This information provides an introduction to the most common cancer treatments and their side effects.
It includes information about the possible effects of treatment on an employee’s ability to work, and strategies for managing side effects in the workplace.
The impact of cancer and its treatment on a person depends on the type of cancer, its stage and symptoms, the type of treatment and its side effects. Cancer treatments may cause a range of side effects. These vary depending on the treatments given, and also from person to person, even among people having the same treatment. Side effects can occur during or after treatment. Some issues resolve quickly; others take weeks, months or even years. In some cases, they are permanent.
Treatment
The main treatments for cancer are surgery, chemotherapy and radiation therapy. Other treatments, such as hormone therapy, targeted therapy and immunotherapy, can also be used. Treatments may be used alone or in combination, according to cancer type, needs of the person, and the advice of their health professionals.
Surgery
Surgery is used to diagnose cancer, remove cancerous tissue from the body, or repair a part of the body affected by cancer. Sometimes surgery is used to work out whether the cancer has spread to other parts of the body.
For some people, surgery will be the only treatment they need. Others will need chemotherapy, radiation therapy or another treatment before or after surgery.
How long a person is in hospital will depend on the type of surgery they have and their recovery. Some people do not need to stay in hospital overnight – this is known as day surgery. Others stay a few days or weeks. After some types of surgery, people may have mobility issues or need speech therapy or physiotherapy.
Chemotherapy
This uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. There are many different types of chemotherapy drugs. They are usually given through a vein (intravenously), but some may be given as tablets, creams or injections.
Most people have chemotherapy as an outpatient and do not need to stay in hospital overnight. There may be several treatment cycles over a number of weeks or months on a daily, weekly or monthly basis. Intravenous chemotherapy takes several hours. Some people schedule chemotherapy around work, others may feel too unwell to work for a few days. Oral chemotherapy is generally taken daily at home.
Download our booklet ‘Understanding Chemotherapy’
My chemo infusions took about 8 hours because I had 2 drugs and a saline solution in between. It was a long day, sitting in the chair.” CHERYL
Radiation therapy
Radiation therapy, also called radiotherapy, uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow or multiply. The radiation is usually in the form of focused x-ray beams, also known as photons. It can also be in other forms such as electron beams, proton beams or gamma rays from radioactive sources. There are 2 main ways a person can have radiation therapy – externally or internally.
In external beam radiation therapy (EBRT), radiation beams from a large machine are aimed at the area of the body where the cancer is located. Treatment is usually given daily on weekdays at a treatment centre for 4–8 weeks. Each EBRT session lasts about 15–25 minutes, with the treatment itself taking only a few minutes.
Brachytherapy (a type of internal radiation therapy) may be used to treat particular types of cancer. It delivers a high dose of radiation directly to the tumour. The radioactive material is sealed in an applicator or metal seeds and inserted near the cancer.
Targeted therapy
Targeted therapy uses drugs to attack specific particles (molecules) within cells that allow cancer to grow and spread, while minimising harm to healthy cells. It is most often given in tablet form (orally), which can be taken at home.
Immunotherapy
Immunotherapy is a type of drug therapy that uses the body’s own immune system to fight cancer cells. These drugs are usually given into a vein (intravenously).
Hormone therapy
Hormone therapy uses synthetic hormones to block the effect of the body’s natural hormones. The treatment may be given as tablets or injections. People usually have hormone therapy for months or years.
Side effects
Common side effects – Changes to sleep, appetite and energy levels, tiredness, nausea, and bowel and bladder changes are normal after any treatment. After surgery, pain and risk of infection are common.
Different drugs have different side effects – The side effects of drug therapies will depend on the type of cancer being treated and the type of drugs being used. For instance, some chemotherapy drugs may affect memory and thinking, and some cause hair loss. Immunotherapy drugs can cause inflammation anywhere in the body, such as in the joints (leading to pain), lungs (shortness of breath), bowel (diarrhoea), skin (rash) or thyroid gland (abnormal hormone levels). Hormone therapy sometimes causes mood swings, and targeted therapy may cause high blood pressure, or skin problems such as a rash or sensitivity to sunlight.
