Return to Work Programs and Cancer Survivors

More people are surviving cancer, but cancer is occurring in more people (one factor associated with longer life spans). From lost time to high health coverage costs, employers should take note of what this might mean for them.

The most recent data compiled by the National Cancer Institute, which was released in April 2018, show that from 2006 to 2015 cancer death rates decreased by 1.8% among men and 1.4% among women. Cancer affects a significant portion of Americans. According to the American Cancer Society, in 2015, there were an estimated 15,112,098 people in the United States living with cancer. Many of these people are of working age. While our research did not discover statistics about working-age people in the United States with cancer, the Macmillan Cancer Support in the United Kingdom reports that people aged 18 to 60 living with cancer in that nation increased by an estimated 10% between 2010 and 2015.

What does this mean for employers? Cancer, as well as cancer treatment, are debilitating conditions that can adversely affect mental, cognitive, and physical functions. Yet, Return to Work (RTW) for cancer patients, whether they have survived cancer or are being treated for it, can be a valuable step for the employer if the employee can still accomplish the objectives of the job. Furthermore, RTW may be a positive rehabilitative measure for cancer survivors. However, RTW for cancer survivors will likely be a losing proposition for both the employee and the employer if certain measures are not taken to accommodate the returnee. Many large U.S. companies have programs and procedures to assist in RTW for cancer survivors as well as for survivors of other illness. Large companies often have the resources to adjust to a survivor’s gradual return to full productivity or to provide other less taxing responsibilities.

Smaller companies may not have the resources to make similar adjustments, although, in some cases, they may have no choice. In the United States, all but the smallest microbusinesses are subject to the 1990 Americans with Disabilities Act (ADA), which prohibits private employers with 15 or more employees, as well as state and local governments, employment agencies, and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other privileges of employment. A narrower form of this prohibition was enacted in the Rehabilitation Act of 1973, which bars discrimination based on disability in programs conducted by federal agencies, in programs receiving federal financial assistance, in federal employment, and in the employment practices of federal contractors.

EU OSHA discusses RTW

Given their legal obligations to cancer survivors as well as the benefits experienced and qualified individuals can provide, employers should consider developing approaches and procedures that will promote a smooth reintroduction of employees into the work environment. The European Agency for Safety and Health at Work (EU OSHA) has issued several documents intended to assist employers seeking to help return employees to productivity. One report, Rehabilitation and Return to Work after Cancer—Instruments and Practices “provides an insight into the issues surrounding rehabilitation and RTW after a cancer diagnosis and the problems encountered by workers affected by cancer and their employers. Further, the report presents recommendations for instruments, practices, policies, and interventions to successfully support the RTW of workers affected by cancer.”

EU OSHA does not downplay the effects of cancer on performance.

“The impact of cancer on a person’s daily life is immediate and striking,” states EU OSHA. “The diagnosis usually results in long periods of sickness absence because of medical treatments and functional restrictions. Although, in general, cancer management has improved over the past three decades and the overall number of people who survive cancer is increasing, many cancer survivors still face long-term symptoms and impairments after their treatment ends, such as fatigue.”

Furthermore, employers should bear in mind that cancer survivors who cannot return to their existing places of employment will encounter more difficulty finding new employment. EU OSHA notes that the risk of unemployment among cancer survivors is 1.4 times higher than among people who have never been diagnosed with cancer.

At the same time, EU OSHA points out that RTW for cancer survivors is economically important.

“Not returning to work during or after treatment leads to a financial loss for the worker, the employer, and society,” says EU OSHA. “Adapting the work environment may enable RTW. This may come with costs for the company and the worker but, in the long run, these may be less than the costs of long-term sick leave.”

The Stigma of Cancer

Still, there is little argument that reintroducing a worker can be very difficult. EU OSHA says that one barrier is that a company may have only a single type of taxing physical work. Other barriers include lack of clarity as to who is responsible for supporting workers in their RTW, the stigma of a cancer diagnosis—sometimes applied by coworkers and colleagues—and cultural misconceptions about the ability to work after a cancer diagnosis.

