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Job accommodations for cancer-specific issues

Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Cancer and its treatment affects everyone differently. For example, immediate and long-term effects and the degree to which people may or may not experience symptoms depend on the type of cancer and the type of treatment received and the individual. Read cancer’s impact on work to learn about some common symptoms and treatment effects as well as how they may impact the ability to work.

Following are accommodation ideas specific to common cancer symptoms and treatment side effects. Click directly on each of the symptoms to view accommodations ideas.


Fatigue

Job accommodation ideas

There are many ways that jobs can be modified to accommodate cancer-related fatigue:

  • Plan a graduated return to work.
  • Identify non-essential job tasks and explore delegating them to other employees.
  • Reduce workplace stress.
  • Modify work schedules.
  • Modify the work environment.
  • Reduce physical exertion.
  • Do tasks that are less physically demanding.
  • Break demanding tasks into smaller steps.
  • Rest between the steps.
  • Make multiple trips with lighter loads.
  • Use electric tools to replace manual efforts.
  • Change positions frequently to minimize physical demands.
  • Switch tasks before becoming fatigued.
  • Use wheeled devices to move items (e.g., cart, wheelbarrow).
  • Work in a seated position. If not possible, keep a rest-chair nearby.
  • Consider offering a stand-lean chair.
  • Reduce typing by using speech-recognition software.

Reduce workplace stress:

  • Identify which tasks or work environments are most stressful.
  • Work with the employee to develop alternatives.
  • Consider providing instruction on relaxation and stress management techniques.
  • Refer the employee to employee wellness resources, if available.

Modify work schedules:

  • Use flexible work hours to accommodate low-energy times of day.
  • Change shifts to fit the employee’s highest daily energy level and prevent fatigue.
  • Reduce long commute times by avoiding rush hour.
  • Allow work from home if possible.
  • Grant time off for medical appointments.
  • Explore job sharing or part-time hours, if full-time hours are too demanding.

Modify the work environment:

  • Grant a parking spot close to the building entrance.
  • Relocate the workstation closer to the washroom, break room or other frequently used space.
  • Set up a resting room, bring in a couch, or store a cot for the employee to nap or rest during breaks or lunch.
  • Offer a headset if the employee frequently uses the telephone.
  • Offer noise-cancelling headphones or earplugs to reduce distracting sounds.
  • Move the workstation to face a wall instead of a busy hallway to decrease visual distractions.
  • Optimize the workstation lighting. Eliminate very dim lights or bright, flickering lights and glaring surfaces.
  • Ensure comfortable temperatures by installing a space heater, fan, portable air conditioner or humidifier/dehumidifier.
  • Provide an anti-fatigue mat where the employee frequently stands.

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Sleep disturbances

Modify work schedules:

Modify work environments:

  • Set up a resting room, bring in a couch, or store a cot for the employee to nap or rest during breaks or lunch.
  • Workplace changes and strategies to handle fatigue will also help with sleep disturbances.

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Pain

There are several ways that jobs can be modified to accommodate pain:

Modify work schedules:

  • Use flexible hours to accommodate pain levels.
  • Schedule extra rest breaks.
  • Change shifts to match the employee’s daily pain levels or capabilities.

Modify tasks and work location:

  • Identify tasks, workspaces, and positions that cause the most discomfort.
  • Work with the employee to develop alternatives. For example, consider providing a standing up option desk, or a special chair.
  • Allow work from home when possible.

Reduce physical exertion:

  • Assign the employee tasks that are less physically demanding.
  • Use electric tools to replace manual effort.
  • Reduce repetitive tasks. Vary them with other duties.
  • Consider a mobility aid such as a two-wheeled walker. It can take much weight off the lower extremities and fits most work spaces.
  • Change positions frequently.

Modify work environments:

  • Provide access to a refrigerator and/or microwave for storing pain-relieving hot and cold packs.
  • Maintain comfortable temperatures by using a space heater, fan, portable air conditioner, humidifier or dehumidifier.
  • Provide an anti-fatigue mat where the employee frequently stands.
  • Offer a headset if the employee is frequently on the telephone.
  • Offer the use of a wrist support if the employee has upper body pain.

Pain can be exhausting. Workplace changes and strategies to handle fatigue will also help with pain.

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Nerve damage

There are several ways that jobs can be modified to accommodate nerve damage:

Modify work tasks to accommodate neuropathy in hands and fingertips:

  • Reduce risk of injury by assigning alternatives to tasks that involve sharp objects, tools or extreme temperatures (for example, boiling water or freezers).
  • Offer safe electric tools in place of manual tools when possible (for example, an electric drill with screwdriver bits instead of a manual screwdriver, or a food processor instead of a knife).

