The occurrence of cancer has several pronounced repercussions on people’s lives. Diagnosis and treatment of tumours are very burdensome events that often deeply impact mental health and quality of life.

In parallel to personal life, the onset of a tumour has important effects on the professional life of working patients. Workers with cancer and their caregivers often experience deep psychological distress and mental health issues because of the disease itself, its consequences at a psychological and physical level, and barriers in the workplace environment that can cause difficulties.

Several negative influential factors can be present in the work environment, whatever the employment sector. In most cases, barriers are reported by patients to be related to an inappropriate interaction between the type of work, the organisational and managerial environment, the skills and competencies of the peers and other staff, and the facilities offered to carry out the work. Stigma and discrimination at work are also frequent problems that can have considerable negative effects on mental health.

The most relevant one is facing difficulties when re-entering the labour market. Workers with cancer often have to give up work entirely, change jobs, or reduce their hours or duties, and they are often not supported by their work environment. Vocational Rehabilitation programs have shown to be effective, but their implementation worldwide is still limited.

In addition to these problems related to the work environment, many research studies highlight the difficulties experienced by workers with cancer because of symptoms and treatment. Some patients with tumours continue to work but report limitations at work due to symptoms that produce difficulties in managing job demands. This causes impairment in their “work-ability”, which means their ability to work and the ability of the environment to adapt to the present functioning of a person.

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Symptoms that significantly impact work activities that can be particularly mentally or physically demanding include fatigue, cognitive and sleep disorders, pain, and psychological distress. Because of the impact of their symptoms on their ability to work, patients with tumours are more likely to leave their job if the environment is unable to adapt with reasonable accommodations to the person’s new needs.

Cancer has a profound effect on patients themselves and their family and friends, particularly those who assume the role of caregivers, who commonly experience deep psychological distress.

Different research studies outlined the burden of caregivers of patients with cancer. Caregivers often experience a consistent impairment in their quality of life and mental health, experiencing anxiety and depressive symptoms. The caregivers’ burden also appears in their ability to provide care and financial strain.

Also, caregivers often struggle with managing their daily life, and if they are working, they can find difficulties balancing caring activities and job demands.

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However, work has a central role in people’s life. Working contributes to autonomy, independence, self-esteem, self-realisation, quality of life, and life satisfaction. Indeed, employment, work satisfaction and good work-life balance benefit mental health and quality of life. In contrast, unemployment and a negative work environment are risk factors for physical and mental health problems.

For patients with cancer, returning to or maintaining their work as much as possible means maintaining income, identity, social relationships, and improving quality of life.

Given these premises and the importance of work for people’s lives, job retention and return to work of patients with cancer need to be a primary goal for society.

There is a need to support workers who suffer from cancer and workers who care for an affected relative. Different actions can be undertaken to reach this aim.

First, it’s crucial to raise awareness and sensitise employers and employees on this topic to promote a safe work environment with no stigma or discrimination and work inclusion.

Second, it is likewise important to develop and implement reasonable accommodations and specific programs that let workers with cancer and caregivers maintain their jobs. It is also of uttermost importance. Flexible work conditions can allow working patients and their working caregivers to conciliate job demands and assistance needs.

Finally, taking care of the mental health of patients with cancer and their working caregivers is a priority.

It is essential to offer care and support to patients and caregivers, helping them cope with the psychological distress they experience in their personal and professional life.

References:

• https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/mental-health-in-the-workplace
• Political declaration and list of actions against cancer recommended by a panel of european stakeholders. 2022 European Meeting of the French National Cancer Institute.
• 2021-2030 France ten-year cancer-control strategy / 2021-2025 roadmap. French National Cancer Institute.
• Silvaggi F, et al. Employment and Work Ability of Persons With Brain Tumors: A Systematic Review. Front Hum Neurosci 2020;14:452.
• Seifart U, Schmielau J. Return to Work of Cancer Survivors. Oncol Res Treat. 2017;40(12):760-763.
• Feuerstein M, et al. Work productivity in brain tumor survivors. J Occup Environ Med 2007;49(7):803-11
• Ho PJ, Hartman M, Gernaat SAM, Cook AR, Lee SC, Hupkens L, Verkooijen HM. Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study. Support Care Cancer. 2018 Aug;26(8):2815-2824.
• Geng HM, Chuang DM, Yang F, Yang Y, Liu WM, Liu LH, Tian HM. Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Sep;97(39):e11863.
• Petruzzi A, et al. Living with a brain tumor. Support Care Cancer 2013;21:1105–1111
• https://www.aimac.it/aimac-per-te/pro-job-risorse-impresa-lavoratori

Claudia Toppo, Alberto Raggi, Martina Cacciatore, Matilde Leonardi
Fondazione IRCCS Istituto Neurologico Carlo Besta (Milan, Italy)
https://www.istituto-besta.it/

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