Breast cancer is the most common cancer in women globally with the risk of developing invasive breast cancer in their lifetime ranging from 1 in 8 to 1 in 26, depending on a woman’s genetic predisposition[i].
However, greater understanding and effective support by employers can assist women in regaining momentum after a life-threatening diagnosis, remain productive at work and aid their recovery.
The high incidence of breast cancer in working-age women poses a growing challenge to organisations’ human capital, while remaining in work contributes positively to their prospects of recovery and those that do continue working have a higher survival rate, according to a paper published by Stellenbosch Business School. [ii]
Mia Barnard, a Stellenbosch Business School MBA Healthcare Leadership graduate, said that while many women would suffer a temporary loss of work capacity, “breast cancer does not take away their ability to work”.
October is Breast Cancer Awareness Month, highlighting that breast cancer accounts for a quarter (24.11%) of all cancers in South African women, with over 11 000 new cases diagnosed in 2022i, and is the leading cause of cancer deaths in women worldwide.[iii]
“Misperceptions about an individual’s ability to work during and after cancer treatment are common amongst employers. Where cancer patients fear potential discrimination and threats to job security, they are reluctant to disclose their condition and request workplace accommodations that would enable them to remain productively in work and reduce absenteeism.
“This in turn prevents employers from being able to plan timeously and make the adjustments needed for business continuity.
“However, a culture of open communication and a supportive environment, with all the legal, ethical and practical issues taken into consideration, can mitigate the risk to the employer of loss of skills and talent, and enable women with breast cancer to maintain productivity, work performance and work-life balance,” Barnard said.
She said that significant advances in breast cancer treatment had improved recovery prospects and research had shown that most women were able to return to work within the first year after a breast cancer diagnosis, and to remain in full-time work.
“However, employees living with cancer are at high risk of discrimination and unfair labour practices. More than half of women in full-time employment are forced to downscale to part-time work and those undergoing chemotherapy are doubly at risk of losing their jobs.
“Given the prevalence of breast cancer and the risk of unnecessary loss of human capital, it is vital that employers understand the impact of breast cancer and what is needed to effectively support affected employees to enable them to return to and remain productively in work,” Barnard said.
Co-workers also have a role to play, she said, in providing moral and practical support and encouraging a “fighting spirit”.
Breast cancer diagnosis and treatment presents a life-changing challenge that impacts every aspect of women’s lives, including “their ability to navigate the workplace with confidence”, she said.
In addition to a range of complex and conflicting emotional and psychological impacts, women diagnosed with breast cancer are faced with making immediate decisions on treatment options and the associated costs, along with considerations of insurance coverage and illness benefits, amid the fear of possible job loss.
“They must coordinate appointments for treatments, supportive care and possibly surgery and hospitalisation with a multidisciplinary team of specialists, while attempting to strike a balance between maintaining their career and life commitments and the time needed to recover and heal.
“They need to cope with the physical symptoms and the side effects of treatment that affect their productivity, job performance, and career advancement. Psychological impacts such as anxiety, depression, and emotional distress are common throughout the cancer journey.
“These women need comprehensive support systems, in both the clinical and work environment,” Barnard said.
In the article on breast cancer care in the South African workplace in the 2024 Women’s Reportii published by Stellenbosch Business School and the SA Board for People Practices (SABPP), Barnard recommends strategies for employers to respond to the psychological and practical challenges and “create more compassionate, inclusive, and supportive workplace environments for employees battling breast cancer”.
Strategies and interventions to support employees living with breast cancer should be developed in the context of the demographics and culture of the workforce, she said, and allow for balancing of potentially conflicting interests between employer and employee on what constitutes “reasonable accommodations” and a return-to-work that works for both parties.
Legal position
In terms of South African employment law, employers may not discriminate on the grounds of chronic illness. Cancer sufferers cannot be demoted, dismissed, or given unfavourable performance reviews without being provided with clear communication, reasonable adjustments, and workplace accommodations. Employees must also be informed of their rights, legal protections and workplace policies.
