A brilliant chapter in a brilliant book lists a 10-point plan for successful return to work after cancer treatment. The book is Handbook of Cancer Survivorship edited by Michael Fuerstein (Springer, 2007) and the chapter is entitled simply 'Work', written by Jos Verbeek and Evelien Spelten.

The return to work plan includes – among other points – the following:

• Schedule an appointment with your occupational health physician and the professional who is there to help you with return to work
• Keep in contact with your employer. You will need him or her to get back to work and to realise work accommodation if needed
• Keep in contact with your coworkers. Go to work and see them and tell them how you are doing
• Draw up a return to work plan in consultation with your supervisor and occupational physician
• Start to return to work before full recovery, but start with a very limited number of hours
• Make sure the return to work plan encompasses the date and number of hours of the start, which days of the week will be worked, the timing of expansion of hours, the tasks and number of hours of this expansion, and the proposed date of full return to work
• Evaluate the return to work plan with your supervisor every two weeks. Adjust the plan according to your evaluation
• In the chapter the authors discuss a literature review they published covering the period 1985 to 1999. Their findings are fascinating, and, more importantly, very helpful for anyone working with cancer survivors returning to work.

The authors wrote that medical and technical advances, combined with an aging population, will result in a greater number of cancer survivors in the future. It is imperative, therefore, that the rehabilitation to which cancer survivors have access improves, and that levels of understanding about the experience of cancer survivors are raised. The better health and return to work professionals understand the challenges faced by cancer survivors in returning to work, the more help they may give survivors.

“Being able to return to work and to stay at work is important, both for society and for the individual,” write Verbeen and Spelton. From a societal point there is economic loss to contend with. “From an individual's point of view,” write the authors, “not being able to return to work following an illness frequently results in financial loss, social isolation, and reduced self-esteem.”

We derive from our work more than simply financial reward, but also a sense of purpose, social interaction, a sense of worth and more still. “Return to work can improve the quality of life of cancer patients, and can have a positive effect on self-esteem and social or family roles. Patients consider return to work to be important. Work performance after cancer treatment is often seen as a measure of recovery in its own right,” they wrote.

In their findings, the authors found positive return to work for cancer patients was linked to a supportive work environment and the positive attitude of coworkers. The authors made reference to a study in which survivors of breast cancer who perceived discrimination in their workplace because of the cancer were three times less likely to return to work than those who did not perceive discrimination.

For some patients, surviving debilitating cancer treatments made them perceive themselves as stronger and more capable. Other patients felt less confident about their physical ability in relation to their work, or about their ability to cope with stress.

The authors deduced from their studies that it is not simply the diagnosis and treatment of cancer that affects return to work, but the symptoms patients experience as a result of diagnosis and treatment; for example fatigue, depression, sleep problems, physical complaints, cognitive dysfunction and psychological distress.

G.A. Curt, in his essay 'Fatigue in cancer', described fatigue as “The commonest and most debilitating symptom in patients with cancer.” If we take this to be the case, fatigue should be addressed in rehabilitation as having the capacity to hinder the resumption of work.

The authors recommend that clear and well-established guidelines for the management of fatigue by physicians be implemented. They also recommended that physicians:

• advocate workplace adaptations to prevent disability using the science of ergonomics (see link below)
• focus on person-related factors, such as attitudes and opinions, and address patients' misconceptions about recovery as the way the patient perceives their illness affects their chances of successful rehabilitation and return to work. “The functioning of the patient is dependent on the idea that the patient has of the illness,” the authors write
• refer cancer survivors to rehab programs that address fatigue and depression.

Verbeen and Spelton argued the need for better treatment of cancer-related symptoms, improved return to work strategies, graded activity (ie gradually increasing work activities according to a plan) and goal-oriented rehabilitation: “Goal setting provides the opportunity to work toward a concrete goal and to evaluate the activities against the goal set,” they wrote.

Finally the authors recommended that great old thing that RTW Matters won't stop espousing, (even when the cows come home): the benefits of communication. “Involve the supervisor right from the start,” they write, “to facilitate – at least temporarily – work accommodation.” If supervisors hear from workers what they need to make their return to work easier – and if the supervisor listens – the chances of successful work resumption will be much higher.