Heather Grimshaw: Welcome to Absence Management Perspectives: A DMEC Podcast. The Disability Management Employer Coalition, or DMEC as we're known by most people, provides focused education, knowledge and networking opportunities for absence and disability management professionals. DMEC has become a leading voice in the industry and represents more than 20,000 professionals from organizations of all sizes across the United States and Canada.

This podcast series focuses on industry perspectives and delves into issues that affect DMEC members and the community as a whole. We're thrilled to have you with us and hope you'll visit us at www.dmec.org to get a full picture of what we have to offer. From webinars and publications to conferences, certifications, and much more. Let's get started and meet the people behind the processes.

Heather Grimshaw: Hi, we're glad you're with us. I'm Heather Grimshaw with dmec, and today we're talking about how employers can help employees stay at work and return to work after receiving cancer diagnoses. We're talking with Dr. Raghav Murali-Ganesh, who is the Chief Executive Officer and co-founder of Osara Health, and Robin Newman, Clinical Program Consultant with Osara Health. They co-authored the article Supporting Effective Return to Work Practices for Employees with Cancer in @Work magazine and have agreed to share some additional guidance and insights into this important issue. To set the stage for our discussion, I'd like to cite one of the data points in the article, which is that cancer is the second leading cause of unscheduled absences and new disability claims for employers. The authors, our guests today explained that this personal health crisis has practical implications for employers, and we appreciate you providing some specifics in our conversation today. So to dive right into our questions, interacting with employees who need accommodations for medical issues like cancer can be daunting for employers, and your article cites an example of a 73% higher return to work rate with certain interventions. I'm hoping that you will talk a little bit more about the types of interventions that help employees return to work.

Raghav Murali-Ganesh: Thanks Heather. Firstly, for having both Robin and I on this podcast. We're thrilled to be here. It's a topic that is enormously close to my heart, and speaking about it gives me great joy because I think it allows further destigmatization of a challenging topic when we think about kind of cancer within the workplace.

I kind of mentioned that in my opening kind of intro. I think we always There's a massive stigma around it. I think that comes from the fact that cancer is a disease historically has been a death sentence, and Employers stand on tippy toes when they speak to their employees, not knowing prognosis, not knowing outcomes, and view return to work as a final stage of the process.

You know, this is the end of the road of your cancer treatment. Once you get better, once there's, you know, convalescence, rest time, come back to work and return to work.

I think the first thing is kind of considering framing return to work as both a clinical endpoint, but actually earlier in that timeline as an intervention, a therapeutic intervention, which is good for both the patient, good for the family unit, good for the employer, and then kind of in a wider society sense, kind of good for productivity and kind of the wider society as a whole.

But it should be considered as a win. I think that's the first kind of way I'd love to frame return to work in cancer. Robyn, I'm sure you have thoughts on this as well, but I'll pass to you.

Robin Newman: Yeah, I couldn't agree with you more. And you know, many, many people want to continue working throughout this process if it's possible as well, you know, so I couldn't agree more that it is this sort of, this return to normalcy that people so crave. You know, cancer is an interruption. It's an interruption that happens when you don't expect it very often. Right. And so when you think about working and returning to work and being supported in that process, it gives people such reassurance and comfort that going back to something that they really, really care about is, is possible.

Raghav Murali-Ganesh: And I think the evidence, again, kind of suggests and supports that, thinks it's there, you know, even, you know, let's say in clinic, from a pure oncologist perspective, I'm seeing a patient when they're about 70% better, you want to get them home because the rest of that rehabilitation occurs when they're moving around, when they're not like on a hospital bed, when they're not so medicalized.

And I think work is similar. Cancer treatment is generally an outpatient therapy, so patients are at home. But thinking about cognitive rehabilitation, physical rehabilitation, work is a fantastic tool on an opportunity to consider an additional value add.

But then when we look at the evidence, you know, we have lots of data on people who have returned to work from a cancer diagnosis. Three really important outcomes have been demonstrated, like, you know, improving quality of life.

So that includes improved anxiety, depression scores, you know, kind of greater mental health. That point you made on normalcy and self esteem and purpose, I think as individuals, the hierarchy of need, as far as human beings, you Know, self esteem and purpose is really important.

