Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers?
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Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers?
- 1. Safety and health at work is everyone’s concern. It’s good for you. It’s good for business. Rehabilitation and return to work after cancer — how could instruments and practices support workers and employers? Focus: non-OSH experts
- 2. 2 http://osha.europa.eu Content Background Impact of cancer diagnosis on work Overview of instruments, practices, policies and interventions Innovative instruments, practices, policies and interventions Programmes in enterprises and employers’ experiences Implementation of instruments, practices, policies and interventions — barriers Implementation of instruments, practices, policies and interventions — facilitators Recommendations
- 3. 3 http://osha.europa.eu Background: employment after a cancer diagnosis Increase in the number of workers diagnosed with cancer at the workplace • Number of cancer patients of working age is increasing • Better treatment and higher survival rates • Increasing retirement age • Ageing working population • 3.4 million new cases of cancer each year in Europe • Of which 1.4 million people are of working age each year RTW after cancer is important • Worker − Quality of life for cancer patients − Income and insurance − Structure in normal life and social contacts • Employer − Keep experienced workers in companies − Reduce financial impact on companies and society
- 4. 4 http://osha.europa.eu Background: RTW after a cancer diagnosis is important Therefore, optimising the rehabilitation and RTW of workers with cancer is essential Providing cancer patients with policies, programmes and instruments to support their RTW process is important • Modifiable factors provide opportunities for interventions • Despite a limited number of interventions, little is known about: − their success factors − facilitators of their implementation in other settings − barriers to their implementation in other settings • Policies and practices are needed to avoid problems • Employers need advice in assisting the worker affected by cancer while returning to work
- 5. 5 http://osha.europa.eu Impact of cancer diagnosis on work: health implications and costs Health and safety implications for workers affected by cancer • Effects of cancer and its treatment on health: − Psychological and cognitive symptoms, e.g. depression, anxiety and concentration problems − Physical symptoms: mainly fatigue • Occupational implications: − Diminished work productivity − Work ability impairments and reduced functioning Costs for workers, employers and society • Sick leave and no RTW: − Financial loss for the worker, the employer and society • Total economic loss to the European Union owing to lost working days as a result of cancer: €9.5 billion in 2009 https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review
- 6. 6 http://osha.europa.eu Impact of cancer diagnosis on work: occupational cancer and SMEs Work-related and occupational cancer • RTW issues seem to be no different from those concerning non-occupational cancers − Most occupational cancers have long latency − Exposure to carcinogens at work may be unknown Small and medium-sized enterprises (SMEs) • RTW of cancer patients seems more problematic for those in SMEs • Barriers − Information and resources for RTW programmes are lacking − Fewer alternative jobs and tasks • Facilitators − Family-like atmosphere: more supportive environment https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review
- 7. 7 http://osha.europa.eu Overview of instruments, practices, policies and interventions Aimed at workers • Workplace accommodations, including: − workload − tasks − assistance • Information and training on cancer and RTW issues • Psycho-educational interventions • Rehabilitation services • Job coaching Aimed at employers • Support for employers in constructing RTW plans for employees with cancer • Workplace accommodations to facilitate RTW • Improved communication between the employee and co-workers • Factual information on diagnosis and treatment of cancer • Guidelines
- 8. 8 http://osha.europa.eu Innovative interventions: Macmillan and municipality-based programme 1. Working through cancer programme of Macmillan Cancer Support (UK) • Online information, support, training, tools, videos • Help for different stakeholders − people with cancer and their family/carers − health and social care professionals − employers 2. Municipality-based occupational rehabilitation programme (Denmark) • Individual, tailored to worker’s needs • Involves different stakeholders: − hospital (nurses) − employer − job consultant − worker
- 9. 9 http://osha.europa.eu Innovative interventions: in-hospital and work reintegration agencies 3. In-hospital rehabilitation intervention (the Netherlands) • Early intervention • Involves different stakeholders 4. Work reintegration agency Rentree (Belgium) • Involving different stakeholders • Worker chooses who is involved in the RTW process • Tailored to the worker 5. Work reintegration agency Re-turn (the Netherlands) • Includes issues regarding work, home, family, relationships and physical/mental effects of treatment and RTW • Involves different stakeholders
- 10. 10 http://osha.europa.eu Innovative interventions: work reintegration agency and booklet 6. Work reintegration agency oPuce (the Netherlands) • Provides help for unemployed cancer patients • Results in new jobs for unemployed cancer patients • Works together with large companies 7. Booklet of the Irish Congress of Trade Unions (Ireland) • Aiming at: − Breaking the stigma of cancer and RTW − Encouraging good conversations between the employer and worker − Providing assistance to unions who are representing members diagnosed with breast cancer who are returning to work
- 11. 11 http://osha.europa.eu RTW process: role of employers and the importance of communication Employers are key stakeholders in the RTW process • They are in a position to create good working conditions • They can reduce discrimination and stigmatisation • They help minimise the economic impact of a cancer diagnosis Communication between companies and workers • Depends on the size of the company − In small companies, the communication lines seem to be shorter and the worker is likely to be informed sooner • Depends on the situation of the worker, including the severity of the medical diagnosis and their personal preferences
