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Reasonable Adjustments On Your Return To Work

Your needs and capacity may be different when returning to work after cancer treatment. Here are some common concerns and suggestions of how they can be managed with reasonable adjustments in your workplace:

Physical Concerns

1. Fatigue

Feeling tired is common both during cancer treatment and for some time after. Returning to work after a prolonged absence is also tiring, along with looking after a young family. It is likely you will tire more quickly at work and may find it hard to carry out tasks that you previously did easily.

Possible Adjustments You are entitled to request a phased return to work, allowing you to build up your hours over a period of several weeks. It may be appropriate to ask to start work a little later and finish earlier than usual to avoid the additional stress of rush hour commuting. While at work, ask about taking regular short breaks to allow you a chance to relax and perhaps get some fresh air. Consider asking to do some work from home initially, if your role allows.

2. Loss of Muscle Strength/Body Conditioning

If your job is quite active or involves heavy lifting, and you have lost strength during your treatment, you may find some parts of your job quite difficult initially.

Possible Adjustments

Building up your hours will help you regain your strength without overwhelming your body. If your job role involves a combination of manual and non-manual work, you can ask to reduce the manual component to start and gradually reintroduce it as your strength returns. If your work is mainly manual, you can ask about a temporary redeployment to a less active role.

3. Menopausal Hot Flushes

If you are experiencing a medically induced menopause, frequent hot flushes may occur. These can be difficult to manage, especially if your working environment tends to be quite warm.

Possible Adjustments If you are in an office environment, you can be moved to a desk near a window that opens or away from close groups of people. Alternatively, you can ask for an agreement to be in place that allows you to go outside for a few moments at short notice if you feel a flush coming on. Consider taking a hand fan into work, layering the clothes you wear so that it is easy to peel off and perhaps taking a change of clothing so that you can remain comfortable throughout the day.

4. Neuropathy

You may have developed, temporarily or in some cases permanently, symptoms of numbness/tingling, pain or muscle weakness in the hands, feet or lower legs. This may affect your ability to use a keyboard or work with small objects. You may also experience problems with balance, walking and climbing stairs.

Possible Adjustments If your hands are affected and your work involves a lot of typing, it would be reasonable to request voice recognition software. Depending on the severity of your neuropathy, whether it is resolving or not, and the amount of fine work you are involved in, specialist advice from Occupational Health may be required.

If your feet are affected, temporarily relocating your workspace to the ground floor and/or near the entrance to the building may be possible. Shifting your responsibilities to more sedentary tasks may also be possible.

5. Aggravation of Chronic Pain

You may be experiencing ongoing pain which could be aggravated on your return to work, limit your ability to carry out physical activities, and add to your levels of fatigue.

Possible Adjustments

It can be difficult to predict exactly how your pain will be impact your return to work, but it can be helpful to note down what kind of activities aggravate it the most. Arrange to talk to your manager to see how your role can be adjusted in response to these findings, and also speak to your health team about pain management and how this can support you.

6. Bowel or bladder weakness/changes

If your treatment has affected your bowel or bladder function or control you might find yourself needing to access toilets more frequently or with greater urgency. Talking about this with a manager may feel awkward or embarrassing, but by doing so you can put in place specific adjustments that will maintain your comfort and ease any bowel/bladder related anxieties.

Possible Adjustments Ask to move to a desk nearer the toilets, and request frequent short breaks to prevent the risk of accidents. Put in a agreement in place that you may need to visit the bathroom at short notice, without needing to find someone to ask permission. You may also want to have a change of clothes stored at work to give you confidence that any accidents can be handled with relative ease.

Mental Concerns

1. Concentration

Tiredness makes it much harder to concentrate. Your brain may also be out of practice concentrating for long periods or working at high capacity. It can take time for you to be able to focus and work as intensely as you once did.

Possible Adjustments A phased return to work can help you build your 'concentration muscles' and having frequent short breaks throughout the working day can help you build mental stamina. You may also want to consider splitting the tasks required of you, starting with something you find easy and/or enjoyable and then increasing them slowly.

Eat healthily to help supply your brain with the nutrients it needs. Find ways to be kind to yourself and accept your capacity wherever it is at, remember that it is normal to need time to regain your mental processing speed and focus.

2. Decision Making

Fatigue and anxiety can also decision making harder. After a prolonged absence from work, your self-confidence might be lower, especially if your working environment has changed during your absence. Together these can impact your trust in your own judgement.