So adding to that identity, which is certainly a large part of, if I reflect personally on who I am, there's been studies that demonstrate that patients who return to work, they reduce kind of risky behaviors, things that can creep in, addictions, gambling, alcohol, et cetera.

And then lastly, there's a financial toxicity, which is a very real challenge of any chronic disease, but especially one which is as expensive on the individual and society as cancer.

So getting back to work from a bottom line perspective helps the financial toxicity, which can further alleviate anxiety, depression, improve quality of life. So it's kind of a virtuous circle there within those three elements.

Heather Grimshaw: That's really helpful to hear you both weigh in there. And I think it's interesting to hear you talk about work as a tool as well as an opportunity to improve quality of life, which is one of the things that you talk about in the article.

And I'm hoping that you'll share a little bit more about whether you believe this is common knowledge for both employees as well as employers. And if it isn't common knowledge, what's the best way to increase understanding of that?

Robin Newman: Yeah, I don't know that it is common knowledge in many ways. So, you know, like we were saying, the return-to-work process is, it's just, it's more than your paycheck.

Right. It's this pathway that we just talked about about, you know, return to normalcy, purpose, all of these really important indicators. But employment just provides this structure and social interaction and sense of identity. All these like very critical components that we think about when we think about recovery and long term wellbeing. That's not usually the first thing that people think about when you may hear from an employee, I might need to take time away because I have a cancer diagnosis.

But to bridge that gap, employers can start by training their managers and their staff on these functional and emotional implications that we just touched on. So things like long term fatigue management or cognitive changes, those could be things like difficulty concentrating, focusing or remembering, you know, as a result of your cancer or cancer treatment.

You know, things like that. Right. So, you know, workshops or webinars, they can highlight these challenges that people face and make them digestible, easy to understand, and also like importantly known that you can still return to work and manage those symptoms that you experience with meaningful and often low-cost accommodations.

So, you know, educating your employees, teaching them about the benefits of, you know, reintegrating into the workforce, destigmatizing the cancer experience, all of those things actually just really contribute to this supportive environment that everybody, you know, really is seeking.

Raghav Murali-Ganesh: I'd add one thing to that, and I think when we see successful employers structure cancer friendly workplaces, I think there is an element of permission. You want that baked into your culture. And that permission comes from a series of actions that HR leaders, organizational leaders do. And you need to permit your organization and permit your staff to be able to develop this culture where you say, look, we are going to be proactive in supporting someone that's not necessarily only driving accommodations, but understanding that work is not the end of the journey, but part of that recovery journey for someone with a cancer diagnosis.

Heather Grimshaw: It's really helpful to hear you both talk about that a little differently from, I think the assumptions that some of us make. And talking about return to work as the final stage of the process is a great way to comment on that, because I do think that even raising the question of does it have to be the final stage of the process? Could there be accommodations that help employees come back to work sooner and continue with their treatments, if I'm understanding you correctly, is something that I think a lot of employers would like to consider.

Robin Newman: Yeah, there are a range of accommodations that really can seamlessly work into the workflow of an employee or an organization. You think about just things like hybrid work or remote work to allow somebody to be able to rest at times when maybe they need a short break, but yet can continue to, to perhaps work just a bit longer than an eight hour day, but knowing that they have those break periods in there to help them manage right, things like that, you know, ergonomic setups for desks, chairs, voice to text, software.

There's a lot of things that people can do that provide people, they empower people to think, you know, I can do this, I can continue working with these accommodations that just support my.

My ability to fully participate in the tasks that I need to do.

Heather Grimshaw: I think that the term cancer friendly workforce or workplace is not something, frankly, that I've seen commonly. And so to raise awareness of that and potentially have that conversation when you're working with or during the interactive process, I should say with an employee, is something that hopefully listeners will take away from this conversation.

One of the things that you write about in the article is the value of employers understanding how cancer affects the workforce as a precursor to designing a supportive and compassionate workplace environment. What are some of the ways employers can do this? And again ties back into that reference to the cancer friendly environment.

Raghav Murali-Ganesh: I think every workforce and workplace is different and specific accommodations will need to be Kind of adjusted. Now, that's a catch all sentence. But I think leading from a place of empathy, which most employers are, you know, acknowledging our role, that we occupy roughly one third of someone's day and therefore one third of someone's life.

