The law is clear. The support isn’t. Why cancer still carries an unfair burden at work

Two years ago, I wrote in this magazine about the cancer tsunami heading for UK workplaces. Since then, the evidence has only grown harder to ignore.

A Macmillan Cancer Support report published in February 2026 projects that the number of people living with cancer in the UK will increase by 58% by 2045, rising from 3.4 million today to 5.4 million.

And it is not only an older population story: global studies show that diagnoses among people under 50 have risen by more than 80% in the past three decades. Cancer is increasingly a working-age condition, and every organisation in the country will be touched by it.

Even for those whose hospital treatment is completed, the physical and psychological residue of cancer is substantial and long-lasting. Photograph: iStock

The same month, the Government published its National Cancer Plan for England, explicitly placing work and employment within the cancer care pathway.

This includes a new employer partnership pilot launching in 2026 and aimed at England’s 830,000 working-age cancer patients, with wider rollout targeted by 2028. And in April this year, Statutory Sick Pay was extended to be payable from day one of illness, a practical step for employees managing appointments and treatment side effects without losing income from the outset.

These are welcome developments. But policy progress at a national level is one thing. What happens on the ground, in line managers’ offices and HR inboxes across the country, is quite another.

The gap between the law and lived experience

The legal framework has never been unclear. In the UK, everyone with a cancer diagnosis is classed as disabled under the Equality Act 2010 (or in Northern Ireland, the Disability Discrimination Act 1995), and protected against discrimination in the workplace.

That classification is lifelong, covering every aspect of employment: recruitment, retention, promotion and post-employment references. Employers are legally required to make reasonable adjustments to support employees with a cancer diagnosis. 

And yet, Working With Cancer’s research with the Institute for Employment Studies, the Bevan Report (2024), found that 96% of UK organisations have no dedicated cancer policy. Only 18% collect data on employees with a cancer diagnosis and more notably, only 22% said their organisation had formally trained line managers on how to support someone living with cancer. 

A separate cancer and employment survey (2022) found that among employees who had returned to work after treatment, knowledge of the Equality Act was low at just 57% and only 22% of those who did know their rights had learned this from HR or occupational health. 

The law is clear. The implementation is not.

Cancer is not a short-term absence - it’s a long-term condition

One of the most persistent misunderstandings in workplace cancer support is the assumption that cancer follows a recognisable arc: diagnosis, treatment, recovery, return to work. That once treatment ends, normal life resumes.

This is not how cancer works.

Treatment timelines are long and unpredictable. Breast cancer patients, for example, are typically on strong hormone medication for five to 10 years after initial treatment, causing joint pain, insomnia, cognitive difficulties, mood changes, and fatigue - conditions that affect performance, concentration, and quality of life on a daily basis, for years.

For those with advanced or metastatic cancer, treatment is not a finite chapter at all: they may be in active treatment indefinitely, while continuing to work, manage teams, and contribute fully.

Even for those whose hospital treatment is completed, the physical and psychological residue is substantial and long-lasting. Fear of recurrence, scan anxiety, cognitive difficulties, profound fatigue and changed capacities are all documented consequences that can persist for years. What felt manageable before a diagnosis may no longer be possible in the same way.

None of this is captured by a standard absence management policy. Return-to-work interviews and absence frameworks designed for short-term illness do not map onto the reality of living and working with cancer. When organisations apply them anyway, they inadvertently punish people for an illness they did not choose and cannot control and place the entire burden of navigating that gap on the person least able to carry it.

The problem with putting it all on the employee

Here is what we see again and again at Working With Cancer: employees spending enormous energy they do not have on educating their employers about their own rights.

The single most influential factor in whether an employee with cancer has a positive or negative workplace experience is their line manager. Photograph: iStock

Because most HR managers do not proactively share information about legal rights and available support when an employee is diagnosed, the employee finds themselves having to research the Equality Act, identify what adjustments they are entitled to, and make the case for a reasonable phased return - all while managing treatment, appointments, and the physical and emotional weight of their diagnosis.

In our direct work with employees navigating cancer, fear of disclosure is one of the most consistent themes we encounter. People stay silent not because disclosure offers no benefits, but because they cannot predict how their employer will respond. Experience tells many of them that the risk of discrimination, reduced opportunity, or being quietly managed out is real.

But disclosure alone is not the answer. Even among those who do tell their employer, most are never proactively informed of their rights. They disclose, and then wait for a conversation that rarely comes, for information that is rarely offered. So they push through regardless, carrying a workload their body and mind can no longer sustain at the same pace, because no one has told them they are entitled to ask for something different.

Whether they stay silent or speak up, the outcome is too often the same: burnout, early medical retirement, or being managed out on capability grounds, not because they could not have continued with appropriate support, but because that support never materialised.
This is a systemic failure of organisations, not individuals.

And it is one that employment law, as currently applied, does not adequately prevent. Employers can still dismiss employees on capability grounds even where the capability issue is a direct consequence of cancer treatment, a particular injustice for those with advanced or metastatic cancer, managing ongoing treatment indefinitely within a legal framework that was never designed with their situation in mind. We believe this needs to change.

