After the treatment finishes then what? (Dr Peter Harvey)
20 Going back to work
This particular problem (how you identify yourself and how you talk about your illness) has a special relevance when talking about returning to work.
But before moving into the problems of managing your first day back there is a decision to be made before that - do you want to go back to work and, if so, when? Now this will not be a problem if you were not working before your diagnosis.
Likewise, the decision to return to work or not will be influenced by practical issues like money, especially if your income has dropped significantly during your treatment (an all too common problem). However, you may be in a position where you have some choice in the matter.
For many people, getting back to work is a key part of their return to ‘normality’ and the ordinary. This sometimes becomes an overwhelming pressure and can force people into returning too early, before their strength and stamina are back. But,as with regaining your energy and managing fatigue (see Dealing with fatigue), taking things in a step-by-step fashion is a helpful approach.
The first stage, of course, is the be realistic about what is and is not possible. Questions about changing jobs or working part-time may not be an option if your financial situation does not allow it. Whilst this is not the place to offer financial advice it is important to acknowledge that economic hardship is counter-productive to psychological well-being.
It may be that you would benefit from unbiased advice about this if it worries you and some support centres have welfare rights advice, as do some charities (see Further help and support on the Resouces page).
So, if you are in a position where return to work is something you may have some control over, what decisions do you have to make? For some people the time after treatment has finished is an opportunity to decide whether they wish to stay in their old job, make a career change or stop work altogether.
These are not always easy decisions as so much of our identity, self-esteem and self-worth is tied up in what we do. It is important not to rush any decisions like this and it may be helpful to talk through the pros and cons with someone neutral who you can trust.
If you have a sympathetic employer (a luxury unfortunately not available to everyone) it may be helpful to talk about any alternative jobs that they might have. You may have been in a very stressful and demanding post and would prefer to take on something less pressurised, for example.
In this situation it is important to see a change as not giving in or being weak. It can be a very creative step in terms of taking care of yourself and ensuring that your future health is not compromised in any way. Whilst there is no strong evidence to suggest that stress on its own is a direct cause of cancer or its recurrence it would be foolish not to accept that over-exposure to high levels of difficult-to-control stressful situations will have a negative influence on general health.
So the first set of decisions revolves around whether to return to the same job or not. The next set of decisions is about how you manage your return.
Let’s look at two different scenarios, one where you return to your old job, the other when you go into a new job. We will look at leaving work entirely separately. One important assumption - that you have given yourself enough time to build up your strength and that you have recuperated and convalesced.
One of the most disheartening experiences occurs when people return to work before they are ready and have to take more time off because they are not fully fit.
Going back to your old job after some months off is not going to be easy. Many of you will be familiar with the length of time it can take settling back in after even a short break like a holiday, so the length of time itself can be a major problem. Systems, procedures and people can all change and leave you feeling isolated and unsure, feeding into any residual lack of self-confidence (see Regaining trust in yourself).
Many of the more responsible employers will not allow people to return to work full-time after a significant period of sick leave and insist on a phased return. While the details of this will vary from company to company, the principles are very much in line with the one step at a time model outlined here.
It may start with a morning or afternoon, then a day, then two days and so on until you are ready to face the full week. Many people are surprised at how exhausting this process is and find that it can take some weeks before they can come home and not fall asleep immediately.
During this time you can familiarize yourself with the new routines and processes if you need (again, a good employer should ensure that proper training is in place to help you) or to re-acquaint yourself with former work practices.
These are relatively straightforward issues to address - a much more problematic one concerns how you want people to react to you and your time off sick. There can be embarrassing and uneasy silences when people may feel unable to talk about cancer or ask how you are. You may feel inhibited, not wanting to upset people or to feel that you are playing for sympathy. This is a decision only you can make. Sometimes it is possible, especially of you are in a relatively small and cohesive workgroup, to start out be setting down your ground-rules.
You may be the sort of person who is quite happy to talk about your diagnosis and treatment to whoever will listen; on the other hand you may find talking about the whole affair unpleasant and distressing. This is your call but it is often better to tell people how you want them to behave rather than assuming they know.
You yourself may have been in a position before your diagnosis when you were faced with someone who had cancer - did you feel confident in having a conversation with them? You may want to think ahead. Because cancer is so common, it may well be that one of your colleagues or one of their relatives or friends is diagnosed. Would you like to know or not? Again, by giving guidance on what you would like you are helping both yourself and those around you.
If you starting a new job then you will have similar additional burden to that you would experience whatever your history - how much do you tell of your immediate past? As before there is no single answer to this.
Honesty is generally the best policy and being open with your new work colleagues in the same way as outlined before avoids potential pitfalls. One advantage of beginning a new job is that you can start afresh with your own work discipline. Perhaps you will want to address that currently fashionable issue, the work-life balance.
One of the phrases that people use after the treatment finishes is the ‘Life is too short’. Taking this seriously can benefit your health and well-being in a significant manner.
The Cancer Counselling Trust has now closed.
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