Integrated Absence Management: Cancer and Disability - Disability Management Employer Coalition (DMEC)

Cancer and Disability: Making the Transition from Successful Treatment to RTW

By Glenn Pransky, MD

Scientific Advisor
Lincoln Financial Group

By Paul Barker, MD

Regional Medical Officer
Lincoln Financial Group

A diagnosis of cancer was once the beginning of the end for many people — and often it guaranteed approval for an early “retirement” onto Social Security Disability Insurance benefits. Over the last three decades, however, the proportion of the U.S. working-age population who are “cancer survivors” (anyone alive who was ever diagnosed with cancer) has increased substantially^.1,2

More than two-thirds of these survivors are able to return to work (RTW),³ but they often face significant challenges. Lower likelihood of RTW is associated with several factors: more advanced stage of cancer (such as more aggressive brain, lung, and liver tumors), extensive surgery, and significant treatment side effects.⁴On the other hand, predictive factors of successful RTW include younger age, higher education, less physically demanding work, fewer comorbidities, shorter sick leave, and more complete functional recovery.⁵

Once back to work, cancer survivors often face ongoing problems due to the residual effects of treatment. In one study, 31% of employed cancer survivors reported some reduction in ability to do physical job tasks, and 23% reported a reduction in ability to do mental job tasks, including coping with stress and concentrating on their work.^6,7Some returning workers experience less satisfaction with their work or their relationships with coworkers and may feel stigmatized because of their diagnosis.^8,9Thus, RTW outcomes are highly variable. Among those who return to work, between 40% to 60% do so by six months post-diagnosis, increasing to about 89% after one to two years^.10,11

In multiple studies, cancer survivors report that several factors were associated with more successful and sustained RTW outcomes: a supportive work environment, workplace accommodations,¹²receiving advice from their doctor about RTW, meeting with their employer to plan RTW,¹³ social support from employers and coworkers,¹⁴and the absence of perceived employer discrimination.¹⁵

Based on these observations, a few programs have been developed to improve RTW outcomes, and these programs have been the subject of scientific evaluations. The best available evidence suggests that multidisciplinary interventions combining vocational counseling, psychological support, physical exercise, and educating patients and employers improve RTW outcomes.

These interventions often feature a coordinator facilitating communication among the workplace, patient, and treatment team.^10,16 Cancer often requires anticipating the effects of treatment on work ability. Important information from specialists should be communicated to employees, employers, family members, and primary care providers on what to expect, including the time course for improvement or resolution of symptoms and functional limitations.^17,18Promising strategies to rapidly identify RTW challenges and facilitate dialogue among key persons are currently being tested, and these studies will soon provide useful information to guide employers.

Employers have many opportunities to improve RTW for cancer survivors. Key first steps include communicating that RTW is desired for cancer survivors and that resources are available, and encouraging employees to use them — ideally before a cancer occurs. Many major oncology centers now have care coordination teams to facilitate conversations about RTW, help develop accommodations during and after treatment, and help anticipate and solve problems that can occur after RTW. As in all RTW situations, positive encouragement from coworkers and supervisors is invaluable.

As cancer treatment continues to improve, employers will benefit from more employees who can return to work by applying these key principles.