Stress and the total disease: supporting employees after cancer

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Returning to work after cancer treatment can be a very difficult process for most people. In some cases it becomes such a stressful experience that some fail to cope, especially if their employer does not know how to manage the return.

Sometime ago I was called to a case in one of my client companies. Maggie, a well-educated woman in a senior position at a global company’s internal communications team, had returned to work after a long absence due to breast cancer. Within a week she was at home again, refusing to talk to her boss and telling colleagues she was stressed, exhausted and ‘unable to stop crying’.

Colleagues were upset, confused and felt guilty that they should have done more to ease her transition back to work. The work group, of around five people, were in conflict, laying the blame on each other and unable to work effectively. The boss, a calm and reasonable man with whom I had worked for a number of years delivering communication training workshops, was at a loss. He asked me to talk to Maggie and see what could be done. Later, as I became more involved in cases relating specifically to cancer rehabilitation, I discovered this is an all-too-familiar scenario.

People at risk
Women become more susceptible to breast cancer from around 50 years of age – the risk increasing year by year. This means many of them are still working, often have children in their teens, are already coping with the physical and psychological changes of the menopause and may also be providing support to ageing parents. They are the ‘spider in the web’; in a life situation where there are many demands and pressures, with a group of people relying on them to be well, strong and effective. In addition they have often reached reasonably senior roles at work with all the inherent responsibility and pressure to perform.

In Maggie’s case, long periods of being in bed, nauseous and exhausted from her treatment, had allowed one of her three teenage children to stray completely off track, not attending school and experimenting with drugs and alcohol as a means of avoiding the emotional anxiety about his mother’s illness. The other children were doing their best to keep the household together, as well as regularly visiting their old and infirm grandparents to provide the sort of practical assistance Maggie normally provided.

School work was low down the priority list and all their additional after-school activities had stopped as there was no one to support them. Maggie herself felt guilty about the children and her inability to do anything. The elder son ended up in a youth programme for drug abusers. Maggie’s husband found the situation intolerable and left the family home. A divorce followed shortly and all the accompanying problems of having to sell their house, re-adjust to a lower income and manage the emotional reactions of the children.

Maggie’s return to work was traumatic for many reasons:

  • A sudden change of pace after months at home
  • New information and processes to which she had to adjust
  • Sensitivity to stress and pressure not experienced previously
  • Loss of confidence due to the physical changes brought about by the cancer treatment
  • A sense of being avoided by some colleagues who did not know what to say
  • A sense of being watched and talked about by other colleagues
  • A reminder of the life she had before it was changed so dramatically in every way by cancer.

As I talked to Maggie it became clear there was not a holistic rehabilitation programme for her and her family and also a lack of support from her work team and boss, who were very willing and kind, but also afraid of doing the wrong thing; as a result they did nothing. There was also the huge risk to Maggie for further illness, either from cancer or stress-related conditions, due to the great pressure she was under.

The relationship between stress and cancer is only now starting to be fully explored and researched. However, ever since the time of the ancient Greeks there has been an interest in the relationship between psychological states and cancer.

Those who have devoted their lives to finding ways to treat and cure the illness long ago recognised that an individual’s holistic state plays a vital role in how they respond and recover. In the mid 1950s, Sidney Farber, who is considered the father of modern chemotherapy, insisted that cancer must be seen as a ‘total disease’, due to its hold on patients psychologically, socially and emotionally, as well as physically. He talked about the concept of ‘total care’, believing that only a multi-faceted programme of treatment would ensure success.

Today there is even greater understanding of the holistic nature of cancer and the need for a multi-dimensional approach, not just during treatment but afterwards. A paper published in The Lancet in 2004 reviews the evidence that various cellular and molecular immunological factors are compromised in periods of chronic stress and depression. It discusses the clinical implications in the initiation and progression of cancer. 

Undoubtedly, the relationship between stress and cancer is not exclusive to women. There is increasing evidence that risk factors such as social adversity, depression and stress play a role in cancer progression for any individual. Yet what I see when I work with women in business is that, despite what legislation, quotas and political correctness would have us believe, it is still very often women who take this ‘spider in the web’ role in their families. When they ‘break down’, albeit temporarily, the whole family breaks down with them. This in turn increases their stress levels to an extent which inhibits their recovery.

If the workplace is also creating stress by not providing a well-thought-through rehabilitation plan, there is a risk of losing the employee for longer periods of time and even completely. The return to work should be a welcome experience of life beginning to normalise again, the opportunity to re-connect with colleagues who can provide friendship and a renewed sense of self-worth by being able to contribute again.

What can employers do?
There are a number of key steps:

  • Get advice from experts on how to ensure you have a holistic rehabilitation plan for employees
  • Make this plan explicit in the organisation so that employees know what is available
  • Ensure that managers and HR personnel have the training and communication skills to deal with the disease without fear and anxiety themselves
  • Avoid a ‘one size fits all’ approach and ensure someone in the organisation has an ongoing and open dialogue with the employee which allows for maximum flexibility
  • Ensure the teams who have suffered the loss of a colleague due to serious illness or death are fully supported, with counselling available as needed.


Deborah Mattsson Clarke is director of The Way Forward



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