There are few things as scary, yet as common as a cancer diagnosis. Statistics show that one in two people in the UK will get cancer at some point in their lifetime and according to Macmillan, over 700,000 people of working age are currently living with a cancer diagnosis. Yet the taboo surrounding it is still very real. For me, as someone who was recently diagnosed, one of the worst aspects of the whole situation was telling people and seeing their faces. A mixture of sadness, terror and sheer helplessness. Then people calm down and start to ask questions about your prognosis, your treatment and how you’re generally doing. It is the answers to these questions that define cancer for each unique individual. Not just because there are hundreds of types of cancers, all with different prognoses and treatments, but because each person reacts differently, both physically and psychologically to their situation. If someone has a broken leg it’s often fairly straightforward to understand their restrictions and healing period, but despite its prevalence, the same cannot be said of cancer.
Putting that into the context of a workplace and it’s clearly complicated. There isn’t a one size fits all approach that can work. So how does an employer both look after someone with cancer whilst ensuring business continuity? This is where flexibility and communication come in. The employer will need to be flexible, whilst the employee needs to be confident in articulating their situation, their needs and their changing circumstances as they go through treatment and progress reports. Both will need to work together to strike the right balance.
It’s important to accept that the only certainty with cancer is uncertainty, as the course of treatment will change based on the response. The patient’s reaction to the treatment is also not clear cut, as each session can result in different side effects, which whilst physically disruptive, also contribute to psychological stress and uncertainty. Most people with cancer, however good the prognosis, are dealing with bigger picture issues over their survival, so the additional uncertainty of day to day wellbeing, cannot be underestimated.
In chemotherapy, for example, the first few treatment cycles may require minimal time out, as the body is still relatively strong, but as time goes by and the cumulative effects kick in, the number of rest days may need to increase as the person gets weaker and in some circumstances it could be a simple question of a ‘phased departure’ from work to sick leave, ideally followed by a phased return as the employee gets better and stronger.
At the same time there will always be other circumstances to consider for the employee. Will work provide an opportunity for the patient to keep their mind occupied, or will it be an additional source of stress which is best avoided? What are the financial issues and sick pay considerations? Is there work that the patient will physically be capable of doing, or indeed work that can be done flexibly with interruptions? In a larger organisation, would a temporary move to a different role be helpful, if the patient’s usual role cannot be done flexibly?
Some workplaces are extremely conscious about consistency, but I would argue that individual circumstances have to take precedent. This requires a high degree of openness on the part of the patient to reduce any potential misunderstanding. This in turn require the employer to demonstrate that they can be trusted to use this information and handle the situation sensitively, clearly explaining the rationale for any decisions they make around attendance, reasonable adjustments etc.
To use an example, imagine an organisation which offers six months full sick pay. Two employees are diagnosed at the same time with similar cancers. They have good prognoses but both require six months of chemotherapy.
- The first is a busy young parent who has most of the childcare responsibility in the family, as their spouse is the main breadwinner and cannot take regular unpaid time off. The cancer diagnosis essentially means that they have to take more time for themselves, but cannot neglect their young children. Their doctor has issued a fit note saying that they are not capable of work until further notice.
- The second person lives alone and has minimal family responsibilities. For them, giving up work would present a major gap in their life as they would likely spend them sitting at home with little to do, potentially getting into a negative psychological state which will impact their physical wellbeing and make it much more difficult for them to return to work when they are better. Their doctor has issued a sick note saying that they are capable of working with reasonable adjustments.
Whilst potentially inconsistent in simple terms, these scenarios seem logical and reasonable in the context of the bigger picture. Of course it may well be the case that reasonable adjustments are not possible, but in the context of the modern flexible workplace which reflects technological advances and lifestyle expectations, approaches and management of common illnesses like cancer should also be a consideration.
In short, employers should consider the following:
- What are the individual circumstances of the illness and how can they encourage employees to feel comfortable providing detailed and open information?
- What is the employee’s support network and lifestyle like – is taking a long period of time off likely to be good for their mental health?
- What does the employee want to do? What does their doctor’s note say?
- What can they realistically offer in terms of adjustments – advice should be sought from an occupational health practitioner wherever possible.
- What are the timescales of treatment and how regularly are progress reports expected?
- Not comparing employees and being aware of the uniqueness of each situation.