Working Through Cancer: Understanding the Barriers and Building Support

By Rachel M Smith (MSc Occupational Psychology)

Supervised by Dr. Colleen Addicott | University of Hertfordshire, 2021

📩 Contact: rachel@elevationoccpsy.com | LinkedIn: www.linkedin.com/in/rachel-smith-psy2020

📸 Follow us: @elevationoccpsy on Instagram

The Aim

As part of my MSc in Occupational Psychology, I conducted independent research to explore a critical but under-researched topic:

What are the barriers and facilitators for people who continue to work while undergoing cancer treatment?

This work aims to provide practical, evidence-based recommendations for employers to better support employees who choose to remain in work during their treatment.

Why This Matters

• Nearly 1 in 2 people will be diagnosed with cancer in their lifetime.

• Thanks to improved survival rates, 900,000+ working-age people in the UK are living with or beyond cancer.

• Yet, a 2016 survey found that while 80% of employees wanted to continue working during treatment, nearly half had to stop or change how they worked, and 1 in 5 experienced discrimination.

Many studies focus on cancer survivors returning to work post-treatment. But what about those who want or need to work during treatment?

Research Method

I used a Systematic Literature Review (SLR) and a case study to explore the topic from both evidence and experience-based perspectives. This dual approach helped identify key themes and form well-rounded, practical insights.

Key Themes: Barriers and Facilitators to Working with Cancer

Through the systematic literature review, two overarching categories of influence emerged: Work Factors and Personal Factors. Each plays a significant role in shaping whether someone is able—or willing—to continue working while undergoing cancer treatment.

Work Factors

These relate to the environment, job design, workplace relationships, and organisational support.

1. Work Ability

• Many employees struggle with the physical side effects of treatment, which impact concentration, stamina, and energy.

• Even when individuals are able to work, the perception that they’re not performing at their usual level can lead to anxiety, guilt, or shame.

• Pressure—either internal (self-expectations) or external (from colleagues or supervisors)—can make the situation worse.

• For some, just looking “well” can create unrealistic expectations from others, masking the invisible toll treatment takes.

2. Adaptations and Flexibility

• Flexible hours, reduced workloads, remote work options, or changes to the job role were identified as critical facilitators.

• But the absence of these—such as rigid scheduling or inability to work from home—was equally detrimental.

• In some cases, even well-intentioned adaptations backfired when not tailored to the individual’s needs, underscoring the importance of collaborative decision-making.

3. Relationships and Support

• A supportive team culture—including understanding managers and empathetic colleagues—consistently enabled people to continue working.

• Where this support was missing, relationships became a barrier, especially when employees felt misunderstood, excluded, or judged.

• Overprotection (removing responsibilities without discussion) was often as damaging as a lack of support, contributing to a sense of powerlessness.

4. Communication and Disclosure

• Open, informed, and empathetic communication helped individuals navigate their work while undergoing treatment.

• However, ambiguity, lack of guidance, or fear of negative judgment made many hesitant to share their diagnosis or needs.

• Strong relationships enabled earlier and more honest conversations, leading to better support and accommodation.

Personal Factors

These refer to the individual’s health, mindset, emotions, and coping strategies.

1. Physical Symptoms

• Fatigue, pain, nausea, cognitive fog (“chemo brain”), and appearance-related changes were significant barriers.

• These symptoms often impacted productivity and confidence, and they weren’t always easy to explain or predict.

• The emotional burden of needing to “perform” while feeling unwell was a recurring theme across studies.

2. Motivation, Commitment & Engagement

• Many participants expressed a deep sense of purpose and identity tied to their work.

• For some, work was a lifeline—providing structure, normality, and distraction.

• However, others reported a loss of meaning, questioning priorities, or re-evaluating career goals, especially in emotionally demanding roles.

3. Stress & Distress

• A cancer diagnosis naturally brings anxiety, grief, and uncertainty. When combined with work-related stress, it can become overwhelming.

• Concerns about performance, meeting expectations, or letting others down compounded emotional distress.

• In some cases, visible symptoms (e.g., hair loss or weight change) led to self-consciousness and reduced workplace confidence.

4. Coping Mechanisms

• For many, work itself was a coping strategy—providing escape, purpose, and a sense of control.

• Others relied on positive feedback, peer support, or self-care routines to manage day-to-day challenges.

• Those with strong internal resources—like resilience, optimism, or problem-solving—tended to fare better, highlighting the importance of developing Psychological Capital (PsyCap).

Insights from the Case Study

The individual case study provided a human lens through which to view the academic findings. This firsthand account brought nuance and emotional depth to the themes identified in the literature.

Some key reflections included:

The Emotional Rollercoaster

• From diagnosis to treatment, the journey was described as turbulent and emotionally exhausting.

• There was often a conflict between the desire to maintain normality and the very real limitations caused by illness and treatment.

Confidence and Self-Efficacy

• The individual openly described self-doubt—wondering whether they were truly capable of performing at work, and whether their continued presence was helping or harming their team.

• These doubts weren’t just physical but deeply psychological, tied to identity, value, and perceived expectations.

