Cancer is a group of diseases characterized by an abnormal growth of cells that have lost normal control mechanisms and thus are able to expand continuously, invade adjacent tissues, and often migrate to distant parts of the body. Cancerous cells from the primary (initial) site can spread throughout the body creating a secondary tumour or a metastasis.
Cancer can affect any part of the body and there are over 100 types of cancer. Doctors distinguish between cancers that affect the blood and blood-forming
tissues (such as leukaemia and lymphomas) and those that are “solid” tumours (such as breast and lung cancer).
There are great differences in the manifestation, prognosis and degree of impairment depending on the type of tumour.
Here, we present breast cancer by way of example.
The case of breast cancer
The case of Kate, with breast cancer
Following the last preventive radiological examinations, Kate was diagnosed with breast cancer. She started her first chemotherapy sessions, during which she is very ill and cannot work. Between one therapy and another, Kate is well enough to work, even if it sometimes proves tiring to go into the office and seeing her colleagues makes her feel better. It is very important for Kate to continue working in order to maintain her family, which is why she fears ending up without a job. She would like to work part time but her work might demand meeting with clients or audiences in Court at set times. She wants to ask for flexi time but HR suggests she just takes sick leave and stays at home until she feels better.
1 What is it
Breast cancer is a disease caused by the uncontrolled multiplication of some cells of the mammary gland, which turn malignant. It is the most common form of cancer in the female population.
There are different types of breast cancer, each with its own peculiarities: they can originate from different components of the breast and arise simultaneously in one or both breasts. All types may also involve, in addition to the mammary gland, the lymph nodes of the axillary or other stations, which drain the lymph of the breast.
Breast cancer signs are not always noticeable; there are often no clear symptoms, especially during the early stages of the disease. Half of breast cancer cases occur in the upper outer quadrant of the breast.
One typical symptom is the presence of palpable, or even visible, nodules, even if these are generally signs of an already advanced tumor form.
However, breast tumors are not always palpable: other indicators may be suspected radiological lesions (not palpable) or micro calcifications of doubtful clinical significance.
In general, the initial forms of breast cancer do not cause pain, which often may be due to natural hormonal changes during the menstrual cycle.
Breast cancer is a potentially serious disease if it goes undetected and is not treated early. Early diagnosis, through an adequate check-up program, is important to prevent the damage caused by the disease and treat it in its initial stages, when the chances of recovery are higher.
The tests used to identify the presence of breast cancer are mammography, mammary ultrasound, magnetic resonance or histological examination following tissue sampling (biopsy).
Knowing the stage of the disease is important to provide the patient with the most appropriate care, as well as to formulate a prognosis.
The most common therapeutic options currently available for the treatment of breast cancer are:
- Surgery: Surgery is the treatment usually offered to most patients to remove the tumor. The operation may be carried out with different techniques depending on the characteristics of the tumor and the breast.
- Radiotherapy: Radiation therapy uses high frequency ionizing radiation to destroy neoplastic cells. Radiotherapy is often indicated as a complementary treatment to surgery, before or after it or to treat relapses.
- Chemotherapy: Chemotherapy is a systemic treatment that involves the administration of drugs (injections or tablets), which spread, through the bloodstream, inside the body and in this way they may reach and destroy the tumor cells wherever they are located. It can be used before or after surgery, or when distant metastases are present and believed to be responsive to chemotherapeutic agents.
- Hormonal therapy: Hormone therapy involves the use of drugs that prevent estrogen from reaching the neoplastic breast cells (thus stopping growth) or reducing the amount of estrogen produced by the body in order to try to reduce the risk of recurrence. Hormone therapy may be taken alone or after chemotherapy has terminated or during radiotherapy.
Following treatment, a multidisciplinary team establishes a personalized plan of periodic medical check-ups (follow-ups) according to the needs of the individual patient and the biology of the disease, to monitor any relapses, as well as the physical and psychological effects of treatment.
4 Psychosocial issues and impact of the disease on employment
Although there are considerable differences in the manifestation, prognosis and degree of impairment depending on the type of tumour, cancer diagnosis and treatment always have great impact on the physical, social and emotional well-being of patients, their family and caregivers. However, it is increasingly becoming a manageable chronic disease. There is a significant percentage of survivors for breast cancer and this is particularly relevant in the working sector, especially as the cancer usually affects young women with families at the beginning, or at the height, of their careers. There may be periods of reduced functioning and productivity, especially during treatment cycles, which alternate with periods in which the person is able to work. Thus, maintaining work or returning to work is of paramount importance for people diagnosed with cancer, for social and financial reasons, as well as for their own wellness and self-esteem.
Multidisciplinary interventions, involving the employee, the employer, stakeholders and health care professionals), are effective in enhancing and facilitating the return to work of cancer survivors. The employer’s approach is crucial in this context. It would be good practice for the company to have a protocol to manage the situation, however, the company should try to adapt and tailor it to a person’s needs.
To manage workers with cancer and help them continue working or returning to work, employers can promote some interventions.
- Support an open flow of communication between the employer and the employee with cancer during the whole pathway (e.g. designate a single spokesperson to mediate between the company and the employee with cancer throughout the entire process, asking the employee about her desire to communicate the diagnosis, and her preferred way of doing so, to colleagues).
- Take individual differences in reacting to diagnosis into account (e.g. respect employee’s reactions to diagnosis and treatment and let the employee know that he can always discuss work issues with the employer, but give the employee some freedom to pick the right moment to have this discussion).
- Be flexible on working conditions where possible (e.g. if the employee wishes to continue working throughout the treatment, remember that this can be very important for her wellbeing: thus, be understanding and facilitate her needs). This reasonable accommodation could, should, be discussed with the person throughout the entire care process, and should be changed if the needs of both parties change along the way.
- When RTW is not possible, talk with the employee about it: if it is an individual decision, discuss possible options and solutions, how to communicate it to colleagues and reorganize the rest of the staff.
For further information, see:
European Cancer Leagues (ECL) – www.europeancancerleagues.org European Cancer Patient Coalition (ECPC) – http://www.ecpc.org
European Society for Medical Oncology (ESMO) – https://www.esmo.org
European CanCer organisation (ECCO) – https://www.ecco-org.eu