The line manager is the deciding factor and most are unprepared

Research is consistent on this point: the single most influential factor in whether an employee with cancer has a positive or negative workplace experience is their line manager. Not HR policy. Not occupational health. Not the employee’s own resilience. The line manager.

Barbara Wilson: "Government policy is moving in the right direction. The question is whether workplace culture will move with it."

Line managers set the tone for whether cancer can be spoken about openly or must be managed in secret. They make day-to-day decisions about workload, flexibility, and whether adjustments are implemented in spirit or just on paper.

And yet the Bevan Report found that 78% of organisations had provided no cancer-specific training to line managers whatsoever. Almost half of HR managers worried their managers might say the wrong thing; a third lacked confidence in their ability to have a difficult conversation at all. 

The consequences are predictable. Untrained managers treat reasonable adjustments as favours rather than legal obligations. They apply a performance lens to employees whose difficulties are medical in origin.

They avoid the conversation out of discomfort, leaving the employee isolated at the moment they most need contact. And they sometimes assume that advanced or metastatic cancer means someone cannot or does not want to work, when many people in active treatment work successfully for years, and work is often central to their sense of identity and wellbeing.

The policy moment is now

The National Cancer Plan and the Macmillan projections together create the clearest case for employer action in years. But the plan works only if employers do their part.

The new employer partnerships need someone at the organisation’s end who knows what to do. The personalised care plans require a line manager who understands what they are looking at. The Statutory Sick Pay change is meaningless if day-one absence is still treated as a disciplinary matter rather than a medical one.

Government policy is moving in the right direction. The question is whether workplace culture will move with it or whether employees with cancer will continue to carry, alone, a burden that the law says should be shared.

Working With Cancer is a UK-based social enterprise founded in 2014 to help employers and employees navigate the impact of cancer in the workplace. Working across organisations ranging from small businesses to global corporations, including banks, legal firms, pharmaceutical, FMCG and retailers, it provides policy development, consultancy, training, coaching, manager support, workplace guidance and employee drop-in clinics to help organisations build more supportive, legally compliant and inclusive workplaces. Free webinars on managing cancer in the workplace are also available throughout the year for both employees and managers. See:
workingwithcancer.co.uk
linkedin.com/company/working-with-cancer
X: @WorkWithCancer
Instagram: @workingwithcanceruk

Barbara Wilson is founder of Working With Cancer

What employers should do now

• Establish a dedicated cancer policy. General absence frameworks are not enough – cancer requires specific, named commitments.
• Train line managers. They need to understand treatment timelines, side effects and how to have difficult conversations and know that reasonable adjustments are legal obligations, not favours.
• Communicate proactively. When someone discloses, provide information on their rights and available support immediately. Do not wait for them to ask.
• Keep in touch. Talk to your employee about their cancer and progress. Give them space to say how they are feeling. Recovery is never a straight line.
• Plan for at least 12 weeks on phased returns and stay flexible. Be prepared to revisit the plan regularly; this is a process that can take 12 to 18 months, not a single event.
• Stop applying a performance lens to medical realities. Cognitive changes, fatigue and fluctuating capacity are clinical, not behavioural.
• Protect confidentiality and do not make assumptions about someone’s career goals, their capacity, or their experience. Every person’s cancer is different.
• Take advanced cancer seriously. Do not assume a metastatic diagnosis means someone cannot or does not want to work. Listen to what they want and need.

A note for employees with cancer

A cancer diagnosis brings an overwhelming amount to manage. Work should not add to that burden but for too many people, it does. Here is what you need to know.

• You have rights from the moment of diagnosis. Cancer is automatically classified as a disability under the Equality Act 2010, giving you lifelong protection regardless of your treatment status. You are entitled to reasonable adjustments, including flexible hours, remote working, reduced workload, rest breaks and phased return. These are legal rights, not favours.
• You control who knows. You can tell only those who need to know, such as HR and your line manager, and ask that they keep it confidential.
• Ask for occupational health. Request a referral from HR. Occupational health can recommend adjustments and support a structured phased return.
• Be kind to yourself. Returning to work is a process, not an event, and it can take 12 to 18 months to feel sustainable. Ask for at least 12 weeks of phased return, and you may need more.
• If you are on long-term treatment, you are not post-treatment. Hormone therapies, monitoring, and ongoing appointments are part of living with cancer. Your needs remain legally protected.
• Access financial support. PIP (Personal Independence Payment), ESA (Employment and Support Allowance ) and the Government’s Access to Work scheme may all be available to you. Always seek up-to-date advice as the benefits landscape is changing.
• Connect with support networks. Inside your organisation or through specialist cancer charities and hospital-based groups, you do not have to navigate this alone.
• Consider specialist coaching. Working With Cancer offers free webinars and specialist coaching for employees and managers at workingwithcancer.co.uk/resources/events.