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Job accommodations for cancer-specific issues

Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Cancer and its treatment affects everyone differently. For example, immediate and long-term effects and the degree to which people may or may not experience symptoms depend on the type of cancer and the type of treatment received and the individual. Read cancer’s impact on work and strategies to learn about some common symptoms and treatment effects as well as how they may impact your ability to work.

The following are job accommodation ideas for common cancer treatment effects. Note that not all these suggestions will suit every employee, job and workplace. Employers are not obliged to put into place the suggested workplace accommodations.


Fatigue

Modify your work tasks and how you work:

  • Consider a graduated return to work.
  • Reduce physical exertion. Break demanding tasks into smaller steps to complete. Take a rest break between the steps.
    • Consider the energy required to carry heavy items versus making multiple trips with lighter loads.
    • Do tasks that are less physically demanding.
    • Use electric tools to replace manual efforts.
    • Change tasks before you become fatigued.
    • Consider a mobility aid on wheels (i.e. carts, wheelbarrow, etc.) to move items. Consult with a local physical therapist or occupational therapist for your best option.
  • Speech-to-type dictation programs may be helpful.
  • Reduce workplace stress—identify which tasks/workspaces are most stressful and work with your employer to develop alternatives. You may want to consider using relaxation and stress management techniques. Talk to your employer to find out what training or employee wellness resources are available.
  • Identify non-essential job duties; speak with your manager to explore delegating these tasks to another employee.
  • Change positions frequently to minimize physical demands on your body.

Modify your work schedule:

  • Ask for flexible work hours to accommodate energy levels.
  • Identify and request shift preference (for example, day shifts only).
  • Reduce the burden of excessively long commute times by avoiding rush hour.
  • Work from home if possible.
  • Request time off for medical appointments.
  • Explore job sharing if full-time work is too demanding.

Modify your work environment:

  • Request parking close to work entrance.
  • Relocate your workstation closer to the washroom, break room or other frequently used space.
  • Speak with your manager about storing a cot to use during rest periods; take a 20-minute nap or rest during your lunch break.
  • Unable to nap? Practice deep relaxation instead with or without an audio guide.
  • Do something energizing on your breaks, such as meditating, stretching or going for a walk to change your environment.
  • Fuel your body:
    • Sip from a water bottle throughout the day to stay hydrated.
    • Keep healthy snacks nearby to help you recharge throughout the day.
  • Clean up: a tidy, orderly workspace requires less effort to locate materials.
  • Work in a sitting position that takes less energy than a standing position, keeping in mind to change your position from time to time. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Wear supportive footwear. Consider clothing options within your dress code that are comfortable and do not restrict your movement or breathing.
  • Decrease sensory overload:
    • Use noise-cancelling headphones or earplugs to reduce noisy distractions.
    • Work facing a wall instead of a busy hallway to decrease visual distractions.
    • Optimize the lighting in your environment:
      • Very dim light can cause eye strain and increase fatigue.
      • Bright, flickering lights or glaring surfaces can cause strain and discomfort.
    • Optimize temperature: consider using space heaters, fans, portable air conditioners or humidifiers/de-humidifiers for comfort.

Request a professional ergonomic evaluation of your workstation. If this is not possible, here are a few tips:


Sleep disturbances

Modify your work tasks and how you work:

  • Adapt your work schedule:
    • Ask for flexible work hours to accommodate energy levels.
    • Identify and request shift preference around your energy levels (for example, day shifts only, regular shifts).

Modify your work environment:

  • Request to store a cot at work to use during rest periods. Take a 20-minute nap or rest during your lunch break. If a cot is not possible, find a comfortable place (chair, your car, etc.) at work to use during rest periods.

See fatigue accommodations for more information.


Pain

Modify your work tasks and how you work:

  • Work from home when possible.
  • Adapt your work schedule and tasks:
    • Ask for flexible work hours to accommodate pain levels.
    • Request more rest breaks.
    • Identify and request shift preference to match your optimal functioning (for example, day shifts only).
    • Identify the tasks/workspaces/positions that cause you the most discomfort and work with your employer to develop alternatives.
  • Reduce physical exertion:
    • Perform tasks that are less physically demanding.
    • Use electric tools to replace manual effort.
    • Reduce repetitive tasks; vary these tasks with other duties.
    • Consider mobility aids such as a two-wheeled walker, which can take a significant amount of weight off the weight-bearing structures of the lower extremities and will fit in most spaces.
    • Change positions frequently to minimize physical demands on your body.
  • Pain can be exhausting – See fatigue for more suggestions.

