This article is adapted by Dr Jane Clark from an article originally written by Jane and Dr Peter Harvey. See our introduction for a background on this series of articles.
Most people think that cancer is like other illnesses – once treatment is completed, the disease is cured and then you are ‘better’.
As you know only too well, the situation with cancer is infinitely more complicated than this simplistic analysis. However, how you manage the transition back into an ordinary world from the extraordinary one of diagnosis and treatment, is not at all straightforward.
‘Getting back to normal’ might not be straightforward
It is important that you do not allow yourself to think or feel that you ‘ought’ to be back to your old self immediately that you leave clinic after your last treatment. Apart from the need to recuperate and convalesce, the old self may well have changed and the idea of ‘getting back to normal’ may not be achievable (see Moving Forward 5: ‘Getting Back to Normal’ and Other Unhelpful Phrases). There may be some specific issues that confront you in this process.
One is about identity. It’s all very well for people to say you have to put it all behind you when they still see you as someone who had cancer. As far as they are concerned, cancer is still a part of the way they see you however hard you want to be rid of it. There is an understandable tension – you may wish to be treated with some compassion and understanding for what you have been through, but you do not always want to be seen simply as that person who had cancer.
Choosing how much or how little you want to talk about cancer
As with so many of the issues dealt with here there is no one simple answer and, again as with other issues, it’s about balancing a tension. One of the things that you can decide on is just how much (or how little) you want to talk about your illness and its treatment.
One of the problems that some people report is that they are met by a wall of silence when they may want to talk about their illness but people around them clam up – and sometimes stop you from saying what you want to say by reverting to the ‘putting-it-all-behind-you’ ploy.
Alternatively, people may feel they have some kind of right to know how you are and your life can become much more public than it was before. But you have a right to keep your life private (see in Moving Forward 8: Coping after Cancer where we talk about protecting your privacy). Sometimes it can help to distract people onto other topics to refocus their attention.
There will be times when you need to talk things through and there will be times when you don’t – it really is in your control to decide this. But you may have to be quite assertive in managing this and this may not be easy for some of you.
Going back to work
This particular problem (how you identify yourself and how you talk about your illness) has a special relevance when talking about returning to work.
But before moving into the problems of managing your first day back there is a decision to be made before that – do you want to go back to work and, if so, when? Now this will not be a problem if you were not working before your diagnosis.
Likewise, the decision to return to work or not will be influenced by practical issues like money, especially if your income has dropped significantly during your treatment (an all-too-common problem). However, you may be in a position where you have some choice in the matter.
Going back to work can signal a return to ‘normality’
For many people, getting back to work is a key part of their return to ‘normality’ and the ordinary. This sometimes becomes an overwhelming pressure and can force people into returning too early, before their strength and stamina are back. But, as with regaining your energy and managing fatigue (see Moving Forward 10: Dealing with Fatigue) taking things in a step-by-step fashion is a helpful approach.
How to work out what is and isn’t possible
The first stage, of course, is to be realistic about what is and is not possible. Questions about changing jobs or working part-time may not be an option if your financial situation does not allow it. Whilst this is not the place to offer financial advice, it is important to acknowledge that economic hardship is counter-productive to psychological well-being.
It may be that you would benefit from unbiased advice about this if it worries you and some support centres have welfare rights advice, as do some charities (see our Useful Resources page for life after cancer).
Do you go back to your old job, make a career change or stop work completely
So, if you are in a position where return to work is something you may have some control over, what decisions do you have to make? For some people the time after treatment has finished is an opportunity to decide whether they wish to stay in their old job, make a career change or stop work altogether.
These are not always easy decisions as so much of our identity, self-esteem and self-worth is tied up in what we do. It is important not to rush any decisions like this and it may be helpful to talk through the pros and cons with someone neutral who you can trust.
If you have a sympathetic employer, (a luxury unfortunately not available to everyone) it may be helpful to talk about any alternative jobs that they might have. You may have been in a very stressful and demanding post and would prefer to take on something less pressurised, for example.
In this situation it is important to see a change as not giving in or being weak. It can be a very creative step in terms of taking care of yourself and ensuring that your future health is not compromised in any way. Whilst there is no strong evidence to suggest that stress on its own is a direct cause of cancer or its recurrence it would be foolish not to accept that over-exposure to high levels of difficult-to-control stressful situations will have a negative influence on general health.
