A special thanks to the Patient and Family Counselling Department at the Vancouver Cancer Centre at the BC Cancer Agency for their ideas on this topic.
After a cancer diagnosis, it is common to think differently about work. Many patients re-evaluate the kind of work they are involved in and the amount of time spent at work. Research has identified this as a “change of priorities,” and it has been found to both motivate and deter some cancer patients in returning or staying at work.1 2
A change of priorities can encompass many emotions and processes for cancer survivors. For some, this is due to the fact that during cancer treatment most of their energy is used to move through treatment and cope with side effects. Research shows that it is common for the emotional impact of cancer to surface after treatment.3 Emotional processing of a cancer experience often happens at the same time someone is considering returning to work. Internal struggles and shifts in priorities often make it difficult to make decisions about work. This may result in some hesitation to move forward with returning to work and may be interpreted by others as loss of interest in working.
Below are changes in priorities that may impact decisions about work.
Time is more important
Time has more meaning for many cancer survivors. A critical illness often makes one aware of their mortality. It is common for people to become more focused on how they spend their time which includes how much they work and what kind of work they do. Some may feel they would like to spend more time with their family and want to cut back on work. Others may want to focus more on engaging in meaningful work.
Desire to live more mindfully
Some may feel that up until diagnosis they were working without thinking about how they spent their time, or “living on automatic pilot.” It is common for cancer survivors to desire to live more mindfully. This may also include being more aware of living in the moment at home and work. This is an area that takes practice and compassion. See mindfulness at work from our Survivors section.
Desire to live a healthier lifestyle
It is common for cancer survivors to want to live a healthier lifestyle. This often comes from the hope of preventing recurrence or advancement of cancer. It can include wanting to focus on healthy living like exercising, eating better and working towards better mental health and wellness. Prioritizing physical and mental health is a common shift for cancer survivors. Survivors often express fears of stress causing cancer and are concerned about stress at work. While the research in this area is mixed, there is a case for encouraging patients to learn good mental health strategies in order to live a more contented, better quality life. Moreover, it is important to remind patients that stress will never disappear entirely from their lives because it is a part of living. However, it is possible for them shift their relationship with stress, with greater awareness and by adopting a healthier balance of day-to-day obligations. Read more about workplace wellbeing in our Survivors section.
Desire for a balanced lifestyle
Some survivors may want to simply live a more balanced life. A balanced lifestyle, as often represented by a balance wheel, involves ensuring that one is working towards each aspect of life; for example, career, finances, health, family and friends, romance, personal growth, fun and recreation, and physical environment. The balance wheel implies that work is only one part of life and, by fulfilling other aspects of life, one is more in balance. Some may interpret a balanced lifestyle as equally fulfilling all these activities which may result in unrealistic expectations. This can be particularly hard for patients who are already fatigued from cancer and treatment and are having difficulty doing basic life activities, such as cooking and meal preparation. Encouraging patients to view the balance wheel as something to work towards may help them be more realistic. They can also view the balance wheel as a reminder of which aspects of life they may be neglecting. Then they can re-assess these aspects and set goals for each one. Healthcare providers can encourage patients to prioritize at least 3 spokes of the wheel to maintain it. A good place to begin would be to consider which 3 spokes are most important for supporting their life. For cancer patients, one of the most important spokes is developing social/family support. Having a support system has been shown to help people through many stressors including cancer, and it helps improve health outcomes.4 For some who have worked many hours, work may come at the expense of maintaining or developing a support system for themselves.
Reflection on meaning and purpose
It is common for people to question meaning and purpose in life after a cancer diagnosis. Life meaning can come in many forms; for example, quality of relationships, work, spirituality and connection to the environment. Questioning meaning and purpose can include questioning what patients gain from their work. Some may want to do work that they feel can make a difference, while others find they would rather focus on finding more meaning in other areas of their life. This is a personal process that takes time to assess and move through.
Reflection on work values
Some may find that the work values that motivated them before cancer diagnosis are not as important immediately afterward or over the long term. Some who prized economic gain, promotion or prestige may now feel differently and not value these aspects of work as much anymore. Alternatively, many cancer survivors want more control over their way of life by having more flexibility and freedom in their work or time at work. This can often conflict with work values such as economic gain or advancement, which typically demand investing more time at work. In many ways, this conflict resembles a competition between the old and new self. For many, it is much like a pendulum swinging in one direction, especially in the early stages of the cancer experience and post-treatment. However, after time, the pendulum begins to balance itself somewhere between the new and old self. Again, this is a process that requires time to find one’s new, stable self.
A grief reaction: losses and changes
Grief is a multi-faceted response to loss and change. Cancer can cause many losses and changes in one’s life. A change in priorities can be a way to heal or move through the grief of a cancer experience.
There is no “right” way to grieve. However, it may be difficult or in some cases unrealistic to expect your patient to work through grief before returning to work. This is especially the case if they are under pressure to return or are starting to feel financial strain. Some may feel uncertain about how to move forward and be concerned that if they make an early decision about retiring, returning to work or changing work they may regret it. Patients need to give themselves as much time as possible before making any dramatic work-related changes. First, they need to work through their grief and consider in what direction they are headed. However, job security and financial pressures may force them to quickly make the best decision they can at the time. If this happens, it is important to remind your patient that this is what they need to do to move forward. They may also want to consider finding ways to shift priorities or lifestyle outside of work in the areas mentioned above.