- 12. 12 http://osha.europa.eu RTW programmes for occupational and work-related cancer and for SMEs Employers’ positive attitude and understanding is crucial Lack of programmes aimed at RTW for workers with occupational and work-related cancer Companies with fewer than 250 workers (SMEs) lack information and resources for RTW strategies or programmes
- 13. 13 http://osha.europa.eu Implementation of instruments, practices, policies and interventions — barriers Barriers • Companies being unable to provide work adjustments • Occupational healthcare after treatment phase not being covered by the health insurer • Cultural stigma of a cancer diagnosis • Cultural misconceptions about working after a cancer diagnosis • Lack of time • Financial difficulties • Privacy legislation that hinders open communication • Attending physicians being too protective regarding RTW
- 14. 14 http://osha.europa.eu Implementation of instruments, practices, policies and interventions — facilitators Facilitators • Communication with worker and between stakeholders • Knowledge among HR personnel and supervisors on cancer and work • Company’s positive policy and attitude • Structural implementation of an RTW programme within the company • Legal possibilities of offering part-time work • Clarity regarding responsibility • Knowledge and sufficient skills at the workplace to support the RTW of the worker with cancer • Failure to address work immediately from the start of treatment
- 15. 15 http://osha.europa.eu Recommendations for practice Allocate enough time for the RTW process Allocate training • in knowledge of cancer and work aspects • in skills regarding elements of the RTW programme Ensure occupational health physician has access to the worker Occupational health physician should support both the worker and the employer early in the diagnosis and treatment process Provide practical information regarding, for example, reasonable accommodation Employer: ‘And then also making sure our HR people are crystal clear about our expectations in this regard so that they can support line managers.’ Employer: ‘Workers have access to the policy at any time. They know what their sickness payment entitlement is but we would more likely talk to them than send them a policy. Everyone is so different and everyone’s needs are so different, it’s not something that lends itself, other than the policy, it doesn’t really lend itself to being written down because everything is so individual.’ Employer: ‘We need to train line managers. The training is about, you know, being an engaging manager but, obviously, our approach to people is a core part of the training, in terms of respecting people, people’s health and safety at the workplace, and familiarising, making sure managers are familiar with our policies.’
- 16. 16 http://osha.europa.eu Recommendations for practice Open communication between the worker, employer and other stakeholders involved It should be mandatory for employers to offer RTW interventions or programmes to workers SMEs should be helped by occupational health services to make work requirements more flexible SMEs should align with other companies that have more flexible jobs Note the privacy rights of the worker Employer: ‘If occupational health thinks that somebody would benefit from counselling, we refer the worker to the Employee Assistance Programme. And then again, if somebody doesn’t want to be counselled, we can’t force them to go to counselling. We can strongly recommend it but we can’t force them. We do encourage people to use the Employee Assistance Programme to unload, you know, where possible.’
- 17. 17 http://osha.europa.eu Recommendations for practice Assess the worker’s needs and tailor the programme to the worker’s needs Stay in contact with the worker Worker: ‘My main point of contact was the head of HR. I mean, that was my choice. When I walked out of work, I really didn't want to be talking to multiple people. I just worked through the HR head, that made it easier. I kept like professionally work updated through her, with her head of HR hat on and then my colleagues updated through her as well.’ Employer: ‘Typically a home visit would always be with an HR person, and sometimes the worker might come into the office, and sometimes they might arrange to meet somewhere neutral like a coffee shop or whatever. So it can vary and its very much driven by the individual and whatever they are comfortable with and some people don’t want their line manager sitting on a sofa drinking coffee, they just don’t want it, they would rather come into the office or have a phone conversation or an email.’
Editor's Notes
- Amendable/Modifiable factors: e.g. fatigue, concentration problems, need for work adaptations
- Regarding 1) This programme shows a particularly comprehensive approach, with different resources targeted at multiple stakeholders, including employees, employers, the self-employed, HR managers and healthcare providers. It has multiple modalities, including online information, information in toolkits, consultations, e-learning modules, expert advice, (telephone) support and in-company training courses. The programme is for patients, healthcare providers and companies. Regarding 2) This Danish intervention is specifically targeted at seven different types of cancer, including more neglected diagnoses such as head and neck cancer and thyroid cancer. The programme is individual and tailored to the patient’s needs, and is carried out by a job consultant of the municipality. The innovative element of this intervention is the timing of the occupational rehabilitation, which is initiated much earlier than usual, and the active involvement of the workplace (employer and colleagues). Vulnerable cancer survivors will benefit from this approach, and the effects of social inequality on work ability will be reduced. The programme also allows patients to receive information on RTW before their treatment is over and before their sickness benefits run out. This is innovative, as otherwise patients do not receive RTW information or support until their sickness benefits are about to end. The involvement of the municipality (job consultant) is also innovative.
