The only addition I have is to say that managers need some education around expectation as well which doesn’t go astray. I noted that people generally expect that chemotherapy wipes people's fatigue out but the often misunderstood factor is the cumulative effect of radiotherapy on fatigue. often the greatest level of fatigue with radiotherapy occurs 2-3 weeks afterwards when it is least expected.

I have had people attend work during chemo albeit on modified work patterns and others who don’t surface at all. Managers make be looking for more precise advice but as Sharon has said, there are some things that are up to the psychological and physical response of the individual and all we can do is give them the options.

In the NHS, we have a modified programme for any immunocompromised individual whether as a result of a condition or of treatment and it is fairly common sensical. They don’t look after anyone who is known to be an infectious risk or a contact of an infectious illness until cleared (even if the employee has previously been known to be immune). Student nurses are not allowed in their first 2 years to work in any of the oncology or high risk of respiratory illness units such as ITU's until they prove that they have both refined their own hand washing techniques and had no infection issues, then they can choose these areas as an elective in their 3rd year. Surgical wards and theatre are considered ok because the patients are generally lower risk. For an experienced person, the risk reduction comes from their own vigilance and of having a relationship with the nurse in charge that doesn't 'forget' to let them know if there are any risks on the ward/unit that day.

New applicants who are immunosuppressed are restricted and it is up to the unit to determine if they can accommodate. We have one of the 3 ITU's which is unable to accommodate any more employees on restriction as it imposes a risk to staffing the unit. This is a legitimate call of the unit.

The same principles may be useful to you. Not everyone who undergoes chemo becomes immunosuppressed across the board of all illnesses but it is an assumption you have to make unless you can test them which is what we do for the childhood illnesses.

regards

Sue

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of sharon naylor
Sent: 24 February 2012 20:21
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] RTW programme and chemo

yep - one size does surely not fit all

Date: Fri, 24 Feb 2012 20:15:31 +0000
From: [log in to unmask]
Subject: Re: [OCC-HEALTH] RTW programme and chemo
To: [log in to unmask]

Hi Sharon

I agree, I worked in oncology for a short time too and I was amazed at how well people cope with very serious cancers and how brave people can be.It was a very humbling time for me

Karen

Sent from my iPhone

On 24 Feb 2012, at 20:00, sharon naylor <[log in to unmask]> wrote:

Agree with all that has been said. My recent experience is two employees, similar jobs, same cancer, same grade tumour, identical treatment, and they also worked at same place. Hospital fantastic - they booked the majority of their treatments together to enable "peer support". Same level of support from work (me). One came back to work considerably earlier than the other one, had a remarkably short phased return. Back in "the saddle" very quickly (maybe too quickly but that was her wish). The other one just couldnt do it in the same way. Exhausted, highly anxious (likely to be a key factor). Extended phased return on restricted duties. Opted to apply for ill health retirement. No rights or wrongs, just different. Interestingll the one who came back early more or less told me to back off, the other one required fairly huge levels of emotional support, therefore cant claim any kudos for getting No 1 back to work early.

In a previous life I worked in oncology units and in a hospice, never failed to be amazed at the emotional fortitude of people - and how it affected their recovery/symptom control. I think we all need to be mindful of that

Date: Fri, 24 Feb 2012 19:42:38 +0000
From: [log in to unmask]
Subject: Re: [OCC-HEALTH] RTW programme and chemo
To: [log in to unmask]

Agree with what has already been said. I usually advise that tolerances are likely to be fluctuating so a flexible supportive approach will best enable the employee to maintain attendance/performance. Management should actively monitor via scheduled reviews and encouraging an open door approach and consider as applicable:

allocating duties to another worker
adjusting performance targets
allowing time off work for treatment
consider flexi-time style approach
adjusting/reducing hours/days of work
allow late starts/early finishes to allow for travel outside rush hour times (to reduce travel duration etc)
modifying attendance procedures/targets
facilitating slower work pace
encourage posture breaks if static/sedentary/repetitive work (usually advised as 30-60 seconds every 15-20 minutes and these can be productive breaks e.g standing to make a call, bringing something to another part of the work place. Toilet breaks, getting a drink of water, doing some stretches at the workstation also count)
accommodating a lower tolerance to physically demanding work
allowing for effects of cumulative fatigue as day/week progresses

From the employee's point of view it can for help for them to:

Keep careful notes about how they feel throughout each day and week (fatigue, stamina, nausea, concentration etc). This can help reveal important patterns about the effects of treatments and medications and can enable identification of peak-performance hours as possible. This can help with scheduling working hours and more important work tasks for when they feel at their best. It can also help determine when it would be best to schedule any treatment appointments (before work, after work etc). It will also show when exhaustion is likely to peak after treatments e.g 3-4 hours or over next day and this can help identify when time of work may be needed.

Carr

On 24 February 2012 19:12, Teresa Fox <[log in to unmask]> wrote:

Agree that treatment affects individuals differently and also putting aside the actual treatment individuals will deal with these life changing events differently which will also impact on their ability to deal cope with treatment . Chemotherapy regimes will vary depending on what's been treated etc

Sent from my iPad

On 24 Feb 2012, at 18:16, Karen <[log in to unmask]> wrote:

> Hi
>
> In my experience chemotherapy affects everyone differently, some people have less energy and side effects, so often it's whatever the individual can cope with ie advise manager on allowing employee to work flexible hours p/t. Re risk of infection , they will be more prone to catch anything that maybe going round at work and all you can do is advise employee to stay away when this is the case. As far as I am aware there are no set policies except they do come under DDA / equality act and employers therefore should make reasonable adjustments for them
> Hope this helps
>
> Karen mills
> OHA
>
> Sent from my iPhone
>
> On 24 Feb 2012, at 17:15, Carolynne Davey <[log in to unmask]> wrote:
>
>> Can anyone advise about a clinical health care worker returning to work initially on chemo, then on radiotherapy - eg guidance re: avoidance of contact with infection, specific tasks. Are there any set protocols or guidance documents, any other advice. thanks
>>
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