Modify your work environment:

  • Request access to a refrigerator and/or microwave to store a hot/cold pack.
  • Maintain a comfortable temperature to reduce further increase in pain: consider using space heaters, fans, portable air conditioners or humidifiers/de-humidifiers for comfort.
  • Request a professional ergonomic evaluation of your workstation. If this is not possible, here are a few tips:

Nerve damage

Modify your work tasks and how you work:

Hands and fingertips:

  • Decreased sensation in your hands puts you at a greater risk of injury. Request alternative duties to work tasks that involve the use of sharp objects or tools, or extreme temperatures (boiling water, freezers).
  • Use safe electric tools in place of manual tools when possible (for example, an electric drill instead of a manual screwdriver, or food processor instead of a knife).
  • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to increase comfort.
  • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter, requiring less grip strength to hold on to.
  • Use a headset if you are frequently on the telephone.
  • For jobs that involve computer use where typing is difficult, consider using speech recognition software. Alternatives to mice and/or switches accessed by other body parts are options for very sensitive fingertips.

Toes and Feet:

  • Work in a standing position? Sit down when you’re able to. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Use an anti-fatigue mat under surfaces where you frequently stand or add anti-fatigue surfaces to your shoes.
  • Consider using a mobility aid (cane, hiking stick, walker) if you are having difficulties with balance.
  • Diab-A-Sheet or other insoles may help manage discomfort in your feet while standing/walking.

Modify your work environment:

  • Maintain adequate temperature: consider using space heaters, fans, portable air conditioners or humidifiers/de-humidifiers for comfort.
  • Request parking close to your work entrance.
  • Relocate your workstation closer to the washroom, break room or other frequently used space.

Lymphedema

Modify your work tasks and how you work:

  • Wear a compression garment as it may help manage your swelling and offer a measure of protection for your skin.
  • Avoid risky work tasks that could cause trauma to your skin. Request alternative duties to work tasks that involve the use of sharp objects or tools, or extreme temperatures (boiling water, freezers).
  • Wear protective gloves for tasks that could place you at risk of breaking your skin.
  • If you are uncomfortable due to a swollen, heavy limb:
    • reduce repetitive physical exertion
    • do tasks that are less physically demanding
    • use electric tools to replace manual effort
  • Reduce repetitive tasks; vary these tasks with other duties.
  • Ensure that frequently used materials are within your reach.
  • Move heavy objects to waist height; slide them on a counter instead of picking them up if possible.
  • Negotiate tasks that involve heavy lifting.
  • Sit down when you’re able to if you work in a standing position. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Pace yourself. Work at a speed that is comfortable for you. Break up heavy and light tasks throughout the day. Complete heavy or the most important tasks when you have the most energy.

Modify your work environment:

  • Locate and ensure that a first aid kit is easily accessible from your workstation, complete with antiseptic to decrease risk of infection if your skin is broken.
  • Elevate swollen limbs when possible. Consider positional supports for a heavy limb, for example, pillows or Aussie bags and adjusting the height of your chair’s arm rests. For legs, consider a desk set-up where you may be able to elevate your foot/ankle.
  • Avoid extreme heat or cold; optimize air quality.

Other general tips:

  • Gradually build up your strength and activity tolerance with a graduated exercise program (see your healthcare provider for guidance).
  • If your affected limb(s) does not fit into your work uniform, discuss alternative clothing with your manager.
  • Regular movement is important to encourage lymphatic flow. Take 2 minutes to stretch every hour.
  • For jobs that involve computer use and typing, consider using speech recognition software, alternatives to mice and/or switches accessed by other body parts as options for swollen hands.
  • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter, requiring less grip strength to hold on to.
  • Consult with your local occupational or physical therapist for mobility aid options.

