Step 1 of 11 in getting ready to return to work:
The first step is to consider factors that can impact your chances for a successful return to work. Understanding facilitators and barriers — what can ease or hinder your return — can help determine what needs to be done. By considering the four kinds of factors (biopsychological, person-centred, system and worksite factors described in the Vocational Rehabilitation Model for Cancer Survivors [see image below]. You can see how these factors might impact your ability to work and help you identify and express your needs to health care providers, insurance providers and employers and find ways to take on these challenges in order to stay or return to work.
(Parkinson & Maheu, 2019)
Bio-psychological factors include all the biological (medical) psychological (emotional), and cognitive (thinking) factors that came before (pre-existing disabilities) and continue after the cancer diagnosis. You will want to see how your these factors affect your recovery and whether any specific disabilities related to the cancer and its treatment are temporary, long-lasting, or permanent.
This information can guide your discussion with your healthcare provider to get the help you need or their guidance about your expected recovery. As well, knowing your physical, psychological, and cognitive challenges early on can help you identify and seek the support you might need at work to help you stay or go back. For job accommodation ideas (something that can be changed to meet a need or situation), see: Workplace accommodations.
Bio-psychological questions to ask yourself
- How do cancer and the treatment affect my work abilities? (To help you assess your abilities, see Step 2: assess your function).
- Can I do the physical tasks required of my work ?
- Can I do the cognitive tasks (thinking) of my job ? For more information see Cognitive Symptoms at Work Checklist
- Are changes in my mood or anxiety affecting my abilities (such as my energy, ability to focus, ability to handle certain work hours )?
- How long are the challenges with my abilities expected to last?
- Do I have other conditions that I am coping with that affect my ability to do certain work tasks?
Here are examples of self-assessment of your bio-psychological factor and its possible impact on work.
Example 1 (biological): A cancer survivor now finds neuropathy (numbness) is causing a lack of feeling in his fingers which makes it difficult for him to hold dental tools to do his work as a dental assistant.
Example 2 (biological): A cancer survivor is coping with fatigue and weight loss including a reduction in her muscle mass. She is concerned that she does not have physician strength to work in construction.
Example 3: (cognitive): A cancer survivor notices that her ability to focus has declined, and is having a hard time handling interruptions when she tries to complete a task.
Example 4: (psychological): A cancer survivor has low mood, and feels anxious. She is afraid of working in customer service where she has to deal with complaints.
Example 5 (psychological and cognitive): A cancer survivor has difficulty multitasking at work because of difficulties concentrating related to depression.
Person-related factors can be the cancer survivors’ perceptions of work including how you view the meaning of work, the importance of work, expectations around recovery and motivation to work. Person-related also includes how you view the impact of cancer and treatments on their ability to work and whether they perceive work positively or negatively.
Also consider how your race, gender, education, and income can influence your access to work.
Person-related factor questions to ask yourself
- What are your feelings about how well you can cope with your return to work?
- What are your feelings about your work? Do you like or dislike your job?
- What does work mean to you?
- How motivated are you to work?
- Do you see working as positive, negative, and healthy or unhealthy?
- How do you see your recovery will impact your ability to work?
- How does your age, race, education, and income (social demographics) influence your chances of getting, staying at, and returning to work?
Here are examples of self-assessment of your person-related factor and its potential impact on work.
Example 1: A cancer survivor feels that stress caused his cancer and feels the main source of stress comes from his work. He is afraid to return to work for fear this will make his risk of cancer recurrence go up.
Example 2: A survivor wants to keep working through treatment because she feels working allows her to stay connected with her colleagues and reduces her risk of feeling lonely.
Example 3: An older worker is concerned that her employer will be less keen to have her back because the temporary replacement worker at her job is younger and is paid less.
Under systems factors, you will want to look at what are the influences of different systems on your access to support, and your ability to return to or stay at work. Systems will include healthcare services, insurance providers, community agencies, legal supports, government support and social and family networks. Navigating these systems can be both a positive and a negative experience that can assist, delay or stop your ability to return to work. For example, influences from healthcare services can include timely access to treatments, scheduling of your treatment that is adapted to your work schedule, cancer symptom management that is work focused, rehabilitation, and views of the healthcare providers. The support by an insurance provider such as income support (how much and for how long) and funding for rehabilitation support can also influence your return to work. Even family influences such as competing demands, like caregiving and family support can affect your return to work. System influences can also include legal support to help keep your job. For more information on legislative support, see Law, policy, and practice information.
Systems factor questions to ask yourself
- What medical treatments or rehabilitation are available to me to help improve my ability to work?
- How does my family feel about me returning to work?
- What family support is available to me to help with my return to work?
- What can the insurance provider offer me with respect to psychological, physical, and cognitive work-focused rehabilitation?
- What supports are available to me such as human rights or union representation to help me return to my job?
Here are examples of self-assessment of your systems factor and its potential impact on work.
Example 1: A breast cancer survivor wants to delay returning to work until she has reconstructive surgery which is scheduled in four months.
Example 2: A cancer survivor has access to funding for an exercise program through a long-term disability provider to help restore physical workability sooner.
Example 3: A cancer survivor is worried that if she takes too much time off for treatment, she will not have the legal protection to keep her job.
For work-site focused factors, you will want to consider the job demands (physical, psychological, and cognitive), work hours (part time/full time, evening/days), availability of accommodations, workplace relationships (with employers and colleagues), and return to work supports such as rehabilitation and disability management that you can access. All of these conditions will influence your return to work and how well it will go.
Worksite factor questions to ask yourself
- Can I manage to work my former hours of work?
- Can I fulfill the physical, cognitive and psychological demands of my job?
For information on the assessment of function and job demands, see Assessment of Your Work Abilities.
- Is my employer able to accommodate my restrictions or limitations of my abilities? Click here to see a definition of accommodation .
- Do I feel my manager and colleagues will support me when I return to work?
- Do I have a good relationship with my manager and colleagues?
Here are examples of self-assessment of your worksite factor and its potential impact on work.
Example 1: The job is physically demanding and the cancer survivor has lost conditioning and suffers from fatigue. The employer has offered lighter duties.
Example 2: The cancer survivor is currently unable to do full-time work and the employer has allowed for a graduated return to work (modified job hours).
Example 3: The cancer survivor is worried that she will not be supported during her return to work because some coworkers do not like her.
By first exploring the biopsychological, person-centred, systems, and the worksite factors, you are now better equipped to understand your strengths and challenges,better able to communicate your concerns with those involved and more ready to follow through on your next steps to guide your return to work.
Reference: Parkinson, M., & Maheu, C. (2019). Cancer and work. Canadian Oncology Nursing Journal = Revue Canadienne De Nursing Oncologique, 29(4), 258-266. http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1019