So we should be considerate around how we choose to spend that time with that individual and the empathy we can bring to the table. Robin spoke a little bit about accommodations.

Things that I've heard, you know, patients from my clinical sense talk about, you know, hybrid work and remote work is absolutely valuable. But even within that, like having empathy for them and asking them if they want their video on, you know, cancer is generally an outpatient therapy.

Patients are well, but then their appearance may be different to what is usually what is usual for them, free cancer. And that appearance may change. You know, it may be that they have some degree of alopecia or they may have some swelling the empathy that employers can understand where that participant is, but they can still probably function in a capacity.

The other thing from a cancer therapy perspective is, is usually a series of treatments over a period of time. Usually radiotherapy, for example, the daily treatment, Monday to Friday, once a day, every day, 30 minutes.

So attendance to the outpatient clinic may be important. Similarly, chemotherapy and outpatient attendance. So understanding that they may have to have scheduled times of the day where the employee is not able to be at work and having a structured workplace or structuring the work in and around that.

Now, again, I speak for some workplaces that have the ability to do that and others that don't. So again, there's a little bit of individuality here, but generally, I think approaching this with empathy to understand where they're coming from and then where, as an employer, you want them to meet your needs in a safe and productive way, I think is important.

Robin Newman: I actually had, you know, there was an experience at a work site where the person said to their director, they disclosed their diagnosis and the person received this response, we will follow your lead.

And it was just such an empowering thing to say from a place of empathy, just like you're talking about that, you know, people will do their best, right? They will manage their care, they will do their best to maintain, you know, their ability to work.

And so those things are really. That place of empathy could not be more. More important, quite honestly. But when you think about, like this supportive and compassionate environment, it's about having this, these open dialogues, right, where you're not afraid to talk about what the employee is feeling or what they might need at these moments, right?

I like to think about when I engage in clinical work, I come from a lens of like partnership. Not this hierarchical way of I'm going to tell you that you need to do X in order to function, but more this place of what will help you.

You're the expert in your own body. So what do you think at this time would be helpful to you as you go through your treatment or as, you know, as you recover? So I think there's like different approaches that people can take in the workplace as far as specific accommodations, if that's what we're talking about. You know, there's a need to understand what disability is. Many people actually with cancer don't identify as actually having a disability because it's a medical condition in their eyes. And the resulting disability can sometimes be really tricky to talk about. So how do you introduce topics like the Americans with Disabilities act and reasonable accommodations if you need them? How do you think about talking about the Family Medical Leave act if somebody needs to take this time away? These kinds of things are just really important in helping people to feel really supported, much like we're, we're alluding to.

Heather Grimshaw: That's such a powerful example. Well, several powerful examples. Especially the, the quote, we will follow your lead and, and connects really nicely in with some of the things that you all have been talking about today.

And I, I think that it sounds to me like some of this may prompt employers to reassess or revise policy and programs to support effective accommodations that make an important difference to an employee who has a cancer diagnosis and that person's ability to stay at work or return to work sooner.

And it does really sound like empathy plays such an important role there. Would you be willing to share a few examples of what that looks like from an employer's vantage point on the front end, so that the assumption possibly isn't made that returning to work is that end result or that end piece.

Raghav Murali-Ganesh: Part of that is the fear, you know, employers have, and I kind of touched on it initially, that cancer is viewed as, you know, I think the historical stigma around cancer being viewed as an acute disease that is, you know, has a, usually a terminal outcome.

So often there is a fear from an employer to insert themselves and you know, they're like, gosh, work should be the last thing in your mind. Go home, look after yourself.

And it's kind of going back to that sense of that may be appropriate. You know, when we think about working age individuals, the overall survival is above 75%. So by and large, for most of your employees Work should be a absolute consideration or it's absolutely an appropriate consideration for them.

Yes, there's a nuance in there that a quarter of people, it won't be an appropriate discussion because they may have a terminal diagnosis and it might be less relevant. That nuance is challenging and without the crystal ball.

Often oncologists don't know which kind of side of that fence a patient would be on. You can have an educated guess, but that's the difficulty. So there's an absolute challenge in there.

Some of the work that we've done in the past is educating employers around that so broadly understanding the types of treatment, the types of cancers, the cure rates, the trajectory of treatment.

