1. Work and cancer Jill Scott Macmillan Cancer Support

2. What I’ll be covering
How cancer can affect the ability to work, and the employment and financial worries that patients and carers may experience.
Appreciating the importance of raising the subject of work with your patients or their carers, and acknowledging their concerns
Helping patients to consider possible sources of support and signposting to sites such as Macmillan

3. The big picture So first of all some of the big picture stats….
Diagnosis of cancer is going up, but so is the survival rate. This means more people of working age are being diagnosed with cancer, but potentially able to stay in or return to work.
What work does for us
Money
Status
Friendships
Social network outside of family & friends
Sense of purpose
Emotional and mental wellbeing
Recognition
Control of our lives

4. Terry’s Story
“I’d worked hard as an electrician and seven years before my diagnosis had bought my dream family home. But then treatment started and my income vanished and for the first time in my life I needed the benefit system.
 “Sick pay, redundancy payments and benefits just weren’t enough to cover the added expenses that come with cancer, let alone my mortgage repayments and we got behind. I had no choice but to sell the house I’d worked so hard for and to ask my two sons to find their own living arrangements. Losing my house was an added stress I didn’t need whilst facing cancer and going through gruelling chemotherapy.  I can’t imagine surviving on any less money.”
So Terry White, 62, from Nottinghamshire, was diagnosed with Non-Hodgkin Lymphoma in He says:

5. Amanda’s Story
“I was diagnosed in 2009 but I'm still suffering not only the physical and mental side effects but also the financial hardships that cancer brings. There have been times when I've barely had enough money to live on.  
“My partner left me on the day I was told I had cancer and with all the extra costs and loss of job, some very basic things in life had to give, even food. It really is that simple. The struggle to pay for things has kept me awake at night crying.
“The benefits system does not understand what cancer does to a person and how it can turn into a hell through none of your own making.  I feel very let down by the system.”
Amanda Whetstone, 52, from East Sussex was diagnosed with breast cancer. Almost 170,000 (7%) people with cancer in Britain are unable to celebrate special family events such as Christmas and birthdays due to lack of money, according to new research commissioned by Macmillan Cancer Support and carried out by Truth Consulting1.
The new research, which includes a survey of nearly 1,000 people living with cancer, also finds that around one in ten (9%) say they’ve had to miss out on visiting family and friends because they couldn’t afford it.
Other research2, which surveyed over a 1,600 people who’ve been in touch with Macmillan, shows that a quarter (28%) of those with cancer are unable to adequately heat their home in winter.
Macmillan warns that many people with cancer will feel ‘cold and lonely’ this Christmas because of the financial impact of their disease. The charity has previously found that four in five (83%) people with cancer are on average £570 a month worse off as a result of their diagnosis.3 This is due to people often having to stop work at the same time as coping with additional costs, such as transport to hospital appointments, new clothes or wigs and spiralling household bills.

6. Key facts about work and cancer
Sickness absence is necessary - 75% need to stop work during treatment
Work generally isn’t the cause or problem
The financial impact of cancer – 7 in every 10 under 55s experience a 50% fall in household income
Work can represent a return to normality “getting better and back to normal”
Cancer is similar to other long-term conditions that impact on workings lives. But it does differ in some significant ways.
Depending on the cancer, the kind of treatment, and how and individual reacts to it, someone might be able to keep working during treatment. However most people find they can’t. Some treatments can last for weeks or months, and the side effects can last months to years. So many patients will need a substantive break from work.
While conditions like back pain or stress may be caused by, or be a reaction to a work situation, this is usually not the case for cancer. Therefore while someone with stress may see leaving work as a solution to their ill health, this is less likely with cancer.
People with cancer can in fact be hugely motivated to return to work, as it can signal a return to normality. Work can mean routine, social contact, validation, financial security.

7. CASE STUDY •

8. Case study: Janice
Janice has recently been diagnosed with breast cancer and has been advised that it is likely she will require surgery and chemotherapy.
Janice is a single parent living in Stroud. She is a hairdresser working in Gloucester.
Her elderly parents look after her seven year old daughter during the school holidays and, when needed, take her daughter to school and back.
Janice is extremely anxious about how she will be able to continue working during and post treatment.
She is even more anxious about her daughter and does not want to tell her about her diagnosis.
Her nurse advises Janice on realistic expectations of treatment and encourages her to consider ways in which she could still continue to work through her treatment
Janice explains her anxieties about her daughter and her nurse refers her to the local HOPE service for further advice and gives her the Macmillan Support Line Card
Her nurse also asks whether there are other options to being self employed and/or exploring different employment avenues, occupational areas

9. Advice for Janice could include
Advising Janice on realistic expectations of treatment and encouraging her to consider ways in which she could still continue to work through her treatment
(?s to ask about Work and Cancer booklet)
Signposting Janice to the MSL and the local HOPE service for further advice and giving Janice the Macmillan Support Line Card
(available free from Be.Mac)
Recommending that Janice talks to her employer and discusses ways in which she could manage her work schedule differently
(using the Macmillan Work Support Route Guide)