An introduction to the most common types of cancer treatment and their side effects.
There may also be possible side effects of cancer treatment on an employee’s ability to work, and some 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.
Cancer treatment and side effects
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 for some types of cancer. Treatments may be used alone or in combination, according to the needs of the person.
Common cancer treatments:
Surgery is used for various reasons: 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 or radiation therapy 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. After some types of surgery, people may need speech therapy or physiotherapy.
Side effects – This will depend on the type of surgery, but pain and risk of infection are common. The amount of time an employee will need off work to recover from the surgery will vary. It could be as little as a day or as much as a few months.
This uses drugs known as cytotoxics to kill cancer cells or slow their growth. The aim is to destroy cancer cells 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.
Drug therapies, like chemotherapy, are delivered into the bloodstream so the treatment can travel throughout the body. This is called systemic treatment.
Most people have chemotherapy as an outpatient in hospital. It may include several treatment cycles over a number of weeks or months on a daily, weekly or monthly basis. Intravenous chemotherapy takes several hours. While 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.
Side effects – Some drugs increase the risk of infection, cause tiredness, nausea, and bowel and bladder changes, and may affect memory and thinking. Different types of drugs have different side effects – for instance, not all of them cause hair loss.
This uses synthetic hormones to block the effect of the body’s natural hormones. The aim is to lower the amount of hormones that help cancers such as breast and prostate to grow. The treatment may be given as tablets or injections. People usually have hormone therapy for months or years.
Drug therapies, like hormone therapy, are delivered into the bloodstream so the treatment can travel throughout the body. This is called systemic treatment.
Side effects – These vary depending on the type of hormone therapy, but common side effects include tiredness, weight gain, hot flushes, sweats, muscle pain and mood changes. Hormone therapy can also cause bones to weaken and break more easily.
This uses drugs to attack specific particles (molecules) within cells that allow cancer to grow and spread, while minimising harm to healthy cells. It is generally given in tablet form (orally), which can be taken at home. Not all cancers respond to targeted therapy.
Drug therapies, like targeted therapy, are delivered into the bloodstream so the treatment can travel throughout the body. This is called systemic treatment.
Side effects – These vary depending on the type of targeted therapy used, but may cause skin problems such as a rash or sensitivity to sunlight. Other common side effects include fever, tiredness, joint aches, nausea, headaches, diarrhoea, heavy bleeding and bruising, and high blood pressure.
This is a type of drug treatment that uses the body’s own immune system to fight cancer cells. These drugs are usually administered into a vein (intravenously). Some people with particular types of cancer may benefit from immunotherapy.
Drug therapies, like immunotherapy, are delivered into the bloodstream so the treatment can travel throughout the body. This is called systemic treatment.
Side effects – The side effects of immunotherapy drugs are different from chemotherapy drugs. The drugs can cause inflammation anywhere in the body, such as in the joints (leading to pain), lungs (shortness of breath), bowel (diarrhoea) or thyroid gland (abnormal hormone levels).
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 two 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 and inserted into the patient’s body near the cancer. The implant may stay in place for a few minutes at a time (during multiple sessions), for 1–6 days, or permanently.
Side effects – It’s common to experience fatigue, which can continue for weeks or months after treatment finishes. Other side effects depend on the part of the body that is treated.
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 with cancer 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 with side effects at work. Adjusting the employee’s workload, hours and environment may mean they can continue working if that is what they’d like to do.
Keep in mind that you’ll need to regularly review the employee’s working arrangements. Their needs may change as treatment progresses. It’s a good idea to have a back-up plan in place for when the employee is unable to attend work and to share these details with them. This will ensure that they 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 by the Commonwealth Disability Discrimination Act 1992 to make changes to help an employee continue working. These changes are known as reasonable adjustments.
Examples of reasonable adjustments include:
- extra breaks to attend medical appointments or manage pain or fatigue
- changes to duties as agreed
- more time to complete tasks
- reduced hours, flexitime, working from home, part-time work or a gradual return to work
- changes to the workspace such as a more suitable chair or a height-adjustable desk or counter
- providing voice-activated software, telephone headsets or screen-reading software.
These adjustments could be temporary or long-term.
An employer can refuse to make these changes if they could cause an unjustifiable hardship to the business. This may include a high cost or disruption to the workplace.
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 some or all days
- working from another worksite
- changing start, finish or break times
- varying work hours, working part-time or job-sharing.
Employers have a duty of care to employees. If an employer feels that the employee is too unwell to be at work, the employer may direct the employee to go home and seek medical attention. An employer can also request a medical certificate stating that an 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 six 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, which includes sick 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
is carried from year to year.
Generally, employees must use their annual leave, and then any long service leave, before taking unpaid leave.
Employees are required to let their employers know of their inability to work as soon as practicable and should advise the employer of the expected period of leave. The employer may require evidence to support the reason for the leave, such as a medical certificate or statutory declaration, as specified 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 their superannuation.
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 and organise any adjustments you as an employer need to make.
- 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 probably need time off to attend medical appointments, and may have days when they are not well enough to work at all.
- Be mindful that treatment can often run overtime and that an employee may sometimes be delayed at medical appointments.
- Temporarily reallocate or adjust some of the employee’s usual duties to avoid very demanding tasks; offer more time to complete work and projects; and prioritise tasks.
- Encourage the employee to plan their work around when they have the most energy.
- 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.
- Allow the employee to have rest breaks, as needed, during the day.
- Offer assistive technology, e.g. voice-activated software, telephone headsets 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 the employee works in a noisy area and is having difficulty concentrating, consider moving their workspace to a quieter location.
- 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?
- Offer your employee a cab voucher or a lift if they feel unwell and have to go home.
- 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.
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.
Visit the Australian Government’s Job Access website for advice and assistance. Their Employment Assistance Fund provides financial assistance to employers for work-related equipment, modifications and services for employees with disability.
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This information was last reviewed December 2019 by the following expert content reviewers: Dr Fiona Day, Medical Oncologist, Calvary Mater Newcastle, NSW; John Boomsma, Consumer; Lydia Chin, HR Business Partner, Australian Red Cross, VIC; Emily Gibson, Social Worker, Mater Hospital Brisbane, QLD; Shai Ishaq, Head, Talent and Culture, Pureprofile, NSW; Nick Ruskin, Partner, K&L Gates, NSW; Andrew Smith, Occupational Therapist, Co-Founder and Director, Allied Education Group, VIC; Amy Wallis, Occupational Therapist, Co-Founder and Director, Allied Education Group, VIC; Kerryann White, Manager, People and Culture, Cancer Council SA.
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 publication, 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.