Longer-term side effects – Some side effects, such as fatigue, can continue for weeks or months after treatment finishes. Other side effects depend on the part of the body that is treated.
How much time off work an employee will need while having treatment depends on their health and the type of treatment. Some side effects appear months or even years after having treatment.
Working during treatment and recovery
Many side effects can be managed or controlled, but some may make it challenging for an employee to do their job for a period of time. Talk to your employee about how they would like to manage work during and after treatment. You may be able to offer practical strategies to make it easier for them to cope, such as adjustments to the employee’s workload, hours, equipment and environment. This may mean they can continue working, if that is what they’d like to do.
You can regularly review the employee’s working arrangements as their needs may change throughout treatment. It’s a good idea to have a back-up plan for when the employee is unable to attend work, and to share these details with them. This will help them feel comfortable that their work is covered if their circumstances change.
Reasonable adjustments
Under Australian law, cancer is considered a disability. Employers are legally obliged under the Disability Discrimination Act 1992 to make reasonable changes to minimise the impact of the disability and help an employee continue working. These changes are known as “reasonable adjustments” and may be temporary or long term.
Examples of reasonable adjustments include:
- extra breaks to attend medical appointments or manage pain or fatigue
- reduced hours, flexitime, working from home, part-time work, gradual return to work, changes to duties
- more time to complete tasks
- changes to an employee’s workspace, such as a more suitable chair or a height-adjustable desk or counter
- providing voice-activated software, telephone headsets or screen-reading software.
An employer can only refuse to make these changes if the changes could cause an unjustifiable hardship to the business. This may include a high cost or disruption to the workplace.
Contact the Australian Government’s Job Access service for advice and assistance. Their Employment Assistance Fund provides financial assistance to employers for work-related equipment, modifications and services for employees with disability. Visit Job Access or call 1800 464 800 for more information.
Flexible working arrangements
Under the National Employment Standards, an employee who has at least 12 months of continuous service has the right to ask for flexible working arrangements. These may include working from home or another site some or all days; varying work hours; changing start, finish or break times; job-sharing or working part-time.
Employers have a duty of care to provide a safe work environment and ensure employees are fit to safely perform their duties without harm to themselves or others. If an employer feels that the employee is too unwell to be at work, they may direct the employee to go home and seek medical attention, or request a medical certificate stating the employee is fit for work.
Leave entitlements
The amount of leave an employee will need will vary according to the type of cancer, its stage and the treatment required.
An employee may need to take time off work to have treatment or recover from treatment. This may be as a one-off, or they may need to take time off periodically. For example, someone who has major surgery may need 6 weeks or more to recover, while someone undergoing radiation therapy may need to attend appointments every morning for several weeks.
There are various leave options available under the National Employment Standards to help employees balance work and treatment.
Most permanent full-time employees are entitled to a minimum of 10 days of paid personal/carer’s leave for each year of employment.
Permanent part-time employees are entitled to a pro rata amount of paid personal/carer’s leave, based on the number of hours they work. Paid personal/carer’s leave that is not used accumulates and is carried over from year to year.
Generally, employees must use their annual leave, and then any long service leave, before taking unpaid leave.
Employees must let their employers know if they can’t work as soon as they can and should advise the employer of the expected period of leave. The employer may request evidence to support the reason for the leave, such as a medical certificate or statutory declaration, as stated by the organisation’s policies, employment contracts or relevant award.
Check the employee is aware of any income protection arrangements they may have as part of the organisation or their superannuation, or if they are eligible for government assistance.
Tips and strategies for managers
At diagnosis
- Ask the employee if it’s possible to have a written outline of their expected treatment schedule, so that you have time to consider any adjustments or support you may need.
- If your organisation has an Employee Assistance Program (EAP), encourage the employee or their family members to use its counselling services if they wish to do so.
During treatment
- Talk to the employee about any assistance they may need to help them do their job and manage the side effects.
- If possible, suggest flexible work hours that will allow the employee to attend medical appointments and work when they can.
- Plan for absences. The employee will need time off to attend medical appointments, and may have days when they are not well enough to work.
