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/letter, completing a form or a formalized assessment. If the survivor needs to stop work or needs accommodations 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, if the recovery from cancer and treatment is longer than expected as a result of side effects such as psychological reactions, arthritis, chronic pain or other chronic conditions, a specialist from these areas may be needed to continue the claim or provide guidance on rehabilitation. As well, if there is some uncertainty about continuing a claim or the start date for return to work, an independent medical physician may be funded by an insurance company to offer an opinion.
The next stage for a medical note or assessment is to determine fitness to return to work which can include a return to work plan with the identification of limitations that need accommodation. The physician assessment can make recommendations for rehabilitation. Additional medical assessments or notes will be provided during the graduated return to work process to guide any changes in hours and whether accommodations are needed for a successful return to work or stay at work.
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 workability.
Functional/physical capacity evaluations1
Health professionals use functional capacity evaluations (sometimes 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 your workplace, using specialized equipment such as weights and treadmills.
Functional capacity evaluations help professionals:
- 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
A neuropsychological assessment can identify any thinking (cognitive) difficulties that might affect your ability to do your job. Neuropsychologists use a series of tests to measure how you are feeling and how well you do cognitive and perceptual tasks at the same time. 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 your ability to drive. They can also measure the effect of a brain tumour or cancer treatment on the brain and whether someone can work. Using these tests, a neuropsychologist can recommend accommodations so that an employee with cognitive problems can work safely and productively.
Neuropsychological assessment may be available through your cancer centre, local rehabilitation centre or general hospital. In these places, the cost may be covered by government health insurance. Some employment insurance policies (short-and long-term disability or extended healthcare plans) will pay for neuropsychological assessments done outside of hospitals, or you can pay for them yourself.
Vocational rehabilitation assessment
A vocational rehabilitation assessment can help you decide if you want to return to your previous job after a cancer diagnosis or move to a different type of work. A vocational rehabilitation counsellor can then help you figure out which jobs would suit your changed work abilities.
A vocational rehabilitation assessment typically includes:
- an interview with you
- a review of your occupational and educational history
- determine your transferable skills
- tests assessing abilities, skills and interests
- a review of your work abilities and challenges, based on your opinions and medical reports, neuropsychological evaluations and functional capacity assessments
- gathering labour market information (that is, job profiles, working conditions, job opportunities, wage rates)
- recommendations for training programs
An ergonomic assessment evaluates how you interact with your work environment, such as a workstation. Using the assessment, the occupational therapist or kinesiologist recommends technical and/or adaptive aids and changes to your worksite that will allow you to work more safely. Ergonomic assessment can be part of a functional capacity evaluation.
Ergonomic assessment typically involves:
- an interview with your occupational therapist
- a review of your health history (medical reports and your report of your health)
- worksite visits to watch you use various tools and equipment
- recommendations for workstation accommodations