Common concerns about returning to work

Life after cancer can affect you in many ways. Cancer may prevent you from working or change how you do your work. Talk to your doctor to see if you are ready to return to work.

Below are some common concerns that people have when getting ready to return to work:

1. Worries about being able to perform your job

If you have or have had cancer, it is normal to worry about going back to work. Your concerns or worries may be about:

• Not being ready for work because of the changes in your energy levels, ability to concentrate or focus, and mood.
• Not being able to do your job as well as before cancer.
• Not being able to do your job at the level that your employer (boss) or co-workers expect of you.
• Not knowing what to say to people about your absence (being away).
• Not knowing how to ask for help from the people you work with.
• Not knowing how to share your concerns about returning to work with your employer.

It is okay to have these concerns. Making a plan to help you return to work can help you lower your anxiety and feel more prepared. A return to work plan can help you:

• Know when you are ready to return to work.
• Return to work at a speed that is right for you by slowly adding hours to your work day.
• Take on less of your full workload at the start and add work as you feel you can do it. This can help to boost your confidence.
• Suggest job duties that are lighter in nature and that are more in line with your current physical condition.

If you have benefits through your work, your insurance adjustor (person who checks your insurance claim to decide how much support you get) will work with you to make a return to work plan that fits your needs.

Ask your cancer doctor to refer you (book a visit) to the Princess Margaret’s Cancer Rehabilitation and Survivorship (CRS) Program to help if:

• Your workplace is not helping you make a return to work plan but you would like help making one.
• You want to learn about supports you can use to help you return to work sooner and safer.

Ask your cancer doctor to refer you (book a visit) to the Princess Margaret’s Psychosocial Oncology Program to help if:

• You would like emotional support for dealing with your fears, mood, worries about returning to work or other issues related to cancer.

2. Changes in the way you think

After your cancer treatment, you may have a hard time forming ideas or thinking clearly. This is sometimes called “cancer-related brain fog” or “brain fog”. Brain fog can be caused by cancer treatments, such as chemotherapy or radiation treatment.

Brain fog may make it hard for you to:

• Pay attention
• Concentrate (stay focused)
• Remember things
• Find the right word(s) when speaking
• Think through and solve problems

These changes may affect your confidence in your ability to work. They may also put more stress on you. To learn more about brain fog and how you can help manage it:

• Talk to your cancer doctor. They can give you tips on how to cope with brain fog and help manage it. Ask for a referral to the Cancer Rehabilitation and Survivorship Program for more help with brain fog.
• Read the pamphlet called Cancer-related brain fog . Ask a member of your healthcare team for a copy, or visit the Patient & Family Library to pick one up (1st floor of the Princess Margaret).
• Attend the patient education class on “What you can do about brain fog”. This group class will help you know why brain fog happens and what you can do to help manage it. The class is led by a specialist (someone trained in helping patients with brain fog) who can answer your questions.
  Call 416 581 8620 ahead of time to book a spot.

3. Cancer-related fatigue (tiredness that does not go away with rest or sleep)

You may have cancer-related fatigue after your cancer treatment is done. Cancer-related fatigue is not the same as other types of fatigue. It is not related to the amount of activity you do and can be hard to cope with.

Cancer-related fatigue may make it hard for you to:

• Be at work for long hours.
• Work uneven days or shifts that change often.
• Do work that takes a lot of energy.

To learn more about cancer-related fatigue and how you can help manage it:

• Talk to your doctor. They can give you tips on how to cope with cancer-related fatigue and help manage it. Ask for a referral to the Cancer Rehabilitation and Survivorship Program for more help with cancer-related fatigue.
• Read the pamphlet called Using your energy wisely” . Ask a member of your healthcare team for a copy, or visit the Patient & Family Library to pick one up (1st floor of the Princess Margaret).
• Watch the online patient education class on how to Reclaim Your Energy. This class lets you know why cancer-related fatigue happens, and what you can do to help manage it.
• Watch a short video on cancer-related fatigue and learn how to cope with it.
• Ask your cancer doctor to refer you (book a visit) to Psychosocial Oncology to discuss how cancer-related fatigue is affecting you. Sometimes one of the ways that depression or low mood presents itself is as ongoing fatigue. A Psychiatrist, Psychologist, or Social Worker can help you assess whether your mood is affecting your fatigue levels.

4. Pain that will not go away

You may have issues with pain during and after cancer treatment. Pain may affect how well you sleep and the types of tasks you are able to do. If pain is stopping you from returning to work, you should:

• Speak to your cancer doctor to find out what is causing the pain and if you can get medication to help manage it.
• Ask your doctor if you can get a “medical restriction”. This is a note that you get from your doctor to give to your employer. It allows you to change your job tasks to avoid doing things that may cause you more pain.
  Medical restrictions often include a date for when your doctor will re-assess (check-up on) your pain. Your doctor will decide if you need more time for any medical restrictions after they re-assess you.
• Avoid pushing yourself past the point of pain or doing things that will make it worse.
• Ask your cancer doctor to refer you (book a visit) to Psychosocial Oncology for tips on how to cope and support for living with chronic pain
• Ask your cancer doctor to refer you (book a visit) to a pain specialist through the Palliative Care Clinic. Palliative Care doctors can help you manage pain symptoms (signs of cancer).