- Regarding 3) This programme shows a particularly comprehensive approach, with different modules targeted at multiple stakeholders, including employees, occupational health physicians (OHPs) and employers. It has multiple modalities, including face-to-face counselling and information, patient education, enhanced communication between treating physicians and OHPs, and collaboration between the employer, employees and OHP. It is executed by an oncology nurse trained in occupational issues. Interesting or innovative features were: Patient education and support at the hospital (as part of usual psycho-oncology care): four 15-minute meetings with an oncology nurse or medical social worker. Improvement of communication between treating and occupational physicians: a letter was sent to the occupational physician (if patients gave consent to allow medical information to be sent to the occupational physician). Regarding 4) This programme has a comprehensive approach, with different modules targeting the employee, but it also includes the patient’s employer and colleagues. It has multiple modalities, including consultation, individual coaching and group coaching. It involves patients and companies. Interesting or innovative features were: Rentree provides three different pathways: Rentree2, which provides support and assistance in finding a new job. Rentree Plus, which provides support and assistance in RTW (employee and Rentree create an RTW plan together), with many communication sessions with Rentree. Solo Rentree, which provides support and assistance in RTW (employee and Rentree create an RTW plan together), with no communication sessions with Rentree (employee returns to work independently). Regarding 5) This programme has a particularly comprehensive approach, with different modules targeted at multiple stakeholders: employees, companies and the self-employed. The programme has multiple modalities, including online information, consultation, expert counselling and in-company training courses. The measure is tailored for both patients and companies, and is specifically aimed at patients with a cancer diagnosis.
- Regarding 6) This programme is innovative because it focuses on the vulnerable and neglected group of unemployed cancer survivors. oPuce works closely with enterprises that are willing to place these unemployed people. The programme has several modalities, including coaching, counselling and on-the-job support. The programme involves patients and companies, the latter having job coaches. oPuce targets unemployed cancer survivors: in the Netherlands, 25% of employed cancer patients lose their job due to cancer and 61% will never work again because they won’t be appointed for a new job. By creating an ecosystem with large employers, social innovations are possible that are in line with the needs of the recovered cancer survivors and their employers. In an ecosystem, all stakeholders are included and play an equal role in finding solutions and making an impact. In the oPuce ecosystem, sharing knowledge and best practices between employers also stimulates job retention. Moreover, employers foster RTW by creating jobs for recovered cancer survivors. Regarding 7) The Irish Congress of Trade Unions provides an overview in booklet form of the processes and policies associated with RTW for those affected by breast cancer and other illnesses. Union representatives, union members and employees have worked together on this booklet, and it is an interesting innovative initiative.
- Regarding bullet 2: Occupational cancer is defined as cancer that is mainly caused by exposure at work, whereas work-related cancer is considered multifactorial and work exposure plays a smaller role, among other factors. No information was found on RTW issues and occupational cancer. This could mean either that this is not a problem that needs examining separately for occupational cancer (in comparison with other types of cancer) or that the problem simply has not been studied. As most occupational cancers have long latency and occur after working life or the prognosis is too severe, it could be that RTW is not a desired outcome. During the EU-OSHA stakeholder seminar, the European Commission underlined the importance of the tertiary prevention of occupational diseases, and outlined the difference between work-related and occupational diseases. The importance of performing risk assessments was also highlighted. Owing to the long latency and sensitivity of work-related cancer, risk assessments are needed so that working conditions can be adjusted in time. Furthermore, in the case of work-related cancer, it is important to talk about the risks (risk communication) so that both the employer and the worker are informed of the risks that RTW poses to health. Regarding bullet 3: The size of a company seems to have an impact on cancer survivors’ possibilities for returning to work. The problems seem to relate especially to small enterprises (with fewer than 50 workers) and to micro enterprises (with fewer than 10 workers). It has been reported that the RTW of cancer survivors seems more problematic for the self-employed and those working in small enterprises. This is because being off work for treatment and necessary rest is more difficult in small companies, as they have limited access to occupational health services and lack experience in the management of sickness absence. During the EU-OSHA seminar, stakeholders indicated that it is important to make straightforward recommendations to stakeholders in companies. It is especially important to recommend how cancer and RTW issues can be integrated into more general RTW programmes. However, the small size of SMEs was also seen as an advantage, as they provide a more family-like atmosphere, which may create a more supportive environment for workers with cancer returning to work.
- Regarding bullet 6: Clarity regarding responsibility (who is responsible for the RTW programme)
- Bullet 2: Training of supervisors, HR personnel and case managers in cancer and work aspects, e.g. long-term side effects, communication with the worker with cancer, and the elements of an RTW programme.