Cancer is the second leading cause of unscheduled absences and new disability claims for large employers.1 It is a personal health crisis that influences absenteeism and productivity loss in workplaces around the globe. With increasing cancer rates and expectations that new cancer diagnoses will cross the 2 million mark in 2024,2 employers should be prepared to support employees through their journeys and encourage them to return to work when possible. 

An increasing number of working-age people are diagnosed with cancer, and nearly half of adult cancer survivors are younger than 65 years old.3,4 With trends like these, dealing with employees diagnosed with cancer is an eventuality for employers. Those that assess and revise policies and programs to support the process can ensure a more positive experience for everyone involved.

For example, one multidisciplinary intervention showed a 73% higher return-to-work rate at 18 months and allowed patients to return to work 16.5 weeks earlier on average compared with the control group. Employees who had been on leave for three months received digital resource modules, calls with an experienced health coach, access to self-management tools, and verified resources for six to 12 weeks. The intervention included behavioral change techniques that were personalized to each patient to help promote better health. The program followed a defined scope that included mental health, oncology nutrition, sleep, symptom tracking, and exercise.

Employer Interventions

The first step is to understand how cancer affects the workforce so you can create a supportive and compassionate environment and adjust when needed. For working-age cancer survivors, returning to work is a key quality-of-life indicator. As a chronic, potentially life-threatening illness, cancer causes a range of physical and emotional issues that can lead to: 
  • Absenteeism. Employees diagnosed with cancer may need frequent time off for treatment, clinical appointments, and recovery. In a study of breast cancer patients, absenteeism was reported in 23% of cases while 31% of patients reported impairment at work, and 45% reported overall work productivity loss.5 
  • Presenteeism. Even when employees who have cancer are physically present, their productivity may be significantly affected due to fatigue, pain, cognitive difficulties, and other cancer-related symptoms. This phenomenon, known as presenteeism, costs employers an estimated $410 per year per person and $118,000 annually.6 
  • Turnover. Between 10% and 38% of cancer survivors lose or quit their jobs,7-9 which is costly and disruptive given that replacing employees costs about 39% of their salary.10 This turnover is not inevitable. Many people with cancer want to return to work. Employment can have a positive influence on quality of life, self-esteem, and finances. It can also provide a sense of purpose and normalcy.11 Conversely, unemployment and long-term absence from work are harmful to mental health and physical recovery. While some employees diagnosed with cancer experience a decline in capacity, many are capable of resuming work post-treatment without lasting disabilities.12-14
Communication is key to facilitating return to work. This brief clinical vignette illustrates barriers that employers can influence. An occupational physician was asked to assess and advise on a return-to-work plan for a 30-year-old woman who had been absent from work for 12 months due to Hodgkin lymphoma. After the assessment, the occupational physician spoke with the oncologist, who said, “I had no idea she wasn’t back at work. She’s been in remission for six months.” The oncologist hadn’t asked about work because he didn’t see it as a clinical outcome. The employer was reluctant to refer for assessment because of the emotional response many people have to a cancer diagnosis.

Challenges to Returning to Work After Cancer

Knowing how to support employees when they return to work during or after cancer requires education and empathy to address these common challenges:  
  • Physical limitations. Cancer and cancer treatment can cause fatigue and pain that may affect an employee’s ability to perform at the same pace before a diagnosis. In fact, it’s estimated that up to 30% of cancer survivors live with chronic fatigue.15  
  • Cognitive problems. These impairments, often referred to as “chemo brain,” may include difficulties with focusing, memory, and processing information.16 
  • Mental health challenges. The emotional toll of cancer can be immense and may result in a variety of challenges, such as anxiety and depression. It’s estimated that 30% to 40% of cancer patients are diagnosed with a mental illness.17 And feelings of frustration or worry can lead to added stress and distractions at work.
  • Interpersonal issues. Some employees may face negative attitudes from teams or leadership due to their cancer diagnosis. Research suggests that 40% of cancer survivors report having an unsupportive employer as a key reason for not returning to work.18 
  • Negative attitudes. Employees may face discrimination in the workplace because of misperceptions about their ability to work during and after cancer treatment.19 Cancer survivors believe their cancer to be highly stigmatized in the workplace, particularly related to ongoing misconceptions and fears associated with death and misperceptions about workplace productivity, reliability, cost to employers, and the potential for cancer recurrence.20
  • Meeting employee and business needs. Employers need to make reasonable work accommodations for employees with cancer while ensuring businesses run smoothly. Examples may include providing flexible work hours to accommodate rest breaks, modifying workspaces with a hands-free headset or a supportive chair, moving a workspace closer to a restroom, and offering hybrid work or the ability to work from home.
  • Lack of knowledge and resources. Employers should ensure that managers and supervisors are trained on legal protections designated by the Americans with Disabilities Act (ADA), federal Family and Medical Leave Act (FMLA), and state paid family and medical leave laws. The Department of Labor publishes fact sheets to ensure managers have the correct information.22 
  • Sensitivity to employee’s needs. Communication must be sensitive and respectful. Employers should consider developing talking points to encourage an open and safe dialogue. For example, a manager might say, “I’m sorry you’re going through this” or “Tell me what we can do to make your workload more manageable.” 
  • Navigating confidentiality preferences. Employers should ask about employee preferences for team or company communications. Some employees may prefer to keep their diagnosis private, and employers must abide by these wishes.
  • Managing workplace dynamics. Having a team member who has cancer can affect team dynamics, especially if co-workers perceive a returning employee is given special treatment. Employers should educate staff about cancer and its impact, including how to support colleagues who may be on medical leave or have returned to work.21

