Reintegration into the workplace after breast cancer

As part of the return-to-work policy of Minister of Social Affairs and Public Health Frank Vandenbroucke, people who have been on long-term sick leave (more than 1 year) with an employment contract will be required to undergo a mandatory reintegration program and cooperate with it from 2026 onwards. If they refuse, they risk sanctions, such as losing part of their benefits. "This mandatory reintegration program does not apply to cancer patients, of course," assures occupational physician Mathieu Versée, lecturer in occupational medicine at the VUB and employed by Cohezio. Cohezio is an external service for prevention and protection at work, and also a partner of Pink Ribbon. "Anyone undergoing treatment for cancer or recovering from treatment will not be pressured to return to work."

Eager to work

Breast cancer treatment can easily take a year, which means that breast cancer patients are often unable to work for a period of time. Often against their will. According to a 2019 study by Christelijke Mutualiteit, 67% of 7,600 breast cancer patients surveyed were back at work full-time or part-time two years after their diagnosis. Of the women with metastatic breast cancer, 27% were also back at work after two years. However, it is rarely possible to simply pick up where you left off. Fatigue and concentration problems (brain fog) can prevent this. That is why adapted work is a necessity, but it does not happen automatically. According to Mathieu Versée, there are obstacles on four levels: the legislative framework is not sufficiently binding, healthcare is inadequate, employers are unfamiliar with the field, and the return to work is not well prepared for the employee.

Barrier 1. Legislative framework for cancer patients is too limited

Companies are encouraged to offer cancer patients adapted work after their treatment, but this is not mandatory. There is also a training course for reintegration coaches, organized by the Riziv, but companies make too little use of it. "If employers were obliged to do so, reintegration would be taken seriously," Versée suggests. "Large companies should appoint a reintegration coach who specifically focuses on returning to work after illness. There are numerous advantages for the company itself. A sound reintegration policy creates a positive image. It prevents employees with expertise from leaving permanently and eliminates the need to train new people. What's more, there are financial benefits too. Reintegration is not an unnecessary luxury given the tight labor market."

Obstacle 2. Healthcare is insufficiently geared toward reintegration

Ideally, the treating physician(s) and the company's occupational physician should discuss the extent to which modified work is possible, as well as the possibilities and limitations. However, cooperation between the various parties involved is lacking. For example, the oncologist does not know exactly what the cancer patient's work entailed and to what extent treatments, side effects, or complications could affect that work. General practitioners sometimes do not know who the occupational physician is and that they can discuss the options for reintegration into the company with the latter. Patients themselves are also unaware of this. Communication would improve significantly if offering adapted work became mandatory for cancer patients who want to return to work.

Obstacle 3. Employers are not always keen on reintegrating cancer patients

Reintegration with adapted work takes more time and effort than not returning to work. "The request for adapted work can be too easily refused. It is sufficient to indicate that an employee is no longer suitable," says Mathieu Versée. "It would be better to emphasize what an employee can still do. For example, in the case of a woman who suffers from brain fog after breast cancer treatment, one could argue that she can function perfectly well, provided she takes regular breaks." In order to arrive at such a plan, it is necessary to describe the employee's capabilities and the conditions and modalities for adapted work. This requires consultation between the treating physician and the occupational physician.

A reintegration policy is legally required for companies, but many smaller companies do not have one. Moreover, even if such a plan exists, it is rarely well developed. There are no clear guidelines on this. Employers often have too little knowledge about the possibilities of reintegration. It is not a priority. External companies that can assist them in this area are not called upon often enough.

An employer may always contact an employee who is absent due to illness, not to monitor them, but to ask how they are doing and to assess the duration of their incapacity for work. This contact will soon be required by law. Showing concern promotes reintegration.

Obstacle 4. The employee must be able to function in a team again

Employees who return to modified work after illness must also accept certain conditions imposed by the employer. For example, working from home may not always be an option. Successful reintegration also involves colleagues, who must be kept thoroughly informed about the illness and the associated limitations of the returning colleague. Who is the point of contact when things get difficult? When will the new situation be evaluated? This requires a good framework and good communication.

Decision

The obstacles listed are far from insurmountable. They can be tackled with a stricter legal framework and good communication. Every patient who wants to return to work after cancer should be given that opportunity. 'Reintegration into the workplace is often viewed negatively at present. People focus on what a person can no longer do. It is high time that this mentality changed and the focus shifted to what someone can still do. Doctors could draw up a 'fit note' listing possibilities and limitations. Companies must also prepare other employees for the return of a colleague after breast cancer. As part of its Pink Monday project, Pink Ribbon lectures in companies that want to prepare a team for such a return. "All companies should participate in Pink Ribbon ," says Mathieu Versée. Many breast cancer patients are highly motivated and resilient. Having a job and belonging somewhere is part of the healing process.

More info:

www.cohezio.be

www.pinkmonday.be

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