Cancer & Work
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8. Develop a formal return to work plan

Step 8 of 11 in getting ready to return to work:

Healthcare providers can play an integral role in the creation of a formal return to work plan by:

  • defining the survivor’s restrictions and limitations once they return
  • recommending any workplace accommodations the survivor needs

These should be given to your patient in writing, so that they can give the document to their supervisor and any other staff at their workplace who can help them return to work. With this document in hand, employer representatives may consider a hierarchy of options for employees who are planning to return to work. Then they determine whether the option easiest to implement is feasible before going on to the next one.

Employers are likely to consider the following, in this order:

  1. Can someone return to their former job without assistance?
  2. Can the job be modified temporarily?
  3. Can the job be modified permanently?
  4. Can some of the tasks be re-assigned?
  5. Can the person move into another job at the same workplace?
  6. Can the person be retrained for a different job at the workplace?

NOTE: Different employers have very different approaches and capacities to fulfill any or all of these options. Option 6, retraining for a different job, is often the last resort and is rarely offered.

Key questions to guide a return to work plan

The employer will likely ask for opinions from a physician and possibly a rehabilitation professional to inform the formal return to work plan. Employers often count on the treating physician’s opinion about restrictions and limitations to guide which types of accommodation they will need to provide the cancer survivor. Physicians can help employers draw up a return to work plan by addressing the following questions:

Time frame:

  • What is the recommended start date for returning to work?
  • Should the employee return gradually?
  • What is the projected end date of the return to work plan?
  • Which days of the week will the employee work?
  • How many hours a day will the employee work?
  • What is the proposed schedule for resuming job tasks?

Restrictions and accommodations:

  • Are there any medical restrictions and limitations that the worker and employer need to adhere to?
  • Are the restrictions temporary or permanent?
  • If temporary, how long are the restrictions expected to last?
  • Are any work accommodations needed?
  • If so, what are the doctor’s recommendations for accommodations?
  • Why is each accommodation necessary?

Monitoring progress:

  • When, and how frequently, will the physician monitor the employee’s progress during the return to work process?
  • What types of supports and resources may be needed in the future to enable the employee to stay at work?

Creating a graduated return to work plan

Graduated return to work has been found to be the most common and best way to ease back into a job. A gradual return allows survivors to slowly increase their stamina, starting with a few days a week or a few hours a day and working up to full time. Sometimes it is impossible to predict the challenges that may come after returning to work. Graduated return to work allows survivors to assess their capacity to complete tasks and identify challenges that need to be addressed.

To hear about a cancer survivor’s experience with returning to work, watch Jen’s story:

There is no “one-size-fits-all” plan for a gradual return to work, because the stages depend on:

  • each survivor’s physical, psychological and cognitive abilities
  • their specific job demands
  • support and resources in their workplace

Some employers have minimum requirements for a graduated return to work, such as expecting the employee to be back to full hours within one month. However, not all survivors can meet this expectation. So it is helpful for your patient to reflect on and tell you, the healthcare provider, what their employer’s expectations are. The treating physician will need this information when making recommendations for a graduated return to work.

It is important to be aware of regulations stipulated by federal and provincial regulatory bodies that you may need to address in determining your patient’s ability to gradually return to work. One example is the fitness to work policies of bodies such as Transport Canada and provincial/territorial departments of motor vehicles. They have regulations about physical and mental conditions that are required for occupations such as driving commercial trucks, operating commercial marine vessels, and flying aircraft. To meet these regulations, employers may expect physicians to report any concerns about fitness to work. For more information on this topic, we suggest that you contact your provincial/territorial college of physicians.

Three guiding principles for developing the plan

Author of this section: Dr. Mary Stergiou-Kita, PhD, Assistant Professor, University of Toronto

How can the patient’s healthcare team, employer and insurance company work together to develop an effective return to work plan?

There are 3 guiding principles for developing formal return to work plans:

Guiding principle #1: Return to work plans should be individual

A return to work plan should vary from one person to another since the needs of every returning employee and every employer are different. Each return to work plan should be based on the employee’s specific abilities and restrictions. There is no cookie-cutter approach as we are all individuals with different needs and therefore plans are based on the individual.

Guiding principle #2: Return to work plans should have feedback by all involved

Return to work plans should have feedback from all parties, consider all their needs, and ensure that each party understands their responsibilities in the return to work process.

Guiding principle #3: Return to work plans need to be flexible

While the plan must give the return to work process some structure, it must also be flexible enough to respond to ongoing changes in the employee’s needs.

Key elements to include in a formal return to work plan

Experts have identified 8 key elements that should be included in a return to work plan:

  • Anticipated start and end date
  • Number of days per week and hours per day that the employee will be expected to work
  • Essential tasks and duties that the employee will be expected to complete
  • Anticipated schedule for increasing work hours and resuming work tasks
  • Medical restrictions or limitations (if any) that must be adhered to, and how long these restrictions or limitations should continue
  • Work accommodations that will need to be put in place, and why the employee needs them
  • How progress will be monitored, recorded and shared. Who will perform these tasks?
  • How the return to work and accommodation plans will be changed as needed and who will be responsible for implementing these changes

Next step:

Step 9: Encourage patients to prepare for going back to work

Back to the list of return to work preparation steps