What can I do to prepare to return to work?

There are many things you can do to prepare to return to work after cancer treatment:

1. Try to do things that are part of a healthy lifestyle:

• Exercise for at least 30 minutes every day
• Eat healthy foods
• Enjoy fun activities and take time for yourself each day

2. Live as if you are back at work

Many people forget how tiring work can be. Take a few weeks to prepare yourself and build your energy before you return. Return to work-related habits before you start work again:

• Get up at your normal work time
• Dress in work clothes
• Take transit or drive somewhere that is as far as your workplace
• Do tasks that you often do at your job
• Try to stay out of the house for as long as you would on a work day

Think of ways to practice the things you do at work. For example, if your job is to work mainly at a computer, you may want to:

• Prepare for your return by working at a home or library computer.
• Try to make the same type of file, report or presentation you would at work.

Keep track of how long it takes to finish this task and how tired you feel after you are done. This will help you know how ready you are to return.

What are some ways to make my return easier and safer?

A return to work from time off for cancer treatment can be hard for anyone. But there are few tips you can follow to help make your return easier and safer.

You may wish to follow some of the tips below as part of your return to work plan:

• Reduce the number of hours you work when you first go back. Then slowly work more hours over time. A slow return to work is often the best way to avoid any stress or fears of not doing your job well.
• Ask your employer if someone else can take on some of your tasks until you are back to full-time hours. As you gain comfort in doing your tasks, you can do more.
• Work shifts that let you avoid rush hour, or work from home if you are able to. This will allow you to save time and energy travelling to and from work. If you do shift work, you can request to work the same shift to help you maintain a more regular sleep schedule while you are recovering from cancer treatment.
• Take a lot of rest breaks. Try to take one short break (5 to 10 minutes) for each hour worked instead of one longer break. This will allow you to save your energy and build your strength to work your normal hours.
• Find a short-term “job buddy” for your first week back to work. This person can help update and re-train you on any new policies or job duties. Try to find a job buddy that you find easy to work with and ask them if they are okay helping you during your first week back.

What should I say to people at my work when I return?

It is helpful to keep in touch with your employer when you are off work and to give them updates about when you think you will return.

You do not have to share the details of your health and treatment with your employer, but you should talk to them about the supports you may need to return to work safely.

Keep in touch with your co-workers while you are away to help:

• Make you feel like part of your workplace.
• Keep you up-to-date with what is going on at work (like new staff or policies).
• Reduce feelings of stress or feeling overwhelmed when you return.

Ask your employer if you can attend a team meeting or lunch before your first day back so you can catch up with other staff. This allows you to get right to work on your first day back. You will not need to worry about feeling stressed by seeing co-workers for the first time or having to answer their questions.

Before talking to people at your workplace about your health, it is important to think about:

• What details you would like to share. You have the choice to share only the details about your health that you want to.
• Why you want to share these details. Share details about your health only if you feel comfortable to. Try not to feel pressure to share or fill co-workers in on where you have been.
• Who you would like to share the details with. You may want to share details about your health with some co-workers and/or employer(s) and not others.

It can be helpful to do a role play or practice talking with a friend. This will help you prepare for how to answer questions about your absence in a safe setting. You can ask your doctor for a referral to the Cancer Rehabilitation and Survivorship program for help planning what to say to your colleagues and employer.

You can speak to someone who has had cancer about returning to work through Cancer Connects (Canadian Cancer Society).

The Cancer and Careers website has information on how to talk to co-workers after returning to work.

The Cancer Rehabilitation and Survivorship Program at Princess Margaret offers a Return to Work education class monthly. The class helps you learn how to prepare to return to work and different things to consider in this process. It is run by an expert in return to work after cancer.

Call 416 581 8620 to register for the next class.

What if I am unsure about returning to work?

Many people choose not to return to work after their cancer treatment. They may instead choose to take time off or enter into early retirement if they have the option.

Before you decide not to return to work after cancer treatment, think about your values and needs for work and your reasons for not returning.

Think about the good things working may offer and if these things still interest you.

Having a job may:

• Be a chance for you to get back to a “normal life”.
• Help you feel active and useful to those around you.
• Help you keep a sense of identity and purpose in your life.
• Help you gain skills, knowledge and learn to be creative.
• Keep you busy and allow you to focus on things other than cancer.

What if I am considering a career change?

If returning back to your pre-cancer job is not realistic or something you want to explore, you may be looking into another career altogether.

As you consider this possibility, think about these points:

• What are my skill sets that I’ve gathered through paid work, unpaid work and through life experiences?
• What are my strengths?
• What are my challenges or limitations?
• What opportunities are available that would match my skill set?
• Do I need further training and how would I get this training?

Your rights as a worker

It is important to know your legal rights in your workplace. This includes all of the things you and your employer can and cannot do by law.

For people living with cancer, the limits cancer places on their body and energy is often thought of as having a disability.