Facilitating the Return-to-Work Journey

Providing employees with support isn’t just about accommodations. Employers can play various roles, including advocate and ally, to help employees with cancer feel valued and remain productive contributors. To accomplish this goal: 
  • Ensure compliance.22-24 The ADA and FMLA protect employees who are receiving treatment and recovering from cancer. Employees may also be eligible for short-term disability under company policies or long-term disability based on employee-sponsored plans or under Social Security. 
  • Create supportive policies. Employers need to recognize the impact of cancer on employees’ lives and offer modified work schedules, remote work options, ergonomic workspace adjustments, and additional breaks throughout the day.
  • Maintain privacy and confidentiality. Any discussion about an employee’s condition, needs, or accommodations must be conducted discreetly, and information should only be shared with those who need the information to make necessary adjustments.
  • Support emotional wellness. Providing access to counseling services or support groups may help employees deal with anxiety, depression, or emotional distress related to their illness and a return-to-work transition.
  • Educate leadership and staff. Managers and supervisors need knowledge and skills to support employees who have been diagnosed with cancer and would like to stay at work or those who are returning to work after treatments. This could involve empathetic leadership training, awareness of cancer symptoms, and the need to follow up with employees regularly.

Improved Return-to-Work Rates

Employers need to review company policies to assess provisions for physical constraints caused or exacerbated by cancer, such as fatigue, weakness, pain, neuropathy, or lymphedema.23,24 Modifications to address these constraints may include taking short breaks to manage or conserve energy, using voice-to-text software to minimize pain or weakness while using a computer to type documents or send emails, or sitting in a supportive chair instead of standing.

Measuring Success: Evaluating Return-to-Work Programs

Measuring the effectiveness of policies or programs that are implemented is essential. Each individual has unique needs, and modifications might need adjustments along the way. Key success indicators may include:25
  • Employee retention rate after diagnosis;
  • Employee satisfaction with the return-to-work program;
  • Manager’s confidence levels in supporting team members with cancer;
  • Total cost of accommodations for employees with cancer;
  • Improvements in employee productivity; and
  • Overall cost difference between retention and replacement, which includes training costs and market differences.
Developing return-to-work plans for employees with cancer is no longer just sensible, it’s necessary. The more prepared employers are to handle cancer in the workplace, the more likely they are to improve employee well-being and productivity while minimizing interruptions and costs.
  1. Council for Disability Awareness. (2011). The 2011 CDA Long-Term Disability Claims Review. Retrieved from https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html
  2. American Cancer Society. (2024). Cancer Facts & Figures 2024. Retrieved from https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html
  3. National Center for Biotechnology Information. March 15, 2005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15700265/
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  5. Mejri, N., Berrazega, Y., Rachdi, H., et al. (2021). 138P Absenteeism at work in breast cancer patients undergoing therapy. Annals of Oncology. https://doi.org/10.1016/j.annonc.2021.03.152
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  7. National Center for Biotechnology Information. 2007. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17497311/
  8. National Center for Biotechnology Information. March-April, 2002. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11921328/
  9. National Center for Biotechnology Information. February, 2011. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20117019/
  10. Equitable Growth. 2020. Turnover Costs. Retrieved from https://equitablegrowth.org/wp-content/uploads/2020/12/122120-turnover-costs-ib.pdf
  11. National Center for Biotechnology Information. September 2014. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24002638/
  12. National Center for Biotechnology Information. March 15, 2005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15700265/
  13. National Center for Biotechnology Information. 2007. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17497311/
  14. National Center for Biotechnology Information. March-April, 2002. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11921328/
  15. Tidsskriftet. 2017. Chronic fatigue in adult cancer survivors. Retrieved from https://tidsskriftet.no/en/2017/11/klinisk-oversikt/chronic-fatigue-adult-cancer-survivors
  16. National Center for Biotechnology Information. November 25, 2019. Cancer-related cognitive problems in cancer survivors who returned to work. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182611/#:~:text=Cancer%2Drelated%20cognitive%20problems%20in%20cancer%20survivors%20who%20returned%20to,planning%20and%20executing%20their%20work.
  17. National Center for Biotechnology Information. July 10, 2023. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540791/#:~:text=Moreover%2C%2035%E2%80%9340%25%20of,while%20also%20increasing%20healthcare%20costs.
  18. Blinder, V. S., & Gany, F. M. (2020). Impact of Cancer on Employment. Journal of Clinical Oncology, 38(4), 302-309. https://doi.org/10.1200/JCO.19.01856
  19. ADA. Rehabilitation Act, 29 CFR Part 1630.
  20. Stergiou-Kita, M., Pritlove, C., & Kirsh, B. (2016). The “Big C”-stigma, cancer, and workplace discrimination. Journal of Cancer Survivorship, 10(6), 1035-1050. https://doi.org/10.1007/s11764-016-0547-2
  21. Osara Health. 2024. Retrieved from https://osarahealth.com/demo
  22. Department of Labor. (n.d.). Workplace Protections for Individuals Impacted by Cancer. Retrieved from https://www.dol.gov/agencies/whd/fmla/workplace-protections-for-individuals-cancer
  23. American Cancer Society. November, 2017. Cancer in the Workplace: HR Tip Sheet. Retrieved from https://www.cancer.org/content/dam/cancer-org/online-documents/en/pdf/flyers/cancer-in-the-workplace-hr-tip-sheet.pdf
  24. Braveman, B., & Newman, R. (2020). Cancer and occupational therapy: Enabling performance and participation across the lifespan. AOTA Press.
  25. Zamphr. (n.d.). How to Evaluate Your Return to Work Program. Retrieved from https://blog.zamphr.com/how-to-evaluate-your-return-to-work-program

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