Employed individuals generally have a good understanding of their disease, their trajectory, their prognosis. Of course, if they're willing to share that. And this is part of having that able to have that discussion and where work is appropriate. And instead of assuming with an employee that work is the last consideration on their mind, but involving him in that process and for them to be an active participant in that decision making is powerful. And treating them in a way that point and will follow your lead. But practical examples, that is to say, look, we think work can offer X, Y and Z as a way of rehabilitation. Keeps you busy, keeps your mind occupied. You're a productive member of our team with accommodations. Would you consider doing work or would this be something that you would want as part of your treatment plan? That's a mature discussion to have with an employee. And I don't think it happens nearly enough because it's challenging. And often the easier thing to do is we'll wait for you to return to work when your doctors say yes.

Robin Newman: I simply could not agree with you more. Right. I think people feel there's like this, this loss. What do you say? How do you know when you should say it's okay to want to be at work at this time? Or you know, the initial reaction that you may have many, many other things on your mind. So work. Work is less. The conversation you're talking about just to have it happen is actually very impactful. You know, people can choose the outcome of the conversation, but having it is actually the real gift to both the employee and the employer.

Raghav Murali-Ganesh: And there's structures, ways to do that, you know, and I think there's a bit of like, for example, we've previously done role playing. You know, we do a little clinical vignettes.

So and so comes in, is shared with you, a cancer diagnosis. What do you say? What do you not say? And that role playing can help alleviate some of the challenges with this from a practical element which I think is useful.

Experienced HR professionals obviously have done this before in their, in their careers. And I think for them, you know, keeping up to date with kind of latest trends within cancer and understanding that, you know, by and large there is a curative outcome for these employees.

Again, not assuming that everyone has that, but understanding that and kind of keeping up to date with that concept and saying, okay, actually this is more of a chronic disease and let's work with you on this, you know, long term.

I think that's, that's an important thing. So these can be templated or have structured discussions and there are a variety of resources. We have resources within, within our organization, but, but elsewhere as well.

There are good resources, but oftentimes no one takes control of that. Patients go through, you know, they go from pillar to post. They are overwhelmed, they're anxious. So I don't think it's easy for them to drive this conversation.

So I think as a responsible parties, you know, employers in this, in, in the room, it's definitely a requirement, which is the challenge, but there's an opportunity here to be kind of leading.

Robin Newman: It's just such an important statement you just made. Yeah.

Heather Grimshaw: So tagging onto that, I wanted to ask you a little bit about some of the references you make in the article about communication with and between medical specialists, which is cited as an opportunity for employers to connect the dots differently or potentially better to ensure everyone is on the same page and aware of possible return to work opportunities. I'm hoping that you will talk a little bit about this and how employers can have a positive influence and ideally provide an example of success in this realm.

Raghav Murali-Ganesh: I think the challenge here, and I'm. I appreciate that I'm speaking on behalf of a profession, medical specialist, radiation oncologists, medical oncologists, surgical oncologists. Return to work isn't point number one for most as part of the treatment plan. There is a couple of assumptions in there, but Generally you have 20 minutes with a patient. [When a] new patient walks into the room I will spend 19 of those 20 minutes consenting someone to a fairly toxic therapy. There is a waiting room of 40 people outside that require my time. So mind space, time, space.

And if I don't consent them and get their signature on that piece of paper, I will be in trouble. And then some administrative person will kind of send me an email saying, this is, you know, not the right way.

So essentially what I'm trying to say here is when you have a hammer, everything looks like a nail. So, you know, medical specialists are trained to deliver either radiation, you know, systemic therapy, or use a knife and fork if they're searching surgeons.

So I think they are structured in that conversation to deliver that. So oftentimes, return to work is in front and center. Access to specialists, like occupational therapy isn't uniform. You know, I work in one of the largest cancer centers in the country, and we don't have a dedicated occupational therapist full time on staff. So it's kind of a challenge. So survivorship is improving, and we are getting better at understanding life with and after cancer. But I don't think it's front and center. So there is a challenge there from the medical side. So when it, you know, when you ask about communication with and between medical specialists, I think there's an opportunity here for employers to be a little bit of a lead to understand where they stand, where work stands between them and their employee.

And using that, using that kind of platform or that area for the employee to be, you know, quite proactive in saying, this is something I want as part of my treatment plan.