Purpose and Motivation

• Work was more than a paycheck. It was a source of pride, identity, and meaning.

• Continuing to work gave the individual a sense of control, helped retain normalcy, and acted as a motivational force to keep going during tough times.

The Power of Honest Conversations

• Honest and emotionally open conversations with managers and colleagues helped the individual navigate workplace challenges more confidently.

• These conversations enabled appropriate adaptations to be made and contributed to a stronger sense of psychological safety.

Resilience and PsyCap

• Over time, the individual consciously developed their resilience and internal strength—key elements of Psychological Capital.

• When supported by positive workplace dynamics, these personal resources helped shift perceived barriers into facilitators, making continued employment possible.

Practical Implications for Employers

Supporting employees who choose to work during cancer treatment requires more than just ticking boxes or applying standard policies. The key takeaway is that there’s no one-size-fits-all approach. Here’s what organisations can do:

1. Start with Empathy, Not Assumptions

• Avoid making decisions on behalf of your employee—no matter how well-intentioned.

• Instead, ask questions like: “What do you need from us right now?” or “What would make this easier for you?”

2. Adapt and Flex as Needed

• Flexible schedules, remote work options, or temporary changes in role can make a huge difference.

• But these must be tailored and revisited regularly, as needs often evolve throughout treatment.

3. Enable Open Communication

• Foster a culture where employees feel safe disclosing their health needs without fear of stigma or bias.

• Train managers on how to have sensitive, supportive conversations and maintain ongoing communication—not just at the point of diagnosis.

4. Include, Don’t Sideline

• Stripping responsibilities away may cause individuals to feel undervalued.

• Instead, co-create solutions that allow the employee to stay engaged in a meaningful way.

5. Support Personal Factors

• Recognise that stress, confidence, and coping mechanisms are interconnected with work experiences.

• Provide access to mental health resources, employee assistance programmes, peer support groups, or occupational health professionals.

6. Focus on Psychological Capital

• Encourage development of resilience, optimism, self-efficacy, and hope.

• Celebrate small wins, offer positive feedback, and allow space for employees to be vulnerable without judgement.

7. Promote Choice and Autonomy

• One of the most empowering things you can do for someone living with cancer is allow them to make their own choices.

• Work with them—not around them—to co-create their journey through work.

8. Remain Flexible and Open-Minded

• Cancer is unpredictable. So should be your response.

• Show your employee that you’re willing to adapt as things change. This ongoing flexibility builds trust and loyalty.

Final Thoughts: Rethinking Support for Employees with Cancer

Supporting employees with cancer goes far beyond creating a flexible working policy or checking in sporadically. It’s not just a matter of compliance or compassion—it’s about co-creation of an environment where people can continue to thrive, even in the face of profound personal challenges.

Cancer is not just a medical condition—it’s a life-altering journey that touches every part of a person’s identity, from physical ability and emotional wellbeing to professional confidence and sense of purpose. For those who choose to continue working during treatment, work can serve as a lifeline—a source of meaning, routine, dignity, and self-worth.

But this only happens when the workplace becomes a source of strength rather than stress.

Work as a Wellbeing Resource

The research consistently shows that when people feel respected, included, and supported, work can offer:

• Stability during a period of uncertainty

• A sense of control when so much feels out of their hands

• A way to retain their professional identity, especially when they feel their personal identity is being reshaped by illness

• A means of maintaining social connection and purpose

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However, this only becomes possible when organisations adopt an integrated approach—one that addresses both workplace structures and personal experiences.

From Policy to Partnership

Supporting someone with cancer at work isn’t about applying a generic solution or offering surface-level gestures of kindness. It’s about entering into an ongoing partnership with that individual—built on trust, adaptability, communication, and choice.

That means:

• Asking, not assuming

• Listening, not just hearing

• Being open to change, not rigid in policy

• Seeing the person, not just the diagnosis

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When employees feel they are being included in decisions, rather than managed around, it restores a sense of agency that is often lost during illness.

The Interplay of Work and Personal Factors

This research shows clearly that workplace adaptations alone are not enough. If personal factors such as distress, low motivation, or declining self-confidence go unaddressed, even the most flexible policies can become ineffective—or worse, create unintended stress.

Conversely, when personal resilience (often shaped by Psychological Capital) is supported, it makes workplace adjustments more impactful and sustainable.

The reality is this: everything is interconnected. Employees’ physical, emotional, and psychological states influence how they perceive their work experience. And the workplace environment, in turn, affects how employees cope with their health journey.

A Call to Action

To employers and organisations:Support your people not just as employees, but as whole human beings. Be curious, be present, and be prepared to adapt. Show your workforce that you don’t just stand by them in good times—but that you walk beside them in difficult ones.

To employees and professionals navigating cancer:You have the right to advocate for your needs, share your story on your terms, and pursue work in a way that supports your healing—not hinders it. Know that your experiences are valid, and your voice matters.

When we choose to lead with empathy, flexibility, and integrity, we not only create better workplaces—we build stronger, more resilient communities.

And in doing so, we show that work isn’t just something we do.It’s a space where people can still belong, contribute, and heal.