Medical assessments can consist of a physical and basic neurological exam, ordering and reviewing diagnostic tests, and interviewing the cancer survivor. Medical assessments are often required at several stages in the cancer and work process by employers and insurance providers.
The first assessment stage is often in the form of a medical note, completing a form or a formalized assessment. If the survivor needs to stop work or needs accommodation to continue working, this is usually completed by a family doctor or an oncologist.
The second stage is during treatment when employers or insurance companies want to be updated on the progress and recovery from treatment. Family doctors may be able to complete forms but in some cases, if the recovery is longer than what would be expected from the cancer or treatment, a specialist such as an oncologist may need to provide such an opinion. For patients with significant physical, cognitive and psychiatric disabilities, physicians may refer or suggest to insurance providers to fund for a rehabilitation assessment and therapy before being able to conclude on a return to work date.
In some cases, recovery from cancer and treatment takes longer than expected because of side effects such as psychological reactions, arthritis, chronic pain or other chronic conditions. In these cases, an opinion from a specialist in these areas may be needed to continue the patient’s disability insurance claim or guide rehabilitation. In addition, if there is uncertainty about continuing a claim or the start date for return to work, an independent medical opinion may be requested (and funded) by the insurance company. Insurers commonly have their own in-house physicians and guidelines for determining the status of claims.
The third medical assessment stage is determining fitness to return to work. This can include identification of limitations that need accommodation as part of a return to work plan. The physician assessment report can also recommend rehabilitation. Physicians may be asked to provide additional assessments and reports during graduated return to work to guide any changes in hours or accommodations needed for successful job maintenance.
Note: Increasingly, insurance providers are reviewing medical charts or progress notes to determine eligibility or continued eligibility of claims even though these notes are not intended for estimating work ability.
While research indicates that clear guidance from a physician is very important part of helping a patient return to work, assessment in the physician’s office may have limitations. As well, patient self-assessments may not capture the physical, cognitive or psychological impacts of cancer and its treatment or their potential impact on work functioning. Determining a survivor’s work readiness, limitations and the job accommodations they may need may require referral to a specialist for a more detailed assessment. Ideally the specialist will have expertise in translating the assessment results into impacts on the patient’s past or future job. Depending on the patient’s challenges, physicians may want to consider a referral for the following assessments:
Work-focused rehabilitation assessments
- Functional or physical capacity evaluation
- Vocational rehabilitation assessment
- Neuropsychological assessment
- Ergonomic assessment
- Neuro-occupational therapy assessment
- Psychological assessment
- Psychiatric assessment
Note that work-focused assessments and the rehabilitation services that follow them may not be funded by the healthcare system. However, if they are covered by the patient’s private disability plan, the physician can recommend that the insurer fund the assessment or service.
Functional or physical capacity evaluation
Health professionals use functional capacity evaluations (also called physical capacity evaluations) to assess physical work ability in a systematic and objective way. These assessments are often done by occupational therapists, physiotherapists or kinesiologists. Functional capacity can be evaluated in simulated work environments or at the patient’s workplace using specialized equipment such as weights and treadmills.
Functional capacity evaluations help professionals: 1
- develop and modify a rehabilitation program
- measure functional capacity before and after treatment
- evaluate whether employees can do tasks in their jobs, and whether or when they can return to work
- generate ideas on what needs to be in place (adaptive aids and accommodations) at the workplace so that an employee can work safely and productively
Vocational rehabilitation assessment
An assessment by a vocational rehabilitation counsellor can help a cancer survivor decide whether they want to return to their previous job or move to a different type of work. The assessment can also help the patient decide which occupations would suit changed work abilities. Assessment typically includes:
- an interview with the cancer patient
- a review of the patient’s occupational and educational history
- tests assessing abilities, skills and interests
- reviewing work abilities and challenges based on the patients’s opinions and medical reports, neuropsychological evaluations and functional capacity assessments
- gathering labour market information (e.g., occupational profiles, working conditions, job opportunities, wage rates)
- determining transferrable work skills
Neuropsychological assessment can identify any cognitive difficulties that might affect a patient’s ability to do a job. Neuropsychologists use a series of tests to measure how a patient is feeling and how well they do concurrent cognitive and perceptual tasks. These tests are far more detailed than a basic neurological assessment and can better pinpoint subtle cognitive problems. For example, they can help determine whether attention and concentration difficulties impede one’s ability to drive. They can also measure the effect of a brain tumour or cancer treatment on the brain. Using these tests, a neuropsychologist can identify cognitive strengths and weaknesses, recommend accommodations so that an employee with cognitive problems can work safely and productively or guide survivors who are retraining or trying to learn a new job.
Neuropsychological assessment may be available through your local cancer centre, rehabilitation centre or general hospital. In these locations, the cost may be covered by government health insurance. Some employment benefit plans (short- and long-term disability insurance or extended healthcare) will pay for neuropsychological assessments done outside of hospitals, or they can be obtained privately. Government employment programs may provide neuropsychological assessments as well. 2 1
In an ergonomic assessment, an occupational therapist or kinesiologist evaluates how employees interact with their environments, such as workstations, assembly lines, counters or desks. Using the assessment results, the therapist recommends technical and/or adaptive aids and worksite changes that will reduce injury risk and allow the employee to work more safely and productively. Ergonomic assessment can be part of a functional capacity evaluation.
Ergonomic assessment typically involves:
- an interview with the employee
- reviewing the health history (medical reports and employee’s report of their own health)
- a worksite visit to observe the employee using various tools and equipment
- recommendations for workstation accommodations