In general, EU OSHA recommends that companies willing to implement RTW programs make implementation a structural part of policies throughout the company. In addition, it is critical to train supervisors, HR personnel, and case managers about the short- and long-term side effects of cancer, how these effects may impact performance, and the importance of open lines of communication between supervisors and RTW employees. One important consideration in how the RTW process is managed is the extent to which the employee wishes to keep his or her condition private. The capacity of an employer to assist in reintroduction will depend to some extent on who within the organization knows about the employee’s health status.

Four RTW Phases

“With the rising number of cancer survivors, effective interventions are needed to enable RTW and to reduce the costs to individuals, companies, and society at large,” says EU OSHA, which offers the following advice to employers regarding RTW of employees diagnosed with cancer.

Phase 1: Disclosure of employee’s condition

• Show empathy and understanding of the situation.
• Discuss with the employee his or her wishes regarding disclosure, e.g., to colleagues and between employer and other employees.
• Discuss the legal rights and duties of both the employer and employee regarding sick leave.
• Discuss whether the worker could possibly stay active at work and to which extent, in terms of workload, tasks, and assistance.
• If the employee cannot stay active, discuss the timing of filling the position/assuming responsibilities with a substitute.

Phase 2: Treatment period

• Stay in contact with the employee and assess his or her needs, expectations, possibilities for returning, and other interests.
• Discuss the possibility of the employee keeping in touch with his or her department and colleagues regarding topics of interest to both parties.
• Discuss the possibility of assisting the employee with physical activity programs designed for cancer patients during treatment.
• Provide information on cancer and work and RTW issues to the employee’s colleagues and supervisors.

Phase 3: Returning to work

• Involve an occupational health physician or specialist in exploring suitable RTW options.
• Inform the employee of the company’s own RTW program. Tailor this program to the employee’s needs and preferences.
• A program with a combination of physical training, psychological support, and work adjustments can be of added value to improve RTW.
• Develop an RTW plan together with the supervisor, employee, and occupational health physician or specialist.
• Discuss with the employee his or her wishes regarding interventions, rehabilitation programs, job-coaching, and external RTW agencies.

Phase 4: Actual return

• The actual RTW of the employee should be performed in phases in close consultation with the employee.
• In case of a serious reduction in work ability, alternative or external reintegration options should be carefully considered with other parties, including the occupational health physician or specialist, social workers, and HR management.
• Monitor and adjust the RTW plan if needed.

EU OSHA also offers a scaled-down set of recommendations for small businesses.

• Provide information to the employee on possible external RTW programs.
• Provide support and education to the employee’s colleagues and supervisors.
• Make work requirements more flexible.
• Align with other companies that have more flexible jobs.

Americans with Disabilities Act

As noted, the ADA may be a major factor in how an employer evaluates a cancer survivor’s employment status and whether work upon return will be identical to what it had been, revised or reduced, or functionally different. Here are ADA provisions an employer must consider:

• The employer may not discriminate against qualified individuals (definition below) with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment.
• A qualified individual is a person who meets legitimate skill, experience, education, or other requirements of an employment position that he or she holds or seeks, and who can perform the essential functions (definition below) of the position with or without reasonable accommodation (definition below). Requiring the ability to perform essential functions ensures that an individual with a disability will not be considered unqualified simply because of inability to perform marginal or incidental job functions.
• Reasonable accommodation may include, but is not limited to, making existing facilities used by employees readily accessible to and usable by persons with disabilities; job restructuring; modifying work schedules; reassignment to a vacant position; acquiring or modifying equipment or devices; adjusting or modifying examinations, training materials, or policies; and providing qualified readers or interpreters.
• Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation. Factors to consider in determining if a function is essential include whether the reason the position exists is to perform that function; the number of other employees available to perform the function or among whom the performance of the function can be distributed; and the degree of expertise or skill required to perform the function.
• Accommodation is not reasonable if it imposes undue hardship on the operation of the employer’s business. Undue hardship is defined as an action requiring significant difficulty or expense when considered in light of factors such as an employer’s size, financial resources, and the nature and structure of its operation.
• An employer is not required to lower quality or production standards to make an accommodation; nor is an employer obligated to provide personal use items such as glasses or hearing aids.