Getting your head around cancer – mental health and returning to work post-cancer


Employers needed to be focused on much more than just the physical and workplace adjustments needed for an employee to return to work following a diagnosis of and treatment for cancer. Returning to work post-cancer can be an emotional and mental rollercoaster too, as Christine Husbands explains.

According to the charity Macmillan Cancer Support, 123,000 people of working age are diagnosed with cancer in the UK every year and an estimated 700,000 employees are caring for someone with cancer.

While the focus following a cancer diagnosis understandably tends to be on the physical symptoms, treatment, surgery and after-effects – the impact of cancer goes way beyond these aspects.

A cancer diagnosis can lead to a wide range of emotional feelings and, in many cases, depression and anxiety, not only for the patient but also for those caring. It is not uncommon for people to feel they have to be “strong” to protect their families and friends, often hiding how they truly feel from those close to them. Some people feel guilty about the impact of their illness on their families such as the worry it may cause and the disruption to everyday family life.

About the author

Christine Husbands is managing director of RedArc Nurses

The range of emotions felt by cancer patients can include denial, feeling overwhelmed, anger, fear, worry, sadness, guilt, isolation and loneliness. Combine these feelings with the physical symptoms of the cancer, the surgery and treatment – such as chemotherapy or radiotherapy – and it’s not difficult to understand how a cancer diagnosis is life changing for the patient and all those close to them.

Cancer patients and work

Contrary to what many employers may think, many cancer patients often want to continue to work in some shape or form when they are feeling well enough. Work gives them a sense of normality – of identity and self-esteem – outside of the cancer journey. And this can be a great help in mitigating some of the possible emotional difficulties they may have.

Inevitably, though, employees will need support from their employer and colleagues to continue in work.

In considering how to offer and deliver this support, it is very helpful for employers and managers to have a basic understanding of cancer, its types, treatment, side-effects and its consequences.

For instance there are more than 200 types of cancer, and the types of treatment provided can vary hugely. This can include surgery, chemotherapy, radiotherapy, hormonal therapies and targeted therapies. All of these can cause a number of physical side-effects, both short and long term, such as fatigue, nausea, vomiting and susceptibility to infection. There can also be changes in the body that the patient needs to adapt to and learn to live with.

Many employees will have specific worries relating to the workplace. These could include confidence in their ability to do their job effectively because of the physical side-effects, low self-esteem and guilt about the extra burden of work placed upon their colleagues.

It can often come as a surprise to individuals, their families and employer that a cancer patient is not overjoyed when treatment is complete and they are given the “all-clear”. In our experience, this is often the time when the full impact of the cancer diagnosis hits home and support is needed most.

Supporting employees with cancer

The effect of cancer on individuals varies; this will depend on the type of cancer, its severity, symptoms and treatment required, as well as how the employee copes emotionally and how well they are supported by family and friends.

As in life, cancer doesn’t exist in a vacuum, so all the other worries – either everyday pressures, or those exacerbated by the cancer – such as financial, relationship or caring responsibilities can also add to the burden.

Clearly, adjustments need to be made by the employer. The most obvious and important one is being flexible in working hours and recognising there may be no predictable pattern. Many people return to work in some capacity after recovering from surgery and have periods of time away from work whilst they undergo chemo or radiotherapy.

It may be difficult for an employer to manage these unpredictable working arrangements but if, it can be achieved, the opportunity to work when feeling well enough can really help some employees.

Other adjustments may include things such as allowing more frequent breaks, rest space, suitable and convenient toilet facilities, provision for the storage of medication and agreeing temporary changes to the role or location.

It is clear there cannot be a “one-size-fits-all” policy for dealing with employees with cancer but rather a high-level approach allowing flexibility.

It is important there is an open, supportive and trusting relationship between the line manager and the employee to enable the employee to explain how they are feeling and what may be helpful to them.

Line managers should be supported and guided by HR and occupational health, and this also gives the employee another port of call if they don’t feel comfortable speaking directly to their line manager.

Employers need to beware of making assumptions on what would be “best” for an employee. The best approach is to speak regularly and ask what would best help the employee (whether they are at work or not). Often it is the simplest things that make all the difference.

Carers at work

Those caring for a family member with cancer often find themselves juggling work and increased family responsibilities, as well as holding down a job. For many, financial circumstances dictate the need to continue working.

However for others, continuing to work can have several positive aspects for a carer, such as a sense of independence and often much needed social contact

It is important the carer looks after their own health and wellbeing; it would be all too easy to become burnt-out with the burden of caring, family and work responsibilities.

According to the charity Carers UK, 600 people leave their job every day because of caring responsibilities, so it is in the interests of employers to ensure that they give good support to this population of employees, to help them stay in work.

External support and services for employees and carers

There are many external resources and guides available that employers can turn to. For example, Macmillan Cancer Support has a range of online guidance and toolkits. Through its Macmillan at Work initiative it also offers training and consultancy, on-site if need be.

The Chartered Institute of Personnel and Development, Cancer Backup and Working With Cancer have a combined guide, Cancer and Working Guidelines for Employers, HR and Line Managers. Bodies such as the TUC and the mediation service ACAS also have useful online resources, available through their respective websites, that may be useful.

Many employers are also proactive about putting services in place to help employees in the event they become ill, for example, private medical insurance, group income protection, critical illness insurance and employee assistance programmes. Many of these services also extend to families, offering support for those with caring responsibilities.

Cancer treatment is, of course, very well catered for by the NHS and may also be covered by private medical insurance. But often the emotional impact is ignored.

Having good internal policies, flexibility and support can go a long way to support staff through what is often inevitably a very tough journey. But the addition of a good quality external support services, working alongside the physical treatment, can make a big difference.

External one-to-one practical advice and emotional support from a medical professional such as a nurse can be invaluable in helping employees through their illness and get them back on the road to physical and mental recovery as quickly as possible.

Support for the long term

A cancer diagnosis is life-changing for patients and carers, therefore support needs to be available all the way through the cancer journey, ideally from diagnosis, through surgery, treatment and beyond – for as long as the employee finds it helpful.

Needs, worries and concerns can change dramatically throughout that period, both relating to the employee themselves as well as concern for family and colleagues, so continuity and consistency is very important.

The best solution is a long-term service provided confidentially – and independently from the employer – enabling employees to discuss worries and concerns in confidence without fear of how the employer might view them.

Employers can’t be expected to understand the intricacies of every single illness and the associated mental health issues. But by offering access to a comprehensive long-term external support service they can really help their employees when they most need it.

This can bring peace of mind for the employee and the employer that the individual can get answers to their questions and information on everything available to them. It supports the employer in their duty of care and demonstrates to the individual and the wider staff community that the employer care about its employees and wants to go the extra mile for them.

In terms of insurance-based products, such as group income protection, critical illness or private medical insurance, it is important to recognise that not all such products are the same or offer the same level of support. It is therefore important for employers to talk to their employee benefit advisers to ensure they can offer the type of support that’s needed.

For example, services can range from a light-touch helpline for a one-off telephone call through to long-term support from a dedicated nurse along with an assessed course of therapy to meet the particular needs of the individual. When looking to support employees with cancer, my view that the more comprehensive and long-term the support, the better.


Macmillan Cancer Support, Introduction for Employers,

‘More than 600 people quit work to look after older and disabled relatives every day’, Carers UK, February 2019,

Training and support for employers, Macmillan Cancer Support,

Cancer and Working Guidelines for Employers, HR and Line Managers,

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