Adapt equipment to accommodate neuropathy in hands and fingertips:

  • Adapt commonly used equipment by covering handles with fabric or padding to increase comfort.
  • “Build up” tool handles with foam pipe insulation to increase the handles’ diameter. Built-up handles require less grip strength.
  • Offer a headset if the employee is frequently using a telephone.
  • Reduce typing by using speech recognition software.
  • Offer alternatives to computer mice and switches accessed by body parts other than very sensitive fingertips.

Modify work tasks to accommodate neuropathy in toes and feet:

  • Work sitting down when possible. Use a stand-lean chair or, if not possible, keep a rest chair nearby.
  • Offer an anti-fatigue mat if the employee frequently stands.
  • Consider a mobility aid (cane, hiking stick, walker) if the employee has difficulties with balance.
  • Offer Diab-A-Sheet or other insoles may help manage discomfort in the feet while standing or walking.

Modify the work environment to accommodate neuropathy in toes and feet:

  • Maintain comfortable temperatures by using a space heater, fan, portable air conditioner, humidifier or dehumidifier.
  • Offer parking close to the building entrance.
  • Relocate the employee’s workstation closer to the washroom, break room or other frequently used space.

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Lymphedema

Occupational or physical therapists can suggest mobility aid options. There are several ways that jobs can be modified to accommodate lymphedema:

Modify work tasks:

  • Avoid tasks that could cause trauma to the skin (e.g., tasks involving sharp objects or tools or extreme temperatures such as boiling water or freezers).
  • Reduce tasks that involve heavy lifting.
  • If the employee works standing up, allow them to sit down when possible. Use a stand-lean chair or keep a rest chair nearby.
  • Allow the employee to work at a speed that is comfortable for them.
  • Allow 2 minutes to stretch every hour to encourage lymphatic flow.
  • Switch heavy and light tasks throughout the day.
  • Complete heavy or most important tasks when the employee has the most energy.

Modify equipment:

  • Provide a compression garment to help manage swelling and protect the skin.
  • Provide protective gloves for tasks that could risk breaking the skin.
  • For jobs that involve computer use and typing, offer speech recognition software, alternatives to mice and/or switches accessed by other body parts.
  • “Build up” handles of tools with foam pipe insulation to increase the handle’s diameter.

Accommodate heavy, swollen limbs:

  • Reduce repetitive physical exertion.
  • Assign tasks which are less physically demanding.
  • Use electric tools to replace manual effort.
  • Vary repetitive tasks with other duties.
  • Ensure that frequently used materials are within reach.
  • Move heavy objects to waist height, so they can be slid across a counter instead of picked up.
  • If the affected limb(s) does not fit into the employee’s work uniform, offer alternative clothing.

Modify the work environment:

  • Ensure that a first aid kit is easily accessible from the employee’s workstation. It should contain antiseptic to decrease risk of infection if skin is broken.
  • Offer positional supports to elevate swollen heavy arms (e.g., pillows, Aussie bags, adjusting the height of armrests on chairs).
  • Offer a footrest to elevate swollen feet/ankles.
  • Avoid extreme heat or cold.
  • Optimize air quality.

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Hot flashes

There are several ways that jobs can be modified to accommodate hot flashes as a result of cancer and cancer treatments:

Modify work tasks:

  • If the job requires a uniform, offer alternative clothing options that allow the employee to remove a layer when needed.

Modify the work environment:

  • Ensure a comfortable temperature using fans, portable air conditioners or dehumidifiers.
  • Provide access to a refrigerator to store wearable cold packs that can be rotated throughout the day, and cold water to drink.

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Breathing difficulties

Modify work tasks and schedules:

  • If the job requires a uniform, provide alternative clothing options that do not restrict the chest or abdomen.
  • Provide flexible breaks where the employee can go outside for fresh air when needed.
  • Allow communication by instant messaging or a chat program instead of telephone.
  • Allow work from home in extreme weather (very humid, very cold).

Reduce physical exertion:

  • Assign tasks that are less physically demanding.
  • Use electric tools to replace manual effort.
  • Vary repetitive tasks with other duties.
  • Arrange an assessment by a physical therapist or occupational therapist, who can recommend appropriate mobility aids to minimize energy expenditure.
  • If the employee works standing up, allow them to sit down when possible. Use a stand-lean chair or keep a rest chair nearby.

Modify the work environment:

  • Relocate the workstation to an area with sufficient air purification.
  • Use a portable humidifier or dehumidifier to produce comfortable air humidity.
  • Institute a fragrance- and smoke-free policy in the workplace.