There are laws in place to help workers with a short-term or long-term disability. There are 2 main areas of law you need to keep in mind:

1. The Ontario Human Rights Code

The Ontario Human Rights Code is a legal document that forbids discrimination (wrong doing against a person or people) in the workplace because of cancer.

The Ontario Human Rights Code says that employers must provide “reasonable accommodations” to help people with limitations because of cancer to be able to continue to work. “Reasonable accommodation” is a legal term used to describe changes to the type of work you do or how you work.

The types of accommodations you can ask for depends on the type of work you do. For example, accommodations can include:

• Picking shifts that allow you to attend your medical appointments.
• Doing some work from home if you do not feel able or well enough to travel.
• Giving your tasks that are hard on the body to other co-workers until you feel ready to do them.
• Doing a different job at your workplace. This may mean doing a job that is less hard on your body until you build the strength to return to your old job.

By law, employers must provide an accommodation to the point of “undue hardship”. Undue hardship is when the accommodation:

• Costs too much money for the employer, or
• Is too hard for the employer to provide.

Learn more about reasonable accommodations and undue hardship on the Ontario Human Rights Commission website.

2. The Employment Standards Act

The Employment Standards Acts lists all the rules for when any worker can:

• Be terminated (fired, or let go).
• Get severance (pay an employee gets when they leave a job).
• Take vacation time.
• Other work issues.

Read the full Employment Standards Act on the Ontario Ministry of Labour website.

Know the rules at your workplace

Most workplaces have a human resources (HR) or occupational (workplace) health department. These places are meant to help staff learn and follow their workplace rules (like knowing when to take sick time).

Visit HR or occupational health and ask any questions you may have. This will help you know what your workplace expects from you when you return.

Sometimes, workplace rules are kept in a “personnel code” or a place where all employees can view them. If you are part of a union, your collective agreement (shared rules between a workplace and its staff) will also include rules and details on your work.

Call your insurance company to check your benefits coverage

If you have been getting an income from a disability plan through your private insurance, the amount of money you get may change once you start working. Call your income provider to know more about this.

Your income provider may be:

• Your private insurance
• Canadian Pension Plan (CPP) office through Service Ontario

You must let CPP know if you return to work. Your income provider will review your case and let you know what your options are. Ask them what will happen to your benefits if you go back to work on reduced hours, and if there is a date that you must return to work by.

Some insurance providers can help you prepare to go back to work. Ask your provider if your plan covers any of the support below:

Occupational Therapy

Occupational Therapists (OTs) can help you improve your ability to do tasks in your daily living and work life. They can help you build your strength and stamina (energy) to return to work, and give you advice based on your work needs and duties.

Physiotherapy

Physiotherapists (PTs) can help you regain your range of motion (full use or movement of joints), strength and balance if these things limit you from returning to work.

Emotional & Social Support

A psychologist can help you deal with feelings of anxiety (worry or unease) about going back to work. A neuropsychologist can help test your memory and give you tips for improving your focus and confidence.

A social worker can help you cope with the stress of cancer and support you with finances (money) and daily living.

Where to get more information and support

Returning to work after treatment for cancer can be hard. Below are some resources that can support your return to work.

Resources at the Princess Margaret

• The Cancer Rehabilitation and Survivorship (CRS) program can help you make a return to work plan. Talk to program staff about important issues like knowing what supports to ask for in the workplace and knowing what information to share with your employer and colleagues.
  Ask your cancer doctor to refer you to (book a visit at) the CRS Program.
• The Psychosocial Oncology Program can provide you with emotional support and tips on how to cope with cancer.
  You can also access a social worker to help you learn about financial programs you may be able to use if you are not planning on returning to work.
  Read the resource called “Coping with cancer: Know how to get financial help for more details on how to get help with finances (money). Pick up a copy at the Patient & Family Library (1st floor of the Princess Margaret).
  Ask your cancer doctor to refer you to the Psychosocial Oncology Program.

Resources in the community

• Wellspring Cancer Community Centre is a group of community-based centers that offer classes and programs to support patients and families living with cancer:
  • Wellspring has online educational videos about Understanding Long Term Disability Benefits.
  • Wellspring’s Money Matters Resource Centre can give you details on income support programs, community resources and help to cope with financial stress.
  • Wellspring’s Returning to Work Program is an 8-week group program that supports you to return to work safely and manage your health at work.
  • Wellspring also offers a Back to Work Program. Each session includes a guest presentation on a specific topic related to cancer and work, plus time for questions with the speaker and talking with peers.
• Gilda’s Club Toronto is a cancer support centre that offers you help to return to routine daily living during and after treatment for cancer.

Online resources

• Cancer and Work is a Canadian website that shares many resources on returning to work after cancer. They have a section of the website for patients, employers and insurance providers.
• The BC Cancer Agency’s information guide on Cancer and Returning to Work helps you to make and use a return to work plan after treatment for cancer.
• Cancer and Careers is a U.S. based website that gives you details on how to cope with the financial, emotional and legal stress of returning to work after cancer treatment.