. Don’t be afraid to ask for support in dealing with your emotions. 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 0808 808 00 00. We are here to help anyone who is affected by cancer, including you.
Employees may also be able to access counselling through work, perhaps through an employee assistance programme (EAP).
If your employee is a carer
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Becoming a carer is often unexpected and can be one of life’s most emotional and physically demanding roles. It can sometimes be very hard to juggle caring and employment at the same time. But working carers have legal rights, which aim to help them stay in work. These include the right to request flexible working or to have time off during an emergency.
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 both physically and emotionally, which 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 also make existing health problems worse, such as high blood pressure or back problems.
As soon as you’re aware of someone’s caring responsibilities, talk with them about your organisation’s policies, their rights as a carer and their options for leave. 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. Side effects and symptoms can also persist after treatment is over, 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 have a negative effect on an employee’s longer-term job prospects. It will help if you can reassure them about this.
Our Work it out for carers tool can help carers find the information they need to manage their caring responsibilities and work. We have information about working while caring for someone with cancer on our website. Our booklet Hello, and how are you? A guide for carers, by carers may also be helpful. Visit be.macmillan.org.uk to order our resources.
We have a series of videos on work and cancer. Our short film Supporting carers features real-life experiences from carers and expert advice on how you can support an employee in a similar situation.