According to 20 cancer survivors who recently participated in a photovoice study exploring work following cancer, there are a variety of motivations underscoring a desire to resume work following cancer. For these participants, the predominant motivations for return to work included the fact that work represented a sense of normalcy and health recovery, underscored individuals’ identity, sense of self and responsibility, and informed a sense of community with others. While the majority of participants did not question a return to their pre-cancer vocation, for some the cancer experience triggered reflection on ideal life balance or a desire to find a more meaningful post-cancer pursuit.
Most participants to this study independently negotiated their return to work. Advice from healthcare providers was absent. With enhanced insight into the importance of work return to survivors’ holistic healing, healthcare providers can play a significant role in facilitating survivors’ return. This can start with a dialogue toward better understanding survivors’ motivations, concerns, and barriers, and facilitating possible solutions which may include a referral to appropriate providers (e.g., occupational therapy). A return to meaningful occupation, however defined by the survivor (e.g., employment, volunteer, family roles), should represent the ultimate outcome of cancer survivorship. Some of the participants’ personal conceptualizations of the importance of work reintegration following cancer are presented below.
Work is more than about financial gain
Society tends to link working to financial incentives. Financial motivations were in fact rarely cited by these survivors as underpinning their desire to return to work. Rather, financial benefits of employment played a secondary role, but for individuals like Kurt underscored his sense of responsibility in caring for family as presented in Figure 1. “She’s the reason that I wanted my business to be successful. I’m not that concerned about my son but I want to make sure that there’s money for her as she gets older for things like education. I have put that on myself. I really assumed that as my responsibility.” [Kurt]
Work represents normalcy, health and resilience
Many survivors spoke of the fact that return to work represented a return to normal, a symbolism of regained health and general well being. “To get back into that work force, I wanted to do something. I wanted life to be the way it was before” (Patricia). Some participants remarked that work provided a distraction in that it allowed them to focus on something other than cancer. Others considered that returning to work demonstrated resilience and strength, both to themselves as well as to others. For example, a competitor used Mary’s cancer diagnosis as a means to try and claim Mary’s corner of business, since it was assumed that Mary was going to be off work for a period of time. As a demonstration of resilience, Mary returned to work less than 1 week post surgery.
Work: A role in self-identity
For some participants, their worker role underscored a component of their identity. Kathy explained, “Work has always been a big part of who I am…I need the work because of who I am.” For others, they recognized that too much of their pre-cancer identity was provided by their work. In presenting Figure 2, Donald reflected on his pre-cancer identity being heavily informed by his work, “My identity and work was who I was, so not unlike the name of a boat. Work was my identity. This kind of represents me, you know it was truly who I was”.
Opportunity for reflection
For some, cancer served as an impetus to reflect and choose to purposefully realign priorities. Several participants noted that while work remained an important part of their post-cancer identity, there was a purposeful seeking of improved life balance in order to ensure that other priorities, such as family members, pets, and overall health, received adequate attention.
For the majority there was never any question that they would return to their pre-cancer employment, whereas for others their cancer experience resulted in a reflective process about a future investment in what they defined as a more meaningful vocation. Carol presented in Figure 3 the process of finding a new vocational direction. “I feel like it’s a new chapter in my life and so I want to start that new chapter. I just don’t know, it’s kind of blank. Like the page is blank right now because I’m not really sure what direction I’m going.”
For Peter, he pointed to his personality and a sense of tradition as underscoring his desire to resume work. Peter explained that he feels most fulfilled when he is productive. He also identified, as demonstrated in Figure 4, an internal motivation created by a tradition more than 100 years old. “You’ll notice that that company there was established in 1784….Our relationship with crops and the land is almost as long on the property that I own almost 100 years less than that but in our family. . . I suspect those are the strongest motivations. Tradition.”
Social support derived from work colleagues
For the majority of participants, their desire to return to work was fueled by social considerations. Most survivors disclosed their diagnosis at work shortly after they received the diagnosis. As exemplfied in Figure 5, support from co-workers was demonstrated through a variety of gestures and spanned the entire cancer experience from diagnosis, through treatment, to return. “I realized maybe about a month and a half ago that one of my friends was still making the full pot, expecting me to come in at anytime…he was making the coffee just in case I came in. How nice is that?” [Lisa]
In the era of patient-centred care, metrics measuring successful survivorship must necessarily consider roles deemed meaningful by recipients of care. There is likely no better measure of successful recovery than an individual’s participation in those occupations deemed to have value, whether these occur at home, in the community, or at work.
Dr. Tricia Morrison has been an occupational therapist for 20 years and is currently a postdoctoral fellow at the University of Ottawa with Dr. Roanne Thomas. Dr. Morrison’s current research is focussed on various cancer survivorship issues, including work reintegration and lymphedema.