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Nausea and vomiting

Modify work tasks and schedules:

  • Allow work from home when possible.
  • If the job requires a uniform, offer alternative clothing options that do not restrict the chest or abdomen.

Modify the work environment:

  • Relocate the workstation closer to the washroom.
  • Offer access to a private washroom if possible.
  • Offer a private place to store a facecloth or wipes, mouthwash and a toothbrush.
  • Ensure comfortable temperatures using fans, portable air conditioners, humidifiers or dehumidifiers.

Control sensory input:

  • Relocate the workstation away from strong odours.
  • Use noise-cancelling headphones or earplugs to limit bothersome sounds.
  • Relocate the workstation to face a wall instead of a busy hallway to decrease visual input.
  • Ensure lighting near the workstation is comfortable.
  • Institute a fragrance- and smoke-free policy in the workplace.

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Challenges to eating and nutrition

Modify work tasks and schedules:

  • Allow flexible and/or extended breaks to accommodate the employee’s eating and nutrition needs.
  • Allow the employee to drink nutritional supplements at their workstation throughout the day.

Modify the work environment:

  • Offer a quiet, private area to eat if the employee is uncomfortable doing so in front of coworkers.
  • Offer storage space for any extra materials or supplies that are required to meet the employee’s nutrition needs.

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Infections

Modify work tasks and schedules:

  • Allow work from home as much as possible.
  • Meet by telephone or video-conferencing instead of in person.
  • When possible, designate work materials and tools for the employee’s use only (e.g., phones, computers, heavy equipment).
  • Offer personal hand sanitizer, disposable sanitizing wipes and disposable gloves for when handling shared equipment is necessary.

Modify the work environment:

  • Relocate the work station away from others to minimize exposure to germs.
  • Provide hand sanitizer and antibacterial soap in all bathrooms and kitchens.
  • Provide hand hygiene education to all staff.
  • Educate staff about compromised immune systems of employees with cancer.
  • Install air-purification systems and proper ventilation to reduce air-borne illness.
  • Provide access to a private washroom.
  • Offer a mini-fridge to keep the employee’s food and medication separate from their colleagues’.

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Bleeding problems

Modify work tasks:

  • Reassign to others work tasks that involve a higher risk of physical injury.
  • Provide safety equipment suited for the job.

Modify the work environment to reduce risk of falls:

  • Remove clutter, loose cords and wires from workspace.
  • Ensure adequate lighting in all workspaces.
  • Keep floors free from spilled liquid.
  • Eliminate uneven flooring surfaces.

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Changes in skin and nails

An occupational therapist can recommend hand exercises to increase strength and coordination if this is an issue as well as a desensitization program.

Modify work tasks and equipment:

Photosensitivity (sensitivity to light)

  • If the employee is photosensitive, assign alternative duties that can be done indoors.
  • If the job requires a uniform, offer clothing options that protect the employee from the sun when working outdoors (e.g., wide-brimmed hat, long sleeved shirts, pants).

Painful fingers and hands

  • Provide protective gloves that are suited to the work tasks. Thin cotton gloves can be worn indoors for comfort. If nails are damaged, waterproof gloves should be used in tasks that frequently expose the hands to liquid.
  • Use electric tools in place of manual tools when possible.
  • Cover the handles of commonly used equipment with fabric or padding to increase comfort.
  • “Build up” handles of tools with foam pipe insulation to increase the handles’ diameter.
  • Supply a headset if the employee is frequently on the telephone.
  • For jobs that involve computers and typing, offer speech recognition software, alternatives to mice and/or switches accessed by other body parts to accommodate very sensitive fingertips.

Painful toenails and feet:

  • Fund an assessment by a foot specialist for custom-made, off-loading insoles to reduce pressure on the feet.1
  • If the employee works standing up, allow them to sit down when possible. Use a stand-lean chair or keep a rest chair nearby.
  • If the employee frequently stands, install an anti-fatigue mat or anti-fatigue surfaces for their shoes.
  • Offer a mobility aid such as a walker to reduce weight load on the feet.
  • Arrange an assessment by a physical therapist or occupational therapist, who can recommend appropriate mobility aids to minimize energy expenditure.

Hand-foot syndrome:

  • Reassign tasks that expose the hands to extreme heat, such as dish washing.
  • Limit tasks that involve repetitive friction on hands or feet.
  • Use electric tools to replace manual effort.
  • Vary repetitive tasks with other duties.
  • Cover the handles of commonly used equipment with fabric or padding to decrease friction.

Modify the work environment:

Painful toenails and feet

  • Grant parking close to the building entrance.
  • Relocate the workstation closer to the washroom, break room, or other frequently used space.

