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Samantha Siegel: Work and Cancer (Again)

Samantha Siegel/LinkedIn

Feb 9, 2025, 14:42

Samantha Siegel: Work and Cancer (Again)

Samantha Siegel, Director of Cancer Survivorship at The Permanente Medical Group, shared a post on LinkedIn:

“Work and Cancer (Again):

Someone recently referred me to the Reed Group Evidence Based Guidelines for Restrictions tool for work accommodations. I found it interesting for general principles, but practically speaking, it still doesn’t cover many issues I face returning people to work. I also find some of the timelines overly ambitious (with ensuing potential for internalized shame and guilt for survivors if they fail to meet these expectations.)

I know that as clinicians, we are advised not to dictate how workplaces are supposed to accommodate an individual. However, it seems like a catch 22 because workplaces often have no idea how to accommodate a protracted, graduated return to work during cancer treatment and recovery.

I’ve given patients work notes for short term modified duty only to be told that their workplace’s solution was to squeeze double the amount of work into the proposed reduced schedule. So, in these situations, I often have to spell out:

may need more time to complete tasks (especially with chemo related cognitive impairment (CRCI) recovery. Interesting to note–there is no ICD code for CRCI and it can often take months, sometimes up to one year to resolve.
may need more frequent breaks for rest and hydration (if a patient is on long term maintenance therapy) – some workplaces then ask me how frequently a break might be needed.

Survivors often have ongoing issues even when treatment is over: lymphedema, neuropathy, pain, emotional trauma and more. I encourage them to receive ongoing treatments to manage these symptoms like acupuncture, PT, OT and psycho-oncology sessions. They request FMLA to attend such appointments and I believe we should support that. The medical condition of cancer survivorship is ongoing, even when active treatment is complete.

I have to explain in my notes what a ‘graduated return to work’ plan looks like and that we frequently can’t anticipate the next increment, neither time spent at work nor intensity of work, until someone starts working. We just have to wait and see how they do.

These are just some of the issues that I face advocating for people who want to return to work, but they do not feel the same as before diagnosis. When returning people to work, we must take into account the nature of the work (including physical and cognitive load) and the type of ongoing issues in cancer treatment and recovery. Only then can we come up with an individualized plan.

When we fail to advocate in this way, going off work completely becomes a path of least resistance.

It’s about time to revise some of these practices, especially as rates of cancer increase in younger individuals.”