The impact and challenge of cancer is becoming a pressing concern for employers. With one in two people experiencing a cancer diagnosis in their lifetime, and the cost of cancer outstripping musculoskeletal conditions to become the condition that costs businesses the most, it’s vital for employers to understand the impact of cancer on their workforce and respond accordingly within and beyond their wellbeing strategy.
In this article, we’ll look at three specific challenges: identifying and including the cancer cohort, mitigating the impact of NHS delays and supporting mental health.
1. Identifying and including the cancer cohort
Around 1.5% of the average workforce will receive a cancer diagnosis, but this doesn’t tell us the full story about how cancer affects businesses. While individuals with an active cancer diagnosis are the most visible to employers (and researchers), because they have to notify their managers and usually take time off work, they account for only a small proportion of a business’ entire cancer cohort. In order to include everyone impacted by cancer in wellbeing strategy, it’s vital that employers identify two further groups and understand the support they need:
2. Those living with and beyond cancer
This group often needs more support than those undergoing active treatment because they are no longer under regular care from an oncology team and are at a higher risk of other conditions, including diabetes, psychological illness, pain and fatigue, not to mention the risk of recurrent or secondary cancer. However, 50% of those living with and beyond cancer won’t reveal their diagnosis to employers. Fearing discrimination, they cope with side-effects without accommodations.
3. Those looking after someone with cancer
Cancer charity Macmillan estimated that cancer carers in the UK exceeded 1.4 million in 2016. The true number is thought to be much higher as the status of many carers goes undocumented. Many of those caring for someone with cancer take years to even identify with the label ‘carer’. What is known is that 90% of cancer carers are also juggling a job. They experience higher rates of psychological and physical illness and higher rates of absence. Many will need to make structural changes to their working pattern in order to manage their caring responsibilities.
4. Mitigating the impact of NHS delays
While unprecedented delays are currently experienced throughout the NHS, cancer is of particular concern due to its increasing prevalence and current failure to meet targets set by the government. Those targets state that 93% of people urgently referred to a specialist team with suspected cancer should be seen within two weeks. This has not been met since May 2020 and, in January 2023, stood at 81.8%. For patients with confirmed cancer, 83.3% should start treatment within 62 days of an urgent GP referral. In January 2023, 54.4% of patients were treated within this timeframe – a record low.
What’s more worrying is that the situation is not improving. New figures show that, at the end of April 2023, 22,533 patients in England were waiting more than two months for either cancer diagnosis or treatment, up from 19,023 at the end of March.
It is estimated that the current backlog will take years to clear, leaving huge numbers of employees struggling to cope with ill health or pain, as well as the anxiety experienced as a result of the uncertainty and delays. This presents a significant challenge to employers. Data from December 2022 found that one in five employees who have been impacted by NHS delays say their work has been affected. Around 40% have had to make changes to the tasks they do, 20% have reduced their working hours while they wait for treatment, and 10% have been forced to go on long-term sick leave.
5. Supporting mental health
According to Cancer Research UK, 3 in 10 people with cancer will experience mental health issues such as anxiety and depression. The reasons for this are complex, ranging from the impact of physical treatment side-effects, to psychological factors like isolation and fear of recurrence, and more practical concerns like financial pressure. A 2021 survey by the charity Maggie’s found that 3 in 5 people who have or have had cancer feel that the mental challenge of the disease is actually harder to cope with than the physical treatment and side effects. Once again, the experience of mental health challenges varies across the cancer continuum:
The mental trauma of a cancer diagnosis can be – understandably – significant. Our healthcare specialists list frightening thoughts, being distracted or overexcited, trouble sleeping and/or feeling detached from oneself or reality, as typical reactions, as well as feelings of shock, fear and helplessness. The newly diagnosed often feel a need to protect friends and family by holding in their feelings.
A study published in 2021 found that cancer patients undergoing treatment – in this case radiotherapy – suffer from depression, anxiety and stress. There are similar reports for people going through chemotherapy, which itself can cause brain fog, fatigue and low mood. The physical side-effects from treatment are also a significant factor in mental ill health. Recovering from surgery, experiencing pain, perhaps reduced mobility, low energy levels and even scarring, can all take an emotional toll.
This group is at an increased risk of mental ill health. Post-traumatic stress disorder (PTSD) is common among cancer survivors and can last months or even years after treatment has ended. Fear of cancer recurrence is also increasingly recognised as a significant challenge. One 2018 study on breast cancer survivors found that half the group reported some level of fear of recurrence, while 20–50% reported that the fear profoundly affected their lives.
Around 30% of caregivers say their mental health is bad or very bad, while 93% agreed that the increase in the cost of living was having a negative impact on their mental and/or physical health.
Finding a way forward
Responding to these and other challenges presented by cancer, while necessary, may feel insurmountable for employers who are trying to promote a happy and healthy workforce during turbulent times. However, employers who are already bought into the positive impacts of promoting positive physical wellbeing should take note that there are ways to tweak wellbeing strategies and evolve them to reflect the ever changing health landscape. Reviewing policies, offering health benefits, and looking for solutions that mitigate the impact of NHS delays are all essential, as is creating a culture in which those impacted by cancer feel safe to come forward, as well as supported and included.
Kelly is CEO and co-founder of Perci Health, the first virtual care clinic focused on the long-term health and wellbeing needs of people living with cancer and their caregivers. As a registered oncology dietitian working within the NHS, then the COO of the UK's largest private cancer hospital, Kelly has first-hand experience of the problems faced by cancer patients and those providing care.