Hot flashes

Modify your work tasks and how you work:
Dress in layers to accommodate your fluctuating temperature. If your work requires a uniform, request alternative clothing options that would allow you to remove a layer when needed.

Modify your work environment:

  • Optimize temperature: consider using fans, portable air conditioners or dehumidifiers for comfort.
  • Request access to a refrigerator to store 2–3 wearable cold packs, which can be rotated throughout the day.
  • Keep a thermos of ice water easily accessible in your workspace.

Breathing difficulties

Modify your work tasks and how you work:

  • Wear loose-fitting, comfortable clothing. If your work requires a uniform, request alternative clothing options that do not restrict your chest or abdomen.
  • Request flexible “fresh air” breaks.
  • Arrange for communication over instant messaging or a chat program instead of the telephone.
  • Request to work from home in extreme weather (very humid, very cold).
  • Reduce physical exertion:
    • Do tasks that are less physically demanding.
    • Use electric tools to replace manual effort.
    • Reduce repetitive tasks; vary these tasks with other duties.
    • Consider using a mobility aid such as a walker.
    • Other mobility aids may also be helpful to minimize your energy expenditure. Assessment by a local therapist (physical therapist, occupational therapist) may be best to help you find the appropriate mobility aid.
  • Work in a standing position? Sit down when you’re able to. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Learn deep breathing techniques. Incorporate relaxation into your breaks—with or without an audio guide.

Modify your work environment:

  • Relocate your workstation to an area with sufficient air purification.
  • Optimize air humidity: consider a portable humidifier or dehumidifier for comfort.
  • Request that your workplace abides by a fragrance- and smoke-free policy.

Nausea and vomiting

Modify your work tasks and how you work:

  • Work from home when possible.
  • Wear loose-fitting, comfortable clothing. If your work requires a uniform, request alternative clothing options that do not restrict your chest or abdomen.
  • Learn deep breathing techniques and apply these when experiencing nausea. Incorporate relaxation into your breaks—with or without an audio guide.

Modify your work environment:

  • Relocate your workstation closer to the washroom. Request access to a washroom that is used only by yourself if possible.
  • Request a private place to store a facecloth or wipes, mouthwash and a toothbrush.
  • Modify your workstation temperature: consider using fans, portable air conditioners, or humidifiers/de-humidifiers for comfort.
  • Relocate your workstation away from strong odours.

Control sensory input:

  • Use noise-cancelling headphones or earplugs to limit bothersome sounds.
  • Work facing a wall instead of a busy hallway to decrease visual input.
  • Optimize the lighting in your environment to your comfort.
  • Request that your workplace abides by a fragrance- and smoke-free policy.

Nutrition and feeding

Modify your work tasks and how you work:

  • Ask for flexible and/or extended break times to accommodate your nutrition and feeding needs.
  • Ask if you can drink (nutritional supplements) at your workstation throughout the day to meet nutritional requirements.

Modify your work environment:

  • Request a quiet, private area to eat if you are uncomfortable doing so in front of co-workers.
  • Request storage space for any extra materials or supplies that are required to meet your nutrition needs.

Infections

Modify your work tasks and how you work:

  • Work from home as much as possible.
  • Evaluate if you can avoid travelling to work with public transit or travelling during rush hours.
  • Schedule meetings to be done over the telephone or video-conferencing instead of in person.
  • When possible, designate work materials and tools for your use only, avoid sharing equipment (phones, computers, heavy equipment). Keep a personal mug, dishes and utensils and do not share with co-workers.
  • Keep a personal hand sanitizer in your workstation, as well as disinfecting wipes to clean surfaces prior to use (e.g., computer keyboards, phones etc.).
  • Wear disposable gloves when handling shared equipment is necessary.

Modify your work environment:

  • Relocate your work station away from others to minimize your exposure to germs.
  • Request hand sanitizer and antibacterial soap to be placed in all bathrooms and kitchens, at your workstation, and hand hygiene education to be provided for all staff.
  • Avoid working with sick co-workers. If appropriate, you might provide education to your co-workers regarding your compromised immune system. You could choose to do so informally, or speak with your manager or human resources department.
  • Air purification systems and proper ventilation can reduce airborne illness.
  • Request access to a private washroom.
  • Consider a mini-fridge to keep your food and medication separate from your colleagues. Bring pre-packed meals. Do not prepare food in common kitchen areas.

