Realistic Responses to Workers with Cancer

Returning to the workplace after a diagnosis and treatment of cancer raises many issues for employee and employer alike. Two experts in the field explain why the challenges may not be as daunting as they first seem.

Cancer survival rates have crept upward for more than a decade and continue to do so. Outcomes are best among people who have access to health care and whose disease is diagnosed at an early stage. Having a job that offers health care benefits increases the chances that one will meet both criteria, but the employer role goes far beyond funding the benefits that detect and treat cancer. For most adults so much of life is tied up in work, and employers can provide a necessary psychological, social and financial anchor during treatment by making it possible for people to continue working.

Over the course of 60 years, CancerCare has offered free professional support services to more than two million people with cancer, as well as to their family, friends, employers and health professionals. The largest nonprofit organization of its kind, CancerCare provides counseling, education, financial assistance and practical help to people of all ages, with all types of cancer and at any stage of the disease.

Each year, CancerCare Connect offers more than 70 national telephone education workshops that explore workplace issues, cancer treatment, fatigue, pain management and specific cancer types. A recent series of three one-hour sessions titled "Strength for Caring, Living, Coping and Working with Cancer" attracted thousands of callers from the U.S., Canada and around the world. This article is condensed from a workplace-oriented session that featured Pat Spicer, Breast Cancer Program Coordinator at CancerCare, and Carol Wilkinson, MD, Regional Medical Director, Global Occupational Health Services, IBM Corp., Armonk, N.Y.

What do cancer patients want?

Pat Spicer: Eight million Americans are living with a cancer diagnosis, and at least 80 percent of them will return to the workplace. No matter how small the company, it's likely that at some point, one out of every four employees will be diagnosed with cancer.

An entire family is affected by one member's diagnosis of cancer. There is a parallel impact on the workplace, but the response of managers and co-workers is often colored by persistent myths. One of the most common is that a cancer diagnosis is a death sentence, despite statistics that show this is definitely not the case. Another is that cancer survivors never regain their former productivity and are poor risks for promotion. That, too, is false. Improved treatment options and reduced side effects have made it possible for many patients to continue working productively. These medical advances challenge employers to abandon stereotypes and deal with people who have cancer on a case-by-case basis.

For a moment, look at the situation from the point of view of the person who has cancer. How often have you been asked, "What do you do for a living?" in the first minutes of conversation with a new acquaintance? Our society ties a good deal of our personal identity to our work. For cancer patients, getting back the piece of their identity that's built on work provides a very important sense of purpose. Working also addresses the even more basic need to maintain financial stability — including employer-funded health care benefits for themselves and their families — at a time when resources can be severely stressed.

Carol Wilkinson: It is true that many employees with cancer really do not want to stop working. Work is not only an important part of their identity but also therapeutic from a social and psychological perspective. It restores their sense of normalcy in an environment where they have been marked as having a disease. So it is a very powerful, important and valuable thing. Helping people stay at work is one role of the health service department at IBM.

Another important role is encouraging employees to concentrate on their illness. The benefit of a company like IBM is that their jobs are secure, and they need to hear that. They need to know that this is time to take care of themselves and to use the benefits that IBM provides. That means we need to be thoroughly familiar with all the provisions of our health plan.

We have a couple of benefits that really stand the employee with cancer in good stead. One is a very generous sickness and absence policy that allows up to a year of full-time medical leave at 100 percent salary over a two-year period. In addition, the company has evolved to a workplace that offers many options of flexible time and work from home, for a number of good business reasons. Finally, as a byproduct of being a big company, we have a medical organization of physicians and nurses who can help both the employee and the manager deal with a serious disease such as cancer.

We can help an employee get a referral for a second opinion — we're affiliated with Memorial Sloan-Kettering Cancer Center — check the credentials of doctors they're considering or simply act as a knowledgeable sounding board as they consider their options. We're there to solve problems. We had an employee who was in the hospital with lymphoma. He had no family except for his mother in Puerto Rico, and this was open enrollment time. We worked with his manager and with Benefits to make sure that he got enrolled and that the plan he selected made sense for his disease. Clearly, that's an exceptional thing, but taking care of the individual is part of the IBM culture.

Honesty and trust

PS: Take time to sit down and talk openly with that employee about a plan for returning to work and what their workload is going to morph into. In order to do this, you really need to be able to talk honestly with an employee about physical limitations and what treatment will entail.

Allow the employee to decide what information they wish to have co-workers told. I mentioned the parallel between the family and the workplace. Very often co-workers are unsure about how much the person can do and fear the added pressure of taking over somebody else's job. You have to talk openly with the patient about what they want their co-worker to know, and also reassure those co-workers about changes that may be needed to make work possible for their colleague.

