Transitioning from active treatment to survivorship presents a major shift for patients to cope with and process. Physical, emotional, and existential changes need to be understood, processed, and managed appropriately. The oncology team can assist in this transition by providing important resources and information about managing long-term side effects and follow-up care.
A significant part of survivorship for many patients, especially those who are younger, is a return to work. As survivors prepare to reenter the workforce, providing information about the Americans with Disabilities Act (ADA) and guidance on any accommodations they may need are an important way to assist patients. Resources and referrals for physical and emotional support can help them prepare for the transition and communicate effectively with their supervisors, colleagues, and human resources (HR) department.
The Return to Work
Returning to work posttreatment can present many challenges and uncertainties for survivors. Anxiety related to managing long-term side effects such as chemo brain and fatigue can add stress when returning to a previous job or starting a new position. Managing physical, mental, and emotional changes can feel overwhelming, but guidance from the medical team can help to ease this transition. Information about what to expect when returning to work, in addition to medications that help manage side effects, is helpful. Additional fatigue and exhaustion are to be expected during the first few weeks or months of a transition back to working. Behavioral modifications such as eating small meals or snacks throughout the day and taking breaks are actions patients can take to alleviate side effects and fatigue.
Cancer survivors also should be prepared to take time off from work to attend follow-up appointments. Clear guidance on what follow-up will entail and the time commitment necessary can help patients make plans in advance. If needed, referrals for physical and occupational therapy can help survivors to better cope with long-term physical side effects, especially if they are managing the compounding effects of aging as well.
When planning a return to work, many survivors struggle with the question of who to share their diagnosis with and how. Disclosing to a supervisor can be challenging, but typically proves beneficial because the ADA protects patients only if they have made their employer aware of a medical condition. Therefore, HR must be notified so they can inform survivors about company policies and how similar situations were managed in the past.1 Information on ADA protections for survivors reentering the workforce should be included in their survivorship plans. Survivors should be encouraged to identify and ask for reasonable accommodations as soon as they return.
Lastly, survivors may struggle with self-consciousness or negative body image due to physical changes as a result of their treatment, such as physical appearance, hair loss, weight loss or gain, and neuropathy. Wigs, prostheses, cancer-focused make-up tutorials, and medications and physical therapy help survivors to rebuild their confidence as they prepare to reenter the workforce.
Many patients are unprepared for the emotional impact of completing treatment and transitioning to survivorship. Posttreatment emotional support services can help them process their emotions, any trauma they may have experienced, and their fears of recurrence. CancerCare is a resource for patients that offers services ranging from individual counseling to support groups for survivors, as well as their families, and can refer patients to local resources if their needs fall outside the scope of its services. Other cancer-focused organizations offer peer mentorship, online and in-person support groups, and virtual meet-ups for survivors. Patients also can be referred to their hospital social worker or navigator for local resources.
Physical changes, whether temporary or permanent, require survivors to make necessary accommodations in their personal and work lives. Adjusting to a new normal can be difficult, especially at work and in view of colleagues. The use of wigs, prostheses, lymphedema garments, a walker or wheelchair, or any other type of physical aid or equipment can help survivors feel more comfortable physically. However, these aids also lead to feeling self-conscious as well as require accommodations at work. This is one reason disclosure can be important, both so accommodations can be made and so supervisors and colleagues can understand how best to interact with people returning to work after treatment.
Cancer and Careers is an organization that focuses on empowering and educating people with cancer and survivors to help them thrive in their workplaces. They offer workshops, career coaching, and additional resources that focus on legal, financial, and practical tools to help people with cancer remain or return to work.
Guidance from the medical team on communication with people at work, emotional and physical changes, long-term side effects, and adjusting to a new normal can help survivors to better prepare to reenter the workforce. The more information and support is provided, the less anxiety and fear survivors will experience when planning to start a new job or return to their previous work environment.
- Whom to tell. Cancer and Careers web site. Accessed June 16, 2022. https://www.cancerandcareers.org/en/at-work/where-to-start/sharing-the-news/who-to-tell