Bleeding problems

Modify your work tasks and how you work:

  • Prevent trauma. Ask for alternative duties to work tasks that involve a higher risk of physical injury.
  • Wear safety equipment suited to your occupation.

Modify your work environment:

  • Reduce risk of falls:
  • Remove clutter, loose cords and wires from workspace.
  • Ensure adequate lighting in all workspaces.
  • Keep floors free from spilled liquid.
  • Eliminate uneven flooring surfaces.
  • Wear well fitting, supportive footwear with a closed heel and rubber sole.

Changes in skin and nails

Modify your work tasks and how you work:

  • Photosensitivity
    • If photosensitive, ask for alternative duties that do not require outdoor work.
    • Wear a wide-brimmed hat, long sleeve shirts and pants while working outdoors. If your work requires a uniform, request alternative clothing options that would allow you to be protected from the sun.
  • Painful fingers and hands
    • Wear protective gloves that are suited to your work tasks. Thin cotton gloves can be worn indoors for comfort. Waterproof gloves should be used in tasks that frequently expose your hands to liquid if nails are damaged.
    • Use electric tools in place of manual tools when possible.
    • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to increase comfort.
    • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter which requires less grip strength to hold tool.
    • Use a headset if you are frequently on the telephone.
    • For jobs that involve computer use and typing, consider using speech recognition software. Alternatives to mice and or switches accessed by other body parts are options for very sensitive fingertips.
    • Contact your local occupational therapist for possible hand exercises to increase strength and coordination if this is an issue. A desensitization program may also be helpful in decreasing sensitivity.
  • Painful toenails and feet
    • Wear well fitting, supportive footwear with a closed heel and rubber sole.
    • Contact your local foot specialist to receive an assessment for a custom-made off-loading insole to reduce pressure on your feet.1
    • Work in a standing position and sit down when you’re able. Use a stand-lean chair if possible if not, keep a rest-chair nearby.
    • Use an anti-fatigue mat under surfaces where you frequently stand or add anti-fatigue surfaces to your shoes.
    • Consider using a mobility aid to reduce weight load to your feet such as a walker.
    • Other mobility aids may also be helpful in managing mobility when you have foot pain. Assessment by a local therapist (physical therapist, occupational therapist) may be best to help you find an appropriate mobility aid.

Modify your work environment:

  • Painful toenails and feet
    • Request parking close to your work entrance.
    • Relocate your workstation closer to the washroom, break room or other frequently used space.
    • Limit repetitive tasks on your feet and try to vary them.
  • Hand-foot syndrome
    • Avoid tasks that expose your hands to extreme heat, such as dishwashing.
    • Limit tasks which involve repetitive friction on hands or feet:
    • Use electric tools to replace manual effort.
    • Reduce repetitive tasks and vary these tasks with other duties.
    • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to decrease friction.
    • Request parking close to work entrance.
    • Relocate your workstation closer to the washroom, break room, or other frequently used space.

Changes in bowel and bladder function

Job accommodations

  • Relocate your workstation closer to the washroom.
  • Ask for access to a private washroom that has a sink and toilet together.
  • Request a private place to store wet wipes, extra ostomy supplies and a change of clothing.
  • Identify tasks that would be problematic to interrupt with an emergency bathroom visit.
  • Explore if there is a way to modify these tasks to allow for unforeseen interruptions.

Visual impairment

For accommodation ideas for vision impairments visit Accommodation Ideas for Vision Impairments at AskJAN.org.


Hearing impairment

For accommodation ideas for hearing impairments visit Hearing Loss Accommodation Ideas at AskJAN.org.


Impaired communication abilities

Modify your work tasks and how you work:

  • Arrange for communication over instant-messaging or a chat program instead of the telephone or in-person.
  • Consider alternate technology or ways to present information such as use of webinars, text-to-talk technology, videos, written information, etc.
  • Work with your speech therapist to explore alternate communication devices to be used in the workplace.
  • See also Accommodation Ideas for Hearing Loss at AskJAN.org.

