Introduction

Return to work (RTW) following treatment can be problematic for cancer survivors. Although some people affected by cancer are able to continue working, a greater proportion of these survivors end up unemployed, retire early or change jobs than those without a diagnosis of cancer [1]. One of the reasons for not returning to work is the lack of understanding and support from employers and supervisors [2]. Currently, it is not clear what factors are likely to influence the employer’s management of employees recovering from cancer. This article reports the outcome from a review of the published literature on factors related to the current employer management of employed cancer survivors.

Method

We conducted an in-depth review (scientific literature from 1980 to 2016) and used the National Institute for Health and Care Excellence evidence-based systematic review guidelines [3]. Articles were identified using PubMed, Google Scholar, Web of Science, Science Direct, Embase, PsychInfo and Cochrane Central Register of Controlled Trials. Inclusion criteria were (1) original empirical articles; (2) data on supervisors and/or employers of patients returning to work after a cancer diagnosis; (3) data on supervisors and/or employers from the employer and/or employee perspective; (4) articles focusing on adult cancer patients; (5) English language articles; and (6) availability of the full article. Results were synthesised according to the Resource Dependence Institutional Cooperation Model (RDIC) model [4].

Results

Twenty-six papers were identified including 11 from Europe; four from Asia; six from the USA and five from Australia. Among these, 16 were qualitative studies predominantly and ten were quantitative studies [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. Review of these articles provided insight into the range and complexity of factors that influence an employer’s management of employees diagnosed and treated for cancer and were synthesised using the RDIC model (Fig. 1).

Fig. 1
figure 1

Factors synthesised according to the Resource Dependence Institutional Cooperation Model (RDIC) model of de Rijk et al.2007 [4]. Note that goals, dependency, resources, perceptions and institutions lead to a degree of willingness and ability to support which in turn leads to amount of cooperation. Employer-related factors that influence an employer’s management of employees diagnosed and treated for cancer, elicited by this review: Goals: none found. Dependence: The psychological contract between employer and employee was found to be important for receiving good return to work management and support; some workers who disclosed their diagnoses to their employer received support, but some expressed discomfort in their supervisor or co-workers finding out about their diagnosis; defer to ‘second hand’ information channels to keep themselves informed. Resources: Lack of guidance to managers; managers have a lack of knowledge in how to best respond; employees’ incapability to effectively communicate with their supervisor about RTW issues; supervisors should be provided the skills to promote good communication and leadership to support all workers and to provide an environment that promotes a strong, supportive work culture. Perceptions: Reluctant to proactively contact their employee with cancer; enabling employees with cancer to maintain normalcy; negative attitudes regarding the individual’s ability to work and meet the demands of the job; favourable attitude in supporting them in the process of RTW; Perceived appropriate work accommodations for cancer survivors as a burden; professional rather than non-professional position influenced employer’s perceptions of employee characteristics; negative attitudes toward employee’s work ability; duration of service rather than occupation played a role with the relationship with the employer; beliefs that cancer treatment will impair work ability; More negative beliefs than cancer patients on the impact of cancer treatment on work; avoidance behaviour from supervisors led to poor work ability among employees recovering from cancer; Perception of employer’s obligations to provide support; perception of employee’ work ability; employer’s confidence in organisational culture and resources; perceptions of overprotection leading to underestimation of employee’s capability; employer’s own personal views and experiences influenced their management of employees recovering from cancer; beliefs and values of leadership often overpower evidence-based practice; importance of a shift in focus from the medical aspects of illness tot functional ability of the employee, with employers and supervisors as natural collaborators in the return-to-work process; supervisors and co-workers should be aware that they play a significant role in the return to work process and that quality of contact is what matters. Institution: absence of RTW policies; practices and procedures not specific to cancer; no clear policies; way polices were implemented; late implementation of organisational guidelines and/or policies; lack of flexible work policy; return to work protocols enabled managers to return employees to work; organisational decision-making is often influenced by a crisis or in response to market factors of legal requirements. Cooperation: Poor lines of communication between employee and employer and between employer and other relevant stakeholders; discrimination; lack of communication; low level of management support; positive employer support; good relationship between employer and employee with cancer consisted of compassion, respect and effective communication; few employer management differences reported between ethnic groups; cancer survivors with poor prognosis experienced slightly more discrimination than subjects with better prognosis; employees perceived good support from their employers during sickness absence and initial return to work; employees perceived different levels of discrimination from their employers; employees perceived good tangible and psychological support from their employers during sickness absence and initial return to work; perceptions of discrimination left women feeling they were unable to reach their full job potential; tangible support from employer aided employee return to work; stigma and workplace discrimination are significant concerns for cancer survivors; ongoing communication and monitoring are required to ensure accommodations

