How to combine cancer recovery and professional life
TRIBUNE. To mark World Cancer Day, two psychotherapists interviewed women about how they return to work after breast cancer.
By Isabelle Faure Kandel and Célia Charpentier*
The fight against cancer is a constant struggle on all fronts.
Breast cancer, the subject of our study, is no exception to this rule.
What does the professional life of these women whose lives have been turned upside down overnight look like?
Given the striking data from a Canto Institute study of 1,874 women published in the Journal of Clinical Oncology (2019), which found that one in five women (21 percent) do not return to work one year after finishing treatment for breast cancer, we decided to highlight the professional problems women face when they are sick. We wanted to find out what could be improved to make life easier for the 60,000 working women diagnosed with breast cancer in France each year.
To this end, we collected valuable testimonies and feelings from women who shared their experiences in this part of their journey. They spoke openly about the barriers that might prevent them from returning to work and provided their recommendations for returning to work in good condition, indicating what they would need to make the most of this period.
A test of strength
Each breast cancer experience is unique and experienced differently, depending on the severity of the cancer and the protocols and treatments used (chemotherapy, radiotherapy, lumpectomy, excision, breast reconstruction, etc.), and the nature of cancer. These testimonies are not generic, but we found many common traits, such as the fact that cancer profoundly changed the lives of these women and had a great impact on their professional lives.
Fighting cancer is a test of strength: do you have to fight again to return to a job where you had status and legitimacy before the disease?
A cancer diagnosis causes an earthquake in a person's life, and the professional aspect is immediately affected. When and how do you disclose it? How do you deal with daily life at work when your colleagues no longer see you in the same way? How do you deal with the way others see you? How do you return to work after such a long and difficult period of absence?
All these questions have very different answers, depending on the company, the environment, the management, and the work situation.
There is also a significant difference between employed and self-employed women.
On average, treatment lasts nine months.
Breast cancer left is one of the longest. In companies, it is common for female employees to take a full year of leave during treatment (which lasts nine months on average), while some self-employed women or small businesswomen like Magali do not even declare a single day of leave to social security and continue working between chemotherapy treatments, which are exhausting anyway.
I had no financial resources not to work," explains the 40-year-old young man. Social Security would give me 40 euros a day, and I have two children to support. I had no choice.
In oncology departments, treatment doses are adjusted depending on whether the patient has to continue working or not.
Broken careers
As for the companies, some testimonies are constructive: delayed development, lack of recognition of possibly reduced abilities after treatment, marginalization, and ostracism. This is an additional difficulty for patients just coming out of treatment, although the return to work should lay the foundation for a return to normality and help them forget the ordeal of months in the hospital.
"When I went back to work, I felt out of place. It was a terrible feeling: I was literally pushed aside," explains Céline.
Elodie, for her part, was to be given a managerial position: "Four months after my leave, a new person was hired for the position I had been promised. My employer told me on the phone, just before he told the whole team. It hurt me.
"A few months after I started, my employer refused to give me the pay increase that most of my colleagues did, even though the company was doing very well," laughs Stéphanie.
Delphine adds, using the termination of her contract as an example: "When you negotiate with your company to leave, it would be nice if the company didn't offer the minimum! I didn't have the strength to fight for more, but I would have appreciated it if my company hadn't treated me like that, or hadn't taken advantage of my situation in that way by offering me the legal minimum.
For her part, Frederick modestly states that when she returned to the company, she found it difficult to come to terms with her image, the loss of her hair, and her body that had grown. "But I also had concentration problems and memory loss. And that at work is complicated.
Exhaustion
The issue of post-treatment exhaustion is also a major issue. Some women say they are unable to continue doing the same activity they did before the disease. Concentration problems, exhaustion, pain after radiation, depressive episodes at the end of treatment in more than a third of patients, and psychological fragility: these symptoms are very well recognized by medicine, but few solutions are applied to avoid them.
Solange is 58 and has asked for early retirement. She confides in me, "Since I got cancer three years ago, I have been exhausted. I have not been able to continue my job as a health care assistant, which I loved very much."
So what are the solutions?
On the way back to work
This course, which is already taught in some oncology centers, explains to women the different steps they need to know to return to work.
Cancer is like a marathon that takes a year," explains Laure, 37. "And when you get to the finish line, they don't say, 'Have a drink, get a massage, eat something, regain your strength.' ' No, it's immediately, 'Get back to work!
Of course, some hospitals, cancer centers, or patient homes offer a more or less set protocol. There is also the program "Mon Parcours Pro", offered at the Raphael Institute in Levallois (Hauts-de-Seine), whose benefits have been praised by patients. However, these offers are not systematic, they are not offered everywhere in France and there is no place for everyone. Return-to-work programs also vary considerably from one center to another, both in terms of content and communication. Information is available, but often women have to find it themselves. Many of them say that returning to work can be a nightmare without effective and comprehensive support.
This process must take place well before the return to work," Isabelle explains. It should be part of a care protocol to avoid recurrences and recurring work interruptions associated with a return to work that didn't go well.
"When I returned to work after cancer, my boss gave me the same workload as before and I found that difficult," says Odile (52), who eventually quit her job as a marketing project manager at a large company to retrain. Today she designs lighting fixtures and is self-employed.
The interviews also revealed the importance of providing information on administrative procedures, living allowances, and financial support in case of loss of income. Depending on their physical and mental condition, it is very difficult or impossible for patients to perform all the necessary administrative tasks as they struggle to survive.
All these issues are a major source of stress in a context where any irritation can be a barrier to recovery. Apart from large companies that sometimes have a human resources manager who deals with long-term sick employees, most employers are very poorly informed about their employees' rights, as Coralie confirms, "I didn't know you could cancel a bank loan. Women must be better informed.
Recommendations from women who have been referred
It's not easy to go back to work," adds Agathe, 43. In the beginning, I didn't feel normal at all. Now I know it was completely normal. She also suggests returning to work before the return day so that people are not shocked (by the loss of hair, the change of body, what to say or do). "It is also very important to be prepared for questions from colleagues and screenings, which can be very invasive and sometimes toxic.
These numerous testimonials demonstrate if any were needed, that the fight to cure breast cancer is not just medical. Women must fight on all fronts: physically, psychologically, professionally, and administratively, with people around them virtually ready to help. The trauma of family members being completely helpless cannot be underestimated. That is why women in treatment often do not express their difficulties and want to do everything themselves.
Changing attitudes
With all these obstacles piling up, it is not surprising that one in five women are discouraged and see returning to work as an insurmountable mountain to climb.
In any case, it is important to prepare thoroughly and well informed. To this end, patients must receive comprehensive care, both from their physician and from professionals who provide support after cancer (psychologists, psychotherapists, relaxation therapists, coaches, etc.) This should be included in the treatment protocol.
It is also important to train the company's human resource managers so that they can support sick employees and inform them of their rights (legal, financial, etc.) during this particularly difficult period of their lives. It can also be a matter of accompanying them on a new professional adventure, as some committed companies are doing by offering their employees new plans.
In France, more than three million people are cancer survivors (of all types); it is time to change attitudes and perceptions of this disease and to facilitate the return to work of many workers who, having overcome this battle, should not devote their energies to anything other than continuing to live their normal lives in good conditions.
* Célia Charpentier, psychopathologist and qualified coach, FF2P member, and Isabelle Faure-Kandel, psychoorganic analyst, FF2P member.
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