And then often again, if a patient comes to me and says, I want to work, I would never stop that. There is very, very little where, in fact, I can't remember in years where I've ever said to a patient who wishes to go to work to stop them from working, but that also has to come from the employer.

Robin Newman: Yeah, I think about when people come to the clinic and we see them in the occupational therapy clinic. And for those that might not be familiar with what occupational therapy is or can do, you know, we're a profession that really is here to support people in the activities that mean most to them and try to figure out, how can you support someone in your everyday life.

Right. And so we know work plays a very central role in someone's life. And when I have the benefit or the pleasure of having someone come, you know, to me to talk about work, it's part of what we do.

And then there's. There's more in the sense of, well, in order to get to work, right, you have to get up, get ready, get out of the house, get there.

And then when you get home from work, you probably need to, you know, make dinner, maybe take care of your family or others, you know, and start this process all over again.

And so, you know, we. When we try to support people in this return-to-work process, it's really a 24, 7 idea here. It's functioning at work, and it's also being able to have that reserve to be able to function in your home before and after. And so one of the things that an occupational therapist can do to partner with the employer is perhaps, you know, an on the job assessment, right. And helping to understand the work demands in real time or being able to help recommend accommodations or, you know, workplace solutions. And so there is that also that opportunity that employers can partner with the rehab providers on site to be able to say what, what can we do here that can be, you know, built right into our environment to keep people able to do what they want to do as well.

Heather Grimshaw: Those are great examples. And I think that the reference to the 247 idea, as well as the additional context for the incredibly valuable role occupational therapists play here is really helpful.

Thank you for that. You both have talked a little bit about fear and stigma with cancer, which is such an important part of this whole conversation. And I'm hoping that you'll talk about whether you think or whether fear plays a role in how employers interact with employees who have been diagnosed, diagnosed with cancer, both on the front end when an employee is seeking help and accommodations, as well as if an employee needs a leave of absence and then that interaction with what a return to work looks like.

Raghav Murali-Ganesh: There is a huge stigma here and not just employers like if you're talking about even in the medical profession, there is a stigma around the word cancer. Cast a mind back 40 years, 35, 40 years. The commonest cancer that we encounter in employed individuals with breast cancer. The five-year overall survival rates for early stage breast cancer was 80%. Four out of five people would survive. One in one in five wouldn't. Fast forward to today. Better research, better techniques, earlier diagnoses, public health awareness, et cetera. We have a 98% overall survival for early stage breast cancer.

We do not think or we, you know, someone comes in at an early stage, we will cure that. By and large, for most people that walk through the door, we will draw a line under that problem that is well known in the oncologist clinic.

But even within other medical specialties, and certainly within employers, that concept hasn't fully been appreciated because of the historical stigma that the word, the C word or the cancer word brings.

So I think there is that fear. Part of it is again with the employer and disclosures, so employees may not always disclose. There is not an onus of responsibility that employees do that.

So creating a supportive culture where you're able to have frank conversations with the employee, they can share with you what prognosis may or may not look like, or sometimes they may not know because not everyone has a crystal ball.

But having an understanding, for most of the people with a cancer diagnosis, there should be an understanding of prognosis. So early understanding of that. Having any discussion around how work can be supported.

Hey, we can offer X, we can offer Y to bring. This is our role here, to breathe the table. We don't want to be the last thing on your mind. We want to be something that can be a partner with you as you go through this. I think it's a really powerful sentiment, requires nuanced communication. It requires experience to have that discussion. It requires a supportive workplace that values kind of the employee. And that's not always the case. So there's a challenge here. But within this challenge, progressive employers, I think it's an opportunity here to be better. And that's an exciting place to be.

Robin Newman: It really is. And I think, you know, you almost can't say enough that the supportive culture sort of wraps its arms around what fear might be. Right? Because if you talk and you have these structured conversations that are guided, everyone feels better, right?

The employer feels better, and so does the employee. That they know that they're in a place where, you know, people care about them. And that's really what people want to know. They want to know that they're… they're caring about.

Heather Grimshaw: Well, thank you both for really shining a light on different aspects of this very important issue. So appreciate your time today and your expertise here and do just want to encourage listeners to read this wonderful article. We will include the link to the article in the notes section. So thank you both again.