Possible Adjustments

The same adjustments for difficulty with concentration (above) will also apply to decision making. Remember, that with time and patience, your skills and confidence will most likely return.

3. Difficulties with Memory

It can be difficult to lay down new memories when you are tired, feeling anxious or generally overwhelmed; all of which can happen when returning to work. Concern about your memory can lead to more worry which may well lead to you being more forgetful. Trauma can also affect memory making and retention; for some people a cancer diagnosis and treatment can be a traumatic experience.

Possible Adjustments

In addition to the adjustments for Concentration (above), it is perfectly reasonable to request some re-training to refresh your memory on the protocols and procedures of your role and workplace. If new policies have been introduced, you can also request training to learn what has changed. You might request access to tools that can support you in remembering and recording necessary information.

You may also find it helpful to develop some anxiety management techniques (e.g., mindfulness and breath control) before returning so that you have them to support you when back at work.

Emotional Concerns

1. Menopausal-Related Mood Swings

Mood swings can feel quite frightening and overwhelming. They may also be aggravated by tiredness and overwhelm, and come on unpredictably, which may leave you worrying about what could happen if they occurred at work.

Possible Adjustments

Communication is key here. Let your manager and any colleagues you feel comfortable talking to know about your concerns with this issue. Request an arrangement that allows you to step out and take a short break if you start to feel overwhelmed. Anxiety management techniques may be useful. Also, consider you environment; are there any sensory factors that might trigger your overwhelm (loud noises, lots of noise, bright lights, buzzing machinery)? If so, find out if it's possible to be moved to a less overstimulating space, or if you can wear noise cancelling plugs such as Loops or Flare.

2. Anxiety about Body Changes

If your cancer treatment involved significant surgery or the treatment that you have received has resulted in changes to your body e.g., lymphodema, you may feel anxious about how your body looks now and how your colleagues or other people may respond to these changes.

Possible Adjustments

If you are required to wear a specific uniform, and you are concerned about how you will look in it, discuss this with your manager as there may be alternative options or the standard uniform could be altered.

If possible, have a workplace visit prior to re-starting work so that you can process your colleagues reactions, and your feelings about their reactions, separate to your actual job.

You may find yourself negatively interpreting glances or comments made by other staff members; anxious minds will often be on high alert for signals that reinforce our fears and concerns. Try to notice when this happens and redirect your focus to listen out for the compliments and positive comments that you may be dismissing. If you find this continues to be a problem, arrange to speak to a counsellor or a trusted family member or friend.

3. Concerns Over Your Capability

Returning to work after a substantial break, for whatever reason, commonly leads to self-doubts in the workplace. It is not unusual to feel concerned that you may no longer be capable of performing the tasks required of you, even if you are!

Possible Adjustments

If you are struggling to remember work processes, ask your manager or HR for refresher training. Similarly, if new processes have been introduced during your absence, request someone go through them with you. This will help improve your confidence. You might also request access to tools or ways of managing your workload that best support you where you are at, with regular check-ins to see what is still helping and where you are developing and succeeding.

It can help to remind yourself of how normal it is to feel self doubt in these circumstances and perhaps use a journal or some other regular check in to notice how they are decreasing in frequency over time.

Remember too, that it is normal to make mistakes, it's how we learn!

4. Worries About Management

Sometimes throwaway comments from others or your own self-criticism may leave you feeling that others are questioning your standards of work.

Possible Adjustments

It is usual after a prolonged absence to have regular meetings with your line manager for you to raise any problems and to get feedback from them. If you have worries that management are unhappy with your progress, this is a good time to mention them. You may find that they have no concerns and are happy with your progress, but if anything is raised you can work together to address them. If no meeting has been scheduled by management, you are entitled to ask for one to discuss your concerns.

5. Concerns Over Special Treatment

During your initial phased return to work, or when working with reasonable adjustments in place, you may worry that other workers, not understanding your situation, are feeling frustrated or upset at your apparent “special treatment”.

Possible Adjustments

If you feel comfortable, you can discuss your agreed plan for return to work with your colleagues, and explain that what the adjustments are for and how long they may be in place. They are more likely to be supportive of you if they understand the situation. If you prefer not to speak with colleagues yourself, you can ask your manager to do this on your behalf. Alternatively, you may want to keep your personal life private and not discuss health-related issues with your colleagues.

It is important, whatever you decide, to remember that you are entitled to the help you need and that reasonable adjustments are not 'special treatment' but a legal entitlement to support you back to work.


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