April is National Bowel Cancer Awareness Month – What impact does Bowel Cancer have on employers and employees

9 Apr

April is National Bowel Cancer Awareness Month

What is your business doing to promote this and how does it affect your employees

Click here to order our leaflets, posters, booklets and balloons for your bowel cancer awareness display. You can also place an order by phone on 020 7381 9711 ext 230.

http://www.bowelcanceruk.org.uk

BOWEL CANCER- OCCUPATIONAL ASPECTS

Dr Sharon East-Miles – Occupational Health Physician

www.Corporatehealth.co.uk

National provider of Occupational Health Services to Corporate Britain

Introduction

Bowel cancer is also referred to as colorectal or colon cancer as nearly all bowel cancer develops in the large bowel. Approximately two-thirds occur in the colon and one-third in the rectum.

Symptoms

The most common symptoms are:

  • Bleeding from the rectum or blood in the faeces
  • A change in bowel habit to looser bowel actions or constipation lasting for 3 weeks or more
  • Unexplained weight loss
  • Extreme tiredness for no obvious reason
  • Pain or a lump in the abdomen.

Diagnosis

Several tests are carried out in stages. They include a rectal examination, blood and stool tests, x-rays, colonoscopy and biopsy and CT/MRI scans. The aim is to find the precise location of the cancer, to confirm the diagnosis and to stage the severity and progression of it.

Treatment

Treatment will be dependent on:

  • the type and size of the cancer
  • the individual’s general health
  • whether the cancer has spread to other parts of the body
  • the grade or aggressiveness of the cancer

If there is early diagnosis and the cancer has not spread i.e. Stage 1, treatment may only consist of surgery to remove some of the colon. For later stages, a combination of surgery, radiotherapy, chemotherapy and biological therapy may be used. The chance of a complete cure depends on the stage the cancer has reached by the time it is diagnosed. If diagnosed early the 5 year survival rate can be as high as 90% and complete cure is usually possible.

Despite the effectiveness of treatment, there can be unpleasant side-effects which are severe enough to cause sickness absence from work.

  • Surgery aims to remove all or part of the tumour. By itself, it may affect the way the bowel functions. There may be pain and temporary or permanent changes in bowel habits and the affected person will need to learn how to cope with these changes.
  • Radiotherapy uses high-energy rays to destroy cancer cells. Side-effects can be temporary and can get better a few weeks after treatment has ended. However, the side-effects can be delayed occurring months or years after treatment. These include effects on bowel, bladder or sexual function.
  • Chemotherapy interferes with the process of cell division and affects both cancerous and normal cells. It can therefore affect the way the entire body feels since it is not a localized treatment and is given either orally for up to 6-7 months or intravenously. It can cause fatigue for several months and changes in sensation in the hands and feet.
  • Biological therapy is a new therapy that can be used for some types of advanced bowel cancer where there is spread to other parts of the body. It helps the body to control the growth of cancer cells. It can help persons to live longer and is given along with chemotherapy.

Impact of Bowel Cancer on Work

Even prior to the official diagnosis the symptoms of bowel cancer may begin to impact on the employee’s capability and affect attendance levels. Following the diagnosis a significant period of sickness absence will take place in order to carry out treatment and to recover from that treatment. If the treatment is limited to surgery and there are no complications, then return to work could be between 6 weeks to 3 months depending on the physical demand of the job. If chemotherapy and/or radiotherapy are used to treat, it could take months before the employee is fit to return to work. However, there are some individuals who are able to continue working while receiving chemotherapy. Chemotherapy usually starts 6 weeks after the operation.

Side-effects of treatment     

Common side-effects are:

  • Fatigue
  • Increased risk of infection
  • Nausea and vomiting
  • Hair loss
  • Sore mouth
  • Diarrhoea or constipation
  • Numbness or tingling in the hands or feet

The range and severity of side-effects vary with individuals. Perhaps the most common side-effect from treatment that will impact on work is fatigue. The employee may:

  • find it harder to perform some tasks
  • experience reduced strength and energy levels making it difficult for him/her to work for the usual hours
  • have difficulty concentrating and remembering
  • experience exhaustion during meetings or after only mild activity
  • struggle to control his/her emotions resulting in him/her being irritable and affecting interaction with others
  • experience dizziness or light-headedness

Legal Requirements

Under the Equality Act 2010, employers have a duty to make reasonable adjustments for persons with a disability. People with cancer in England, Scotland and Wales are covered under this law and in Northern Ireland by the Disability Discrimination Act. Reasonable adjustments will depend on the practicality and cost to the business and the effectiveness that the adjustment has on alleviating any disadvantage to the employee caused by their condition.

Adjustments that may benefit an employee during and after treatment

Even before the employee considers returning to work the employer can be supportive by providing information regarding support services available from the employer. These include:

  • Counselling through the Employee Assistance Programme (EAP)
  • Details of benefits including company sick pay, statutory sick pay, employment support allowance,  insurance and payment protection policies
  • Matters pertaining to job security, career progression and ill-health retirement
  • Impact of work adjustments on pay and benefits
  • Legal rights
  • Options for time off work to attend medical appointments during working hours
  • Maintain contact with employee while signed off work

Most persons will need additional support when trying to continue work while having treatment and when returning to work after treatment. It is prudent to have involvement from occupational health professionals to assist in risk assessment, to provide guidance regarding duration of absence, potential effects on work and to recommend adjustments or restrictions since individuals will vary in the type, amount and duration of adjustments from which they will benefit. It is even more important when there is a concern about health and safety issues. All employees will benefit from a supportive environment i.e. line manager and colleagues. Some of the possible adjustments that your occupational health provider may recommend are:

  • Flexible working
  • Working from home
  • Reduced hours
  • Lighter duties
  • More frequent rest breaks
  • Reduced commuting time by avoiding peak hour traffic
  • Phased rehabilitation
  • Additional support to help manage difficulties with mental tasks
  • Measures to minimise exposure to infection
  • Access to Work scheme to assist with mobility issues, commute and to help in providing special aids and equipment
  • Adjusting performance targets
  • Changes in the work environment, for example, to their workstation and its location
  • Alternative employment

Many employees are successfully rehabilitated back into work following a diagnosis and treatment for bowel cancer with the help and support of the employer.

Bibliography

  1. Understanding bowel cancer http://www.bowelcanceruk.org.uk/understanding-bowel-cancer/
  2. Bowel cancer NHS choices http://www.nhs.uk/conditions/Cancer-of-the-colon-rectum-or-bowel/Pages/Introduction.aspx
  3. Fatigue after bowel cancer treatment http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Lifeaftercancer/Lateeffectsbowel/Possiblelateeffects/Fatigue.aspx
  4. Living with cancer  http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Workandcancer/Workandcancer.aspx
  5. Working through cancer http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/WorkingThroughCancer/WorkItOut/WorkItOut.pdf
  6. Chemotherapy after surgery for bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/treatment/chemotherapy/chemotherapy-after-surgery-for-bowel-cancer
  7. Everyday Life During Chemotherapy http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/chemotherapy/living/everyday-life-during-chemotherapy
  8. Biological therapies http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/treatment/biological-therapies-for-bowel-cancer
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