Mobility impairment

Modify your work tasks and how you work:

  • Wear well-fitting, supportive footwear with a closed heel and rubber sole.
  • Work in a standing position and sit down when you’re able. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Work from home if possible.
  • Other mobility aids may also be helpful in managing mobility when you have foot pain. Assessment by a local therapist (physical therapist, occupational therapist) may be best to help you find an appropriate mobility aid.

Modify your work environment:

  • Ask for parking close to your work entrance.
  • Relocate your workstation closer to the washroom, break room or other frequently used space.

Changes in appearance

Modify your work tasks and how you work:

  • Ask to be able to complete work from home, in a private office, or to conduct meetings by telephone while you adapt to the changes in your appearance.
  • If you’d like, have a trusted colleague or manager disclose the changes in your appearance to your colleagues prior to your return to work. You may also request that they share your level of comfort discussing these changes in order to minimize unwanted questions.

Modify your work environment:

  • Ask for sensitivity training for co-workers and supervisors.

If the employee serves the public:

  • Inform your employer that an employee with a visible difference serving the public sends the message that they value diversity. Hopefully this will lead the public to accept you as they would any other employee. As long as you feel comfortable and supported.
  • Ask your employer to put up signs in places where the public is served saying that rudeness or harassment towards staff will not be tolerated.

Seizures

Modify your work tasks and how you work:

  • Identify high-risk situations for injury (for example, working at heights, working with heavy equipment), and work with your employer to find alternative tasks that would reduce the chance of injury to yourself and others in case of a seizure.
  • Reduce the risk of injury by using safety equipment when possible (for example, harnesses).
  • If you work alone or in an isolated area, consider an AutoAlert lifeline, which will contact emergency services in case of a fall.
  • Identify any potential seizure triggers and work with your employer to eliminate or reduce them (for example, high level of stress, over-fatigue, flickering lights).

Modify your work schedule:

  • Keep your body fuelled:
    • Sip from a water bottle throughout the day to stay hydrated.
    • Keep healthy snacks nearby to help you recharge throughout the day.

It’s not unusual for people who have seizures to also have changes in their memory. Please see the cognitive challenges section for tips on dealing with these concerns.

Modify your work environment:

  • Educate your workplace and co-workers on your condition and discuss the appropriate steps to take if you have a seizure.

Cognitive challenges

Modify your work tasks and how you work:

  • Identify tasks which are most challenging for you, discuss with your manager if these tasks may be simplified, shared with a co-worker, or if you can be given more time to complete them
  • As possible, tackle one task at a time. Complete this task prior to starting the next.
  • Increase your use of external memory supports:
    • Use a daytimer/calendar
    • Set up electronic alerts
    • Make to-do lists, prioritize items, check items off
    • Use sticky notes to remind yourself of information
    • Develop routines: put your keys, files, coat and other important items in the same place every day
    • Request that instructions be provided in writing, check off steps as completed
  • Recognize the effect of fatigue on your attention and memory. Explore further strategies to manage fatigue in the Fatigue section.
  • Arrange with your manager to assign a period of “no interruption” during your day. Use this period to accomplish the your most challenging work tasks.

Modify your work environment:

  • Reduce distractions:
    • Request a quiet work environment when possible or use noise-cancelling headphones or earplugs
    • Declutter workspace
    • Work facing a wall instead of a busy hallway to decrease visual distractions
    • Optimize the lighting in your environment

Changes in mood and emotions

Modify your work tasks and how you work:

  • Identify non-essential job tasks and situations that may cause strong emotional or stress reactions.
  • Can these tasks be re-assigned or shared with a co-worker?
  • Explore ways of using stress management techniques before and while approaching tasks that cannot be modified.
  • Identify supports that decrease your stress and discuss ways of incorporating these with your manager (for example, receiving written vs. verbal instruction, deadline extensions, more frequent breaks, work from home)

Modify your work environment:

  • Create a soothing environment:
    • Request a quiet work environment when possible.
    • Declutter workspace.
    • Wear headphones to listen to soothing music.
    • Work facing a wall instead of a busy hallway.
    • Optimize the lighting in your environment.
  • Identify a quiet, private location at work where you can retreat to if feeling overwhelmed.