Reasonable accommodations to enable employees to continue performing their jobs effectively could include adjustments to work schedules, flexible hours or working from home; adjusting job duties, physical aspects of the job, or performance measures; and physical workplace modifications such as ergonomic workstations.
Barnard advises that in cases where the company has no suitable alternative positions, for example, where the job requires physical activity, the employer requires legal guidance to avoid unfair labour practice.
Workplace policies
Organisational policies should prevent discrimination against employees living with cancer, allow for disability accommodation including flexible work arrangements, and protect patients’ privacy.
“Policies should incorporate psychosocial support to help employees balance their health needs with work responsibilities. A documented return-to-work policy and schedule will provide clarity on mutual expectations and should include a mandatory fitness-for-work assessment before resuming employment,” Barnard said.
Given that cancer symptoms, prognosis, and treatment plans and side-effects are highly variable, she said that policies should allow managers the flexibility to respond to the needs of individual cases. Employers have to evaluate each case individually to provide the right support.
Practical advice for HR practitioners
Barnard said that workplace-based interventions have been shown to substantially support employee health and recovery from illness. In addition to keeping up-to-date on their legal obligations, HR practitioners are advised to consider the following initiatives:
• Providing line managers with training and technical assistance, on dealing with chronic illness, appropriate communication, ethical decision-making and managing conflict, assessing employability, implementing reasonable workplace accommodations and return-to-work approaches.
• Leverage the knowledge and resources available in cancer support organisations such as CANSA to provide managers with information and resources to support employees.
• Provide employees with information on cancer support organisations, community support groups, complementary cancer care services and healthcare system resources within their local area.
• The costs of cancer treatment can be daunting, and prohibitive for those without adequate medical cover.
Barnard said that, to prevent over-reliance on employers, all employees should be provided with information on medical aid schemes and insurance, gap-cover insurance, disability cover, income protection, life insurance, and severe illness cover.
Employers can ensure employees are adequately protected by establishing group medical cover, the costs deducted from salaries.
• Online tools can be developed to equip line managers and employees with information and resources such as policies, legal responsibilities and return-to-work frameworks, as well as links to local support services, to enable them easy access to resources and information they may need.
“Offering line managers easily accessible, concise online information on return-to-work support could reduce misconceptions, improve empathy, prevent potential ignorance, and foster a more inclusive culture,” Barnard said.
• Proactive establish comprehensive employee wellness programmes that encourage healthy lifestyles as well as employee assistance programmes that include breast cancer screenings, access to confidential counselling services, mental health resources and support groups.
• Training and education for managers and employees should address not only legal rights, responsibilities and workplace policies but they must be empowered to deal with these individuals effectively. Help them to recognize signs of distress, respond appropriately and model empathy and understanding, the basis of a supportive culture.
“This can improve the integration of breast cancer survivors into the workplace, reduce stigma and encourage supportive behaviour and networks in the workplace,” said Barnard.
• Establishing trust and open communication is vital, she said, so that employees feel comfortable discussing their health challenges and reasonable arrangements to accommodate their needs can be made timeously.
“Regular check-ins with employees undergoing treatment display empathy and compassion and can help maintain open lines of communication to assess their well-being, discuss challenges, and offer support and resources,” she said.
• While employees are undergoing treatment and in recovery, employers should follow a “vocational rehabilitation approach” to assess employees’ abilities and needs. This enables the provision of appropriate re-training and/or adjustments to duties, schedules or physical workspaces.
Occupational therapists can play a vital role in this process, through assessment of an individual’s ability to work and the accommodations required, and in supporting employees in their transition back to work.
Managers must also collaborate and communicate with health care providers to ensure the return-to-work plan remains relevant and effective, Barnard said. “We can help employees with cancer keep a fighting spirit rather than feeling helpless, afraid, and isolated.”
Employers need to know that supporting women with breast cancer in the workplace is not just an act of compassion; it is a smart business strategy. It boosts overall morale, productivity, and loyalty, ultimately benefiting both employees and the employer.