There are certainly issues for a person undergoing cancer treatment that may affect job performance. As an employer, you need certain information, including the basic outline of their treatment program, possible side effects, physical limitations and probable duration. Much of this might come in a letter from your employee's doctor. It's also a good idea to confirm or update the employee's emergency contact information.

There's an absolute need to respect confidentiality. There is nothing worse for a patient coming back to work to discover that personal information they thought was being kept quiet has leaked all though the company. Supervisors certainly need to know what the individual's work limits are and to be able to reassure co-workers that they won't be overburdened, but nothing need be said that is not absolutely necessary for that person's ability to do his role.

CW: I can't emphasize enough that people vary in how much they want to share with their manager and coworkers — and that's their right. If the employee has requested that the diagnosis be confidential, we tell the manager the employee has an illness and provide operational information only. We'll estimate the length of absence and tell the manager what to expect in terms of ability to work on return, but no diagnosis. That's an important distinction, because some managers feel they need to know the diagnosis to be able to determine whether this is realistic. Our role is to say, "We've assessed this from a medical viewpoint, and we're comfortable with it. This is what you can expect, so you can plan accordingly." As medical professionals, we become valued intermediaries. We've had experience with the disease, so managers really look upon us as a resource.

Of course, cancer is a variable disease, and there will always be some unpredictability. One of our other roles is working with the situation as it changes and evolves.

Practical accommodations

PS: There are relatively few accommodations that employees are most likely to ask for. Flex-time and/or telecommuting are especially important for somebody who's going through treatment. They need to adjust their schedules to keep medical appointments, and they may feel debilitated for a day or two after each treatment session.

You also need to keep clear and current records about all time off, and your employee/patient will have to help you do this. This is not because you want to turn into Big Brother, but rather to resolve any questions down the line. You never want to have to go back and ask, "Was that vacation time, or personal, or FMLA or a sick day? Or were you working at home?" Explain policy and get agreement at the outset.

CW: Flexible hours and working from home are the cornerstone of so much of the accommodation that employees with cancer benefit from. We will work with the employee, the manager and the physician to provide the right recommendations.

One accommodation that we often use is called "working to tolerance." We might have a breast cancer patient who's on chemotherapy three times a week. She will stay home on a day when she just feels too sick to come in. Some days she'll come in and work for a while and then stop down in our medical department and rest for a little bit.

Many employees are unrealistic about how rapidly they can come back to work. They may not understand that they really have deconditioning in addition to fatigue from treatment. We have to help them and their manager be realistic. Half-days Monday through Friday can work for some people, but for others, their round-trip commute turns a half day into a full day. For them, the better solution could be a Tuesday/Thursday schedule that gives them a long weekend plus a day in between to recover. Eventually, they advance to a Monday/Wednesday/Friday schedule and finally back to a five-day week.

There's a common tendency for people to overwork. Certain people just cannot leave the workplace once they come in. They plan to work half a day, but they're still there at 4 or 5 in the afternoon. One suggestion I'll make is to come in later in the morning, 11 or 12. You may work until 6, but at least you have shortened the day. Occasionally we will encourage the manager to simply tell the employee: "Look, you've just got to go home."

PS: Certainly someone who has had extensive surgery — say for lung cancer — and does heavy physical lifting may not be able to perform that job when they first come back to work, but adjustments can be made so that they can do part of their work until they are completely healed. This may mean rethinking individual job responsibilities, perhaps developing something like a buddy system. If a person has been out for a prolonged period, will they need some time to brush up on their skills before they return to work? Computer programs and procedures change rapidly these days. Somebody coming back may work at a slower pace and may need a little time to get back up to speed. That's why a buddy system where someone can shadow them until they've resharpened their skills, is an important thing that an employer can provide.

CW: We work with the managers in terms of suggesting job modifications or shifting responsibilities. An employee who had daily deadlines might function quite well for the time being with projects that are due over the course of several weeks or months.

Making sure the employee has the right support is another thing. Emphasize teamwork. Maybe a junior member can get more responsibility and the employee with cancer can provide insight and supervision.

Sine qua non

PS: Perhaps the most important thing for cancer patients returning to work is a sense that they are welcome when they do come back to work. Atmosphere may seem intangible, but it's very real and makes a lot of difference. Be sensitive to their needs and try to offer as much support as you can throughout treatment and recovery.

CW: Culture is so important. IBM was built upon the respect for the individual. When something like cancer comes up, the culture supports and encourages the manager to function in a compassionate way. Managers want to do the right thing, but they often need help on how to do it.

More Business & Health Articles About This Topic:

What Employers Should Know About Breast Cancer Special Report

Living, Coping and Working with Cancer Special Report

Resource Links:

CancerCarehttp://www.cancercare.org

Realistic Responses to Workers with Cancer.

Business and Health

Aug. 15, 2003;21.