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Employers’ perception and/or implementation of their organisation’s RTW policies

As with other chronic health problems in the workplace, RTW policies were crucial for supervisors or employers to support the RTW of employees following cancer treatment. [10, 20, 23]. Yet in many organisations, RTW policies were not available and for most organisations, practices and procedures for managing RTW following cancer were neither uniform nor specific to cancer [19]. Organisations that did not have explicit RTW policies [19, 30] often had poor lines of communication between the supervisor or employer and the employee and between the manager and other stakeholders involved in the RTW process (e.g. occupational health). This lack of guidance available to supervisors and employers on how to facilitate RTW for employees resulted in a process that was often ‘trial and error’. As a result, supervisors and employers were reluctant to proactively contact their employees and instead would defer to ‘second hand’ information channels to keep themselves informed about their employees. These types of practices increased the risk of employees experiencing distress when their RTW was being managed [19].

Whilst the studies reviewed here have been conducted in different countries with different healthcare and social systems, consistently, they report that the way supervisors or employers implemented workplace RTW policies depended on how clear such policies were. This suggests that there is currently much variation within organisations in how RTW is managed for employees returning from leave for cancer treatment.

A UK study [7] reported that managers held favourable attitudes toward enabling employees with cancer to maintain normalcy and supporting them in the process of RTW. Despite these positive attitudes, some managers perceived the requirement to make appropriate work accommodations for cancer survivors as a burden and they harboured negative attitudes regarding the individual’s ability to work and meet the demands of the job [7, 12].

Employees’ perception of their employer’s role and support

The evidence for employees’ perception of their employer’s role and support was variable. Some studies reported positive perceived employer support for cancer survivors [13, 18, 26] while others highlighted perceived discrimination and low levels of management support [23, 25, 28].

One possible explanation to the variability in evidence is the inconsistent availability of relevant policies applicable to individuals with a history of cancer [16], differences in employee expectations and type of cancer and/or the cancer treatment received [27, 28].

However, a good relationship with the supervisor or employer was a major factor perceived by employees as influencing RTW after cancer treatment [5, 19, 20]. Employees expressed this relationship as a “contract” between the employee and the employer, which consisted of mutual respect, compassion and effective communication [19]. This set of expectations or “contract” was based on the duration of service prior to the cancer diagnosis [5] and was strongly perceived by employees as contributing to long-term employment following cancer treatment [18].

Conclusion

Demand-side employment research is emerging as an important line of employment and disability research. One focus of this type of research is to examine the perceptions of chronic illness and disability (e.g. cancer) from the employer perspective.

There is a strong need for more comprehensive studies that are methodologically sound and that build on many of the qualitative studies reported here. There is little available evidence as to how employer management and support of cancer survivors impacts on their ability to RTW.

Furthermore, our review found no intervention studies related to the effectiveness of employer management. Intervention studies could explore the feasibility and/or effectiveness of various interventions of employer management and support of cancer survivors. Interventions should include the use of explicit workplace RTW policies and employer training on managing a successful RTW or work retention. Furthermore, specific cancer survivor-related accommodations and education on the impact of employers’ perceptions of employee characteristics on poor RTW outcomes are important components which need to be included in any interventions. Results from these interventions will enable those cancer survivors who wish to continue to work to achieve this goal which is important for their quality of life.