Work & Wellbeing After Breast Cancer
We let out a collective sigh when cancer treatments are finished and start to talk about how we kicked cancer’s butt. However feeling grateful to be alive can give way to feeling less than satisfied with the future you fought so hard to get. Part of my anticipated future was returning to my successful career as it featured very prominently in my past. Yet rarely do we talk about the vocational difficulties experienced by women post breast cancer. Many report physical disabilities (e.g. peripheral neuropathy, joint pain, lymphedema) and cognitive difficulties (e.g. depression, anxiety, lack of concentration, fatigue) often resulting from the aggressive treatments used to attack the disease. These disabilities – temporary or permanent - impact our experience at work or indeed, our ability to continue working at all. Unemployment is three times higher among chronically ill and disabled than non-disabled groups.  A Swedish study concluded, “Work is a very important aspect in life after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with breast cancer patients.” In my experience work both as a cancer survivor and as a coach of survivors it is seldom discussed or, at best, seen as a side consideration for women with breast cancer. I wish I’d been more prepared for how my career might change and how this would impact my wellbeing.
I took a six month career break during the chemotherapy and radiation phases of my treatment. I returned to work while receiving Herceptin infusions every 3 weeks. I found my energy levels and confidence affected to the point I no longer knew if I belonged at work despite the fact I’d been working successfully at senior executive level previously. My colleagues assured me I was still doing a great job. I worried about what I was able to do without either risking a setback in my recovery or being ineffective at work. The cumulative effects of clinical fatigue and “chemobrain” were frustrating. Somedays I couldn’t find simple words or remember familiar names during a presentation or meeting. Colleagues didn’t always make the connection to the cause stemming from treatment. They had no people or policies to educate them. What I wanted most desperately was to “get back to normal”. I didn’t help myself as I hid my temporary disabilities pretending everything was just fine. Eventually, I let my working life take a back seat. I accepted part-time, remote work preferring to hide my struggles. I found it less relevant and less rewarding. It left a big empty hole in me and my resume making my job search when I returned to full health more of a stretch. I missed the stimulus, the human connection and the status. I felt bereft of my identity for a second time after diagnosis. (The first loss of identity went with my hair!)
Some women never to skip a beat. Others create a new and fulfilling direction for their career. I did over time but the beginning of my journey, it appeared everyone else had work under control and this undermined my confidence more. I was reluctant to talk about my obstacles in case I was seen as “not coping” in a competitive, male dominated workplace. Every other breast cancer survivor seemed to be Superwoman, returning successfully to work even during treatment. I settled into a cycle of doing work I had no commitment to and from which I gained little satisfaction. I was afraid to make a change in case I wasn’t up to it. I no longer had a reputation as a formidable work warrior so kept any challenges I faced hidden in an attempt to stop its further erosion. I kept all my career-related confusion and anxiety hidden behind a grateful, smiling façade, doing nothing to help my general well-being. It was never part of any recovery plan to have someone help me cope with work, find clarity or direction for my professional future after cancer. On reflection, it should have been!
Why does work matter to women like me coming back from a cancer diagnosis? Work is central to individual identity, social roles and status and helps meet an individual’s particular psychosocial needs in societies where employment is the norm. It also provides financial security and the ability to pay for services necessary to support wellbeing for those with chronic illness. Some breast cancer survivors already have fragile identities laid vulnerable at the hands of a life threatening disease; by treatments – both weakening and healing; and the loss of body parts intrinsically connected to the feminine image (e.g. hair and/or breasts). Work and career can be a place to reassert parts of one’s identity providing a purpose to daily life. Employment is therapeutic for people with chronic illness helping with their recovery and rehabilitation. It improves the quality of life and minimizes the ill effects of cancer and its treatments on mental health.
It is important for breast cancer survivors to have knowledge about how employment and careers are experienced differently by different women after cancer and the varied options available to choose for their future. It is also critical to include career as a topic for consideration in their recovery plan. Just as it has been recognized that a multi-disciplinary team is needed to advise about nutrition, exercise, medicine, treatments and make up, your team needs a source of advice for handling your current career or transitioning to a new one. I believe I would have found my way quicker if career had been discussed rather than side-lined. The guidance should start at the beginning of your journey as some women will have every intention of working during treatment. There is a light touch on BreastCancer.org but it is no substitute for access to an occupational therapist and their specialist knowledge in supporting you with physical and/or cognitive disabilities in your workplace .
Information about your rights and responsibilities for reduced working hours, paid leave, benefits or time off for appointments aids decision-making for breast cancer patients. Advice on how to approach employers for reasonable accommodations or alternative work for the duration of treatment and beyond helps too. Working closely with your HR professional or a manager in your organization at an early stage will get you the information you need that’s particular to where you work.
You might need to examine your own career expectations in this new life phase. Re-establishing priorities and creating a detailed plan can help. A life or career coach, especially those specializing in working with cancer survivors or those with chronic illness, can help you establish a plan of action. Life coaches work with women on life challenges, new career planning and job-seeking strategies as these often move forefront in recovery . There are specialist organizations and job sites such as Chronically Capable  or Flexjobs sharing remote or flexible job opportunities too. Volunteer opportunities listed by Taproot or Volunteer Match provide alternative ways to contribute and rebuild identity. How to respond to colleagues, their reactions and expectations to the “woman who has/had breast cancer” can be an area of focus ahead of any return to work. There are non-profit centers or support groups providing ‘cancer counselling’ to address such issues.
If you are a cancer patient you can expand your cancer care team to include these professionals or resources. If you are an employer or work in HR, consider adding these to your toolkit to help ensure your employees with breast cancer recover, rehabilitate and thrive in your workplace. If breast cancer survivors see career or the world of work as central to their identity before cancer, it is likely that it will remain so after treatment for some at least. I needed to pursue a different, nurturing career path resulting from an informed choice to match the new me. I wish I’d given my career the attention I’d given to other aspects of my post cancer recovery sooner.
Meinhart, A; De Boer, A. & Feuerstein, M. (May, 2013) Employment Challenges for Cancer Survivors, Cancer https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.28067
 Nilsson, M.I., Saboonchi, F., Alexanderson, K. et al. J Cancer Survivorship (2016) 10: 564. https://doi.org/10.1007/s11764-015-0502-7
 Waddell, G. & Burton, A.K. (2006), “Is Work Good for your Health & Wellbeing?” TSO, London https://www.gov.uk/government/publications/is-work-good-for-your-health-and-well-being
 Chronically Capable – a job site https://www.wearecapable.org