Cancer Survivorship Themes: Concerns about Returning to Work

This is the fourth in a series of descriptions of common themes encountered among cancer survivors who attend the Connecticut Challenge Survivorship Clinic at Yale Cancer Center.

For many adults, the work they do (that is, employment) is an important part of self-identity and socialization and an important source of self-esteem.  Understandably, those who have had to cut back or stop working because of cancer treatment have concerns about returning to work.

• I'm starting back to work soon.  I'm looking forward to it, but I'm nervous, too. 
• What if my boss expects too much of me at first? 
• I've developed some healthy habits after my treatment and I'm afraid I won't have time or will get too busy to continue them.
•  My co-workers have been supportive, but I don't know if I'm ready to go back full time-will I have the energy, will I be as sharp?
• I used to have to lift those little kids in my class-I can't do that now.
• My head is in a very different place now.  I wonder if I'll still fit in.  This job doesn't hold the same meaning it once did.

We have asked the Survivorship Clinic specialists to address these concerns in a hypothetical participant.

Advanced Practice Nurse:  Returning to work (at either the same or a new job) is an important milestone for a survivor.  It does require planning and sometimes soul-searching.  Many survivors "ease into it" by starting back part-time or with a reduced work-load, just as a person might who is recovering from an accident or heart attack.  It is both prudent and acceptable to request certain accommodations, such as office work before resuming field work, for example.

Physical Therapist:  How can you return to work and still find ways to stay active or increase your activity level?  If you work on the upper floors of an office building, take the stairs instead of the elevator (and if you do work on the first floor, you can always walk up and down the stairwell several times anyway!)  You can park farther away from where you work in the parking lot; if there is a shuttle to work from the parking lot, try to walk the distance once a day for two weeks, and then as you get stronger you can walk round-trip.  If you plan on going to a gym or working out after work, bring your gym clothes with you to work, and change into them at the end of your work day.  This way, you don't have to go home first to change and then potentially get distracted from your time to exercise.  Encourage a co-worker (or two or three) to come with you on a lunch-time walk or an after work workout.  Having a partner to exercise with makes the task more fun, it makes the time go by faster, it holds you more accountable, and you are getting somebody else to exercise and be healthy too!  Talk to your co-workers and your supervisor about entering a corporate challenge at a local road race, bike event, or other activities such as a weekend hike.  This will help get more people to be active and help build camaraderie amongst all of your co-workers.

Social Worker:  Communication and flexibility are the keys to transitioning back to work.  Have a head-to-head/heart-to-heart conversation with your boss and communicate your reality.  The contemporary work place seems to have more options for survivors.  Do you need to temporarily (or permanently) reduce your hours/days at work?  Is it possible to work some hours/days from home via computer?  Honesty is usually the best policy and most employers want to support their employees for a myriad of reasons.

Nutritionist:  Returning to work can present many obstacles to eating well. All of them can be addressed with a thoughtful plan and a good food store to arm yourself with on-the-go foods. The first challenge is making sure you schedule the time to eat within your hectic day. This starts with a mandatory breakfast. Either at home or at your desk, eating something quick like a bowl of high fiber cereal with berries and skim milk energizes your day. The work environment itself can present many hazards:  candy bowls on desks, Danish by the coffee maker, or the vending machine down the hall. Stock your work area with healthy snacks such as dried fruits, yogurt, or nuts. Try to enlist your co-workers to establish a healthy-food-only office policy to benefit all. Lunch provides a much needed mental and physical recharging.  Brown bag lunch (a simple sandwich or dinner leftovers and a piece of fruit) then take a brisk walk with co-workers.  The late afternoon snack is essential to eat either at work or on the commute home. This is a natural low energy time. Don't fight it, fuel it. A piece of fruit and some cheese or nuts will take the edge off of your hunger. You don't want to arrive home ravenous, thereby setting yourself up to overeat at dinner, or worse, continually grazing throughout the evening. When you fuel your body throughout your workday, you find that dinner becomes your smallest meal.

For those who work evening and night shifts, adapt your eating schedule to fit your work hours even if that means your "breakfast" is at 11 PM and "dinner" is at 7 AM.

Editor's Note: In the June 2009 issue I asked the question, Who Is a Cancer Survivor?  Please see the Tanzman essay, below, for another take on that question.

• Accompanying editorial: Kelley AS, Meier DE. Palliative care--a shifting paradigm. N Engl J Med. 2010;363(8):781-2.
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