- Be mindful that treatment can often run over time and that an employee may sometimes be delayed at medical appointments or not feel well afterwards.
- Temporarily reallocate or adjust some of the employee’s usual duties to avoid very demanding tasks; extend deadlines to complete work and projects; and establish clear priorities.
- Encourage the employee to plan their work around when they have the most energy.
- Offer your employee a cab voucher or a lift if they feel unwell and have to go home.
- If practical, arrange for the employee to work from home some of the time. This may mean employees at risk of infection can avoid people on public transport or in the workplace who are sick. Be mindful that working from home may be isolating and that there are workplace health and safety requirements involved with working from home.
- If the employee works in a noisy area and is having difficulty concentrating, consider moving their workspace to a quieter location.
- Allow the employee to have rest breaks, as needed, during the day.
- Offer assistive technology, (e.g. telephone headsets, voice-activated software or a more supportive chair).
- Arrange an ergonomics assessment to ensure that the employee’s work environment is still appropriate, safe and comfortable.
- Use technology such as email to stay in touch with an employee who is taking time off; ask how often they’d like to hear from you.
- If possible, provide a parking space.
- Consider the allocation of work within the team – can some of the employee’s tasks be reallocated to other team members?
- Because of the increased risk of infection, encourage co-workers who are sick to stay at home until they are fully recovered, or relocate them away from the employee who is undergoing cancer treatment.
- Check whether your employee has any special safety requirements. For example, people having chemotherapy may need to dispose of waste at work. Their medical team will provide advice about how to safely dispose of waste or spills.
After treatment
- Find out if your workplace has a return to work coordinator who could assist in the transition back to work.
- Talk to your employee about their return to work options. These may include returning to work gradually, starting back on light duties, having flexible start and finish times, or taking additional rest breaks or time off to attend medical appointments.
- Be mindful that an employee may put pressure on themselves to return to their normal work situation. Ensure that you do not add to this pressure – reassure them that they are not expected to perform at their usual level while having treatment or recovering.
- Follow up regularly with the employee and adjust plans as necessary.
Working after treatment
Some employees will have long-term physical and emotional side effects from their treatment, including fatigue, pain, changes to their appearance, and difficulty concentrating or focusing.
After treatment, some employees will feel ready to return to their full workload. Others will need your support to return to their usual role. Each situation will be different – talk to your employee about their capacity to undertake their usual tasks, and the support you can provide.
I had no idea that I would still be feeling tired 5 months after finishing treatment. I didn’t know how to make it better and I was scared that’s how it would be: that I wouldn’t ever go back to normal, that I would never go back to having energy again.”
JANE
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This information has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Subcommittee initiative.
This information was last reviewed in November 2024 by the following expert and consumer reviewers: Jenny Lee, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Joey Tass, Partner, Hunt & Hunt Lawyers, NSW; Andrea Concannon, Consumer; Felicity Hale, Supportive Care Specialist, Cancer Council NSW; Pamela Campusano Vallejos, Consumer; Kaylene Jacques, Director, People and Culture, Cancer Council NSW; Emily Mitchell, Advanced Occupational Therapist, Gold Coast Specialist Palliative Care Service, QLD; Anushka Methananda, General Manager, People and Culture, Publicis Groupe Australia; Sophie Michele, 13 11 20 Consultant, Cancer Council SA; Jonathan Park, Consumer; Lucy Wilson, Chief People Officer, Gumtree Australia, NSW; Fiona Wiseman, Senior Social Worker, Peter MacCallum Cancer Centre, VIC; Sue Woodall, Consumer and founder LiveWorkCancer, Sydney, NSW.
This information is intended as a general introduction and should not be seen as a substitute for medical, legal or financial advice. You should obtain independent advice relevant to your specific situation from appropriate professionals. Information on cancer, including the diagnosis, treatment and prevention of cancer, is constantly being updated and revised by medical professionals and the research community. While all care is taken to ensure accuracy at the time of last review, Cancer Council Australia and its members exclude all liability for any injury, loss or damage incurred by use of or reliance on the information provided on this page.