Breast cancer survivors want to have a say in what their return-to-work strategy looks like, finds new study.

If one of your colleagues is diagnosed with cancer, HR managers and workplace leaders will likely have a plan to put in place. With the permission of the employee, they’ll share the news with the wider workforce, they’ll give the employee their leave options and provide details of the mental health or EAP services available to them.

After the employee goes through their treatment and is given the green light that they’re in remission, many employers might consider this the end of the journey. If the employee has been cleared to work and no longer looks visibly sick, this is when a lot of support starts to wane – often unintentionally.

But as anyone who’s ever experienced cancer will tell you, the side effects don’t end when the treatment does. The road to recovery is long, difficult and unique to each individual.

This was an area that Dr Senia Kalfa, senior lecturer in the Department of Management at Macquarie Business School, Dr Layla Branicki from the UK’s Open University Business School and professor Stephen Brammer from the UK’s Bath School of Management, wanted to explore.

Cancer and the workplace: the facts

An estimated 19,998 women and 169 men (with a median age of 44 years) will be diagnosed with breast cancer this year.

Those who survive the illness are 1.4 times more likely to face unemployment. For those who do return to the workforce, it can take years to gain meaningful employment.

Considering survival rates of breast cancer are increasing and women make up 41 per cent of the workforce as of August 2020, having a responsible return-to-work strategy for breast cancer survivors should be a top priority for employers.

In their research paper*, recently published in the Journal of Work, Employment and Society, Kalfa and her co-authors interviewed 29 women who have survived breast cancer. They found that the legal requirements and regulations around return-to-work practices for employees who’ve been diagnosed with cancer are “insufficient to meet employees’ needs”.

What employees need, the authors suggest, is a responsible return-to-work (RRTW) plan that forefronts flexibility and centres their autonomy.

“Work delivers important benefits to breast cancer survivors, giving them purpose and dignity, financial wellbeing, social connection, self-esteem and a sense of normality,” the research paper reads.

Speaking to HRM, Kalfa says a lot of the women interviewed for this research didn’t leave the workforce during their treatment. For some, this was a financial decision – they couldn’t afford to take a large chunk of time off. For others, it was more so about maintaining a sense of control.

“It offers them a sense of normality so they don’t have to think of cancer all the time,” she says.

She says for people whose lives haven’t been touched by cancer, it can be difficult to understand what survivors are going through.

“If you’re in remission or you’re not going through treatment anymore, there’s this mentality that you’re either sick or you’re not. So once you’ve been cleared to go back to work [some people might think] you’re no longer sick, so why are you still suffering?”

Different employer responses

After extensive interviews with the research subjects, Kalfa and her team discovered that organisational support varied greatly. Some were treated with levels of kindness and support that you’d expect only from family members. Others were mistreated in unimaginable ways.

Kalfa shares the example of a healthcare worker whose colleagues set up a roster to cook meals for her and her husband over a five-month period and a single mother whose colleague attended medical appointments with her because she had no one in her personal life to do that.

But there were also examples of appalling workplace responses.

“There’s one example I can think of where a woman was bullied,” says Kalfa. “She worked in the government sector. Fatigue and brain fogginess is common [side effect of chemotherapy]. This woman was frequently yelled at in front of her team about her ‘chemo brain’ and told she couldn’t do her job. There was a constant issue between her and her supervisor.”

Not only was this woman trying to continue working while recovering from chemotherapy, she was also on a secondment in a new department – so she was also having to learn new processes and systems. The intense bullying and pressure to perform meant she ended up leaving the organisation.

There were also less extreme examples of employers that didn’t even bother supplying basic information.

“Most women I spoke to were not aware that, after 12 months continuous employment, they have the right to ask for flexible work arrangements from their employer – and often, this isn’t being offered,” says Kalfa, in a media release about the research.

Kalfa and her co-authors categorised employer responses into four categories: 

The minimal responsibility – they call this a “quasi-legal approach”, meaning all an employer does is offer the bare minimum “based upon compliance within contractual duties and standard provision of support functions”.

The economic response – employers who consider the financial benefits of keeping a particular person employed, be that through improved retention rates or avoiding reputational damage.

The moral response – employers who put responsible, compassionate frameworks in place to support the individual because it’s seen as the right thing to do.

The discretionary response – when employers facilitated colleagues supporting the cancer survivor in ways that went above and beyond anyone’s expectations (such as the example of the people who attended medical appointments/cooked meals).

While it would be lovely to think all employers would put these support mechanisms in place due to a sense of moral obligation, the reality is that it often comes down to the dollars and cents.

When employers are supportive, they end up having a loyal employee. “They will work above and beyond the expectation of their role.”

Minimum responsibility isn’t enough, but a discretionary response won’t always be realistic. A Goldilocks approach – somewhere in between the two – is best, says Kalfa.

Spread the message

Cancer affects everyone differently, says Kalfa, but one consistency identified amongst the women was the need for flexibility.

“Pre-COVID, to have a flexible working arrangement you had to have a negotiation with your manager,” she says. 

“I’m hoping that because of COVID, and because we’ve all proven we can work from home, that this will have an impact on cancer survivors. If someone is going through chemo – and they can work – why can’t they have that ad hoc flexibility?”

All of this, however, depends on the cancer survivors being willing to disclose the details and severity of their illness and recovery.

If a person isn’t willing to disclose, then colleagues might speculate what’s happening. It’s a delicate balance, says Kalfa. 

“HR can’t solve cancer, you can’t solve the treatment [issues], but it’s important you navigate the privacy of the situation effectively – some people might not want their colleagues to know. That’s really important.”

If an employees chooses not to disclose their illness with their wider team and they appear to be receiving “special treatment” from their manager, you want a workplace where people’s first instinct is that something personal might be going on in that person’s life, rather than fuelling jealous behaviours or assumptions of favouritism.

One way to do this, is by adopting personal situation plans (PSP) across your organisation. HRM has covered this topic before and we’ve shared the makings of an effective PSP template, but this is a great example of a situation where a manager might use the information included.

Many HR professionals would be well equipped to have these delicate and important workplace conversations – they’ve been trained for this. So Kalfa suggests they instead focus their efforts on creating an organisation-wide culture of trust.

“Generally, HR managers deal well with physical illnesses, so it’s a matter of how they can develop capacity for the line managers to be able to have these conversations,” she says.

“We found if you have a close relationship with your manager, your experience of working through cancer or returning to work after cancer will be better. Also, if a manager has managed something like this before, or they’ve had family who’ve gone through it before, their empathy levels are higher.”

Kalfa and her co-authors found the majority of managers were supportive at the diagnosis stage, however many were unfamiliar with the chronicity and ambiguity of recovery from cancer. This meant that some made the assumption that cancer survivors could work at full capacity, when that was only sometimes the case. So there’s an important educational role for HR professionals to play. 

(For more details about how to manage cancer in the workplace, you can visit the Cancer Council’s website ‘Cancer, work and you’ for some helpful resources).

Importantly, the researchers encourage employers to think of responsible return-to-work (RRTW) strategies as a journey rather than a destination. As cancer recovery is a long process – and cancer can often recur – it’s important employers are thinking big picture when formulating a RRTW approach.

Kalfa’s final piece of advice for anyone reading this article is to take the time to check their breasts this breast cancer awareness month. 

For more information and for detail on how you can support the cause, visit the National Breast Cancer Awareness website. 

*A link to the research paper will be made available within the next few weeks.