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.

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 very slow-growing cancers, or cancers 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 therapies may also be used for certain cancers. Often a combination of more than one type of treatment is used.

Surgery may aim to remove all or part of a tumour. The effects of the surgery will depend on the part of the body being operated on and the extent of the surgery.

Some operations for cancer may be carried out as day surgery, which may mean that you only need 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.

In some cases, surgery may affect someone’s ability to use a limb.

Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy treatment that aims to cure the cancer will often mean a personthat you needs to go to the hospital every 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 treatment, but may need to reduce their hours. Other people stop working completely while they’re 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 taken as tablets or capsules, which can be taken at home.

Intravenous chemotherapy may take minutes, hours or a few days. 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.

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:

• fatigue
• risk of infection
• nausea (feeling sick) and vomiting (being sick)
• hair loss
• sore mouth
• diarrhoea or constipation
• numbness or tingling in the hands or feet.

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.

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:

• fatigue
• risk of infection
• nausea (feeling sick) and vomiting (being sick)
• hair loss
• sore mouth
• diarrhoea or constipation
• numbness or tingling in the hands or feet.

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.

Fatigue

Fatigue (extreme tiredness) is a common side effect of cancer treatment and can also be a symptom of some cancers. It can be worse at different stages of treatment, or at different times of the day.

Fatigue can affect people in different ways and 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 other people.

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.

Body changes

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:

• hair loss
• changes in complexion or skin tone
• scarring
• 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.

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. We have more information about 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:

• anger or bitterness
• sadness
• fear – of the disease, treatment and dying
• loneliness and isolation.

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.

How you can help

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.

Your own emotions

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.

Employees may also be able to access counselling through work, perhaps through an employee assistance programme (EAP).