Hand-foot syndrome:

  • Grant parking close to the building entrance.
  • Relocate the workstation closer to the washroom, break room, or other frequently used space

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Changes in bowel and bladder function

Modify work tasks:

  • Identify tasks that would be problematic to interrupt for an emergency bathroom visit.
  • Explore whether these tasks can be modified to allow for unplanned interruptions.

Modify the work environment:

  • Relocate the workstation closer to the washroom.
  • Grant access to a private washroom that has a sink and toilet together.
  • Offer a private place to store wet-wipes, ostomy supplies and a change of clothing.

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Visual impairment

For accommodation ideas for vision impairments visit Accommodation Ideas for Vision Impairments at AskJAN.org.


Hearing impairment

See Accommodation Ideas for Hearing Loss at AskJan.org

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Impaired communication abilities

  • Communicate through instant-messaging or a chat program instead by telephone or in person.
  • Provide alternate technology or ways to present information such as webinars, text-to-talk technology, videos, or written information.
  • Arrange a consultation with a speech therapist to explore alternate communication devices for use in the workplace.
  • See also Accommodation Ideas for Hearing Loss at AskJAN.org.

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Mobility impairment

Modify work tasks and schedules:

Modify the work environment:

  • Grant parking close to the building entrance.
  • Relocate the workstation closer to the washroom, break room, or other frequently used space.

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Changes in appearance

Modify the work environment:

  • Institute sensitivity training for co-workers and supervisors.
  • Create a diversity policy for the workplace to spread the message that the employer values all kinds of diversity.
  • Hire other people who have visible differences to build a critical mass of diversity.
  • Ensure that the workplace has an anti-harassment policy. Publicize the policy among managers and staff. Publicize how to make complaints under the policy as well.

If the employee serves the public:

  • Having an employee with a visible difference serving the public sends the message that the employer values diversity. Hopefully this will lead the public to accept the person as they would any other employee. As long as the employee him/herself feels comfortable and supported.
  • Put up signs in places where the public is served saying that rudeness or harassment towards staff will not be tolerated.

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Seizures

Modify work tasks:

  • Identify situations at high risk for injury (e.g., working at heights or with heavy equipment).
  • Assign alternative tasks that reduce injury risk to the employee and others in case of a seizure.
  • Reduce injury risk with safety equipment when possible (e.g., harnesses).
  • If the employee works alone or in an isolated area, consider an auto-alert lifeline which will contact emergency services in case of a fall.
  • Identify any seizure triggers and eliminate or reduce them (e.g., high level of stress, over-fatigue, flickering lights).

Modify work schedules:

  • Avoid fluctuating shifts.
  • Change shifts to prevent over-fatigue (e.g., day shifts only).

Modify the work environment:

  • For supervisors, ask the employee (or the workplace occupational health advisor) what steps to take if the employee has a seizure.
  • If the employee is comfortable disclosing the possibility of seizures with co-workers, tell them what to do if the employee has a seizure. It is not unusual for people who have seizures to have changes in their memory. See “Cognitive Challenges” (directly below this section) for tips on dealing with these concerns.

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Cognitive challenges

Modify work tasks:

  • Ask the employee to identify tasks that are most challenging for them.
  • Consider whether these tasks can be simplified, shared with a co-worker, or whether the employee can be given more time to complete them.
  • Give instructions in writing rather than verbally.
  • Assign a period each day when the employee is not to be interrupted, which the employee can use to accomplish their most challenging tasks.

Modify the work environment:

  • Create a quiet work environment when possible or provide noise-cancelling headphones or earplugs.
  • Declutter the workspace.
  • Move the employee’s work station to face a wall instead of a busy hallway to decrease visual distractions.
  • Optimize the lighting in the workplace (neither too dark nor too bright).

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Changes in mood and emotions

Modify work tasks:

  • Ask the employee to identify non-essential job tasks and situations that may cause strong emotional or stress reactions.
  • Discuss whether these tasks can be re-assigned or shared with co-workers.
  • Ask the employee to identify supports that decrease their stress.
  • Discuss ways of providing these supports (e.g., giving written instead of verbal instructions, extending deadlines, granting more frequent breaks, allowing work from home).

Modify the work environment:

  • Provide a quiet, private location where the employee can retreat if feeling overwhelmed.
  • Create a quiet work environment when possible.
  • Allow the employee to wear headphones to listen to soothing music.
  • Declutter the workspace.
  • Move the employee’s work station to face a wall instead of a busy hallway to decrease visual distractions.
  • Optimize the lighting in the workplace (neither too dark nor too bright).

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