“Having taken an extended leave of absence from work during my cancer treatment, I found the decision to go back to work quite difficult. I wanted to get a better work/life balance and to do this I knew I was going to have make some changes.”
So, the first set of decisions revolves around whether to return to the same job or not. The next set of decisions is about how you manage your return.
Managing your return to work
Let’s look at two different scenarios, one where you return to your old job, the other when you go into a new job. We will look at leaving work entirely separately. One important assumption – that you have given yourself enough time to build up your strength and that you have recuperated and convalesced.
One of the most disheartening experiences occurs when people return to work before they are ready and have to take more time off because they are not fully fit.
Going back to your old job
Going back to your old job after some months off is not going to be easy. Many of you will be familiar with the length of time it can take to settle back in after even a short break like a holiday, so the length of time itself can be a major problem. Systems, procedures and people can all change and leave you feeling isolated and unsure, feeding into any residual lack of self-confidence (see Moving Forward 6: Regaining Trust in Yourself).
Many of the more responsible employers will not allow people to return to work full-time after a significant period of sick leave and insist on a phased return. While the details of this will vary from company to company, the principles are very much in line with the one step at a time model outlined here.
A gradual return
It may start with a morning or afternoon, then a day, then two days and so on until you are ready to face the full week. Many people are surprised at how exhausting this process is and find that it can take some weeks before they can come home and not fall asleep immediately.
During this time, you can familiarize yourself with the new routines and processes if you need (again, a good employer should ensure that proper training is in place to help you) or to re-acquaint yourself with former work practices.
Managing work relationships
These are relatively straightforward issues to address – a much more problematic one concerns how you want people to react to you and your time off sick. There can be embarrassing and uneasy silences when people may feel unable to talk about cancer or ask how you are. You may feel inhibited, not wanting to upset people or to feel that you are playing for sympathy. This is a decision only you can make. Sometimes it is possible, especially of you are in a relatively small and cohesive workgroup, to start out be setting down your ground-rules.
You may be the sort of person who is quite happy to talk about your diagnosis and treatment to whoever will listen; on the other hand, you may find talking about the whole affair unpleasant and distressing. This is your call, but it is often better to tell people how you want them to behave, rather than assuming they know.
You yourself may have been in a position before your diagnosis when you were faced with someone who had cancer – did you feel confident in having a conversation with them? You may want to think ahead. Because cancer is so common, it may well be that one of your colleagues or one of their relatives or friends is diagnosed. Would you like to know or not? Again, by giving guidance on what you would like, you are helping both yourself and those around you.
Starting a new job
If you are starting a new job, then you will have similar additional burden to that you would experience whatever your history – how much do you tell of your immediate past? As before there is no single answer to this.
Honesty is generally the best policy and being open with your new work colleagues in the same way as outlined before avoids potential pitfalls. One advantage of beginning a new job is that you can start afresh with your own work discipline. It is worth really considering the issue of work-life balance. One of the phrases that people use after the treatment finishes is the ‘Life is too short’. Taking this seriously can benefit your health and well-being in a significant manner.
Your time out from work might alternatively give you renewed passion for a job that you truly believe in and that allows you to express your values. So, you might find the return to work energising and feel more committed to your role.
For some of you, the decision about work will be to leave completely. Again, this may not be a realistic choice for some of you but for those of you for whom this is a real option, it will need careful and thoughtful management.
We have already noted how much of our identity and life is tied up with work and leaving it for whatever reason can be a trying and challenging process. As before, it is important to see this as a step towards something which will benefit you rather than as a failure of strength, courage, effort or will.
This is not to say that you need not go through a proper leaving process and acknowledge the real losses that giving up work may entail.
Retiring early on grounds of ill-health is undoubtedly different from retiring at the conventional retirement age – for one thing, it is something that may have been forced on you and you may not feel ‘ready’. But you alone will know what is right for you and your future well-being, both physically and psychologically. Leaving work may be an investment you have to make for your future.
Dr Jane Clark, Consultant Clinical Psychologist
The information and content provided in this page is intended for information and educational purposes only and is not intended to substitute for professional medical advice.