Cancer survivorship and work

The success of healthcare interventions in increasing survival rates of patients with the common cancers is one of the major achievements of modern medicine. Nevertheless, these conditions and their treatment, even with successful treatment outcomes, are recognized to lead to significant morbidity in some 25% of survivors. As diseases largely of age, the common cancers will increasingly be seen in working age populations as both survival and retirement ages in many countries increase. The challenges for those survivors developing immediate and enduring or late complications of treatment will increasingly be manifest in the proportion of workers experiencing consequent impairment of work ability. This chapter explores the nature of the potential long-term impact of cancer survivorship on work ability and the strategies and evidence base for workplace interventions seeking to mitigate these effects.

Cardiovascular diseases

Cardiovascular diseases are one of the leading causes of morbidity and mortality in the UK. Cardiovascular diseases can affect those in employment and can limit working capacity. Multiple considerations should be taken into account when assessing return to work, including psychosocial factors. This chapter provides a comprehensive and up-to-date evidence-based overview of common cardiovascular diseases such as coronary heart disease, valvular disease, congenital heart disease, hypertension, syncope, and implantable cardiac devices including pacemakers (with a special section on implantable devices and electromagnetic fields). Topics of interest also covered within this chapter include travel, firefighters, stress, shift working, hazardous substances, hot conditions, and driving.

Epilepsy

This chapter on epilepsy reviews the epidemiology of epilepsy, including the classification of seizure types, causes of epilepsy, risks of seizure recurrence, and chances of remission, and examines the responsibility of the occupational health professional and sensible employee restrictions. It reviews primary and secondary prevention of epilepsy in the workplace and the impact of alcohol and drugs. It also considers the effect of antiepileptic drugs and other co-morbidities on work performance and special work problems, including disclosure of epilepsy, accidents, absence records, and employment practice. The chapter ends with a review of the medical services available, opportunities for sheltered work, and epilepsy support organizations, along with a brief discussion on relevant legislation and the driving licence regulations.

Ill health retirement

This chapter gives advice to doctors who provide reports for pension schemes about the merits of a patient’s application for ill health retirement. This is a challenging area of practice in which the structure and wording of the report is important if difficulties are to be reduced. An overview of pension provision in the UK is included as well as advice contained in determinations by the Pensions Ombudsman. Rates of ill health retirement for national schemes are shown against which doctors should audit their practice. In general, a retiree’s perceived health status tends to improve after retirement, although the improvement will attenuate over time. Heavy manual workers are more likely to retire on the grounds of ill health than non-manual workers, which has been attributed to their poorer health and less favourable working conditions.

Fitness for work after surgery or critical illness

Occupational health professionals frequently advise about return to work after surgery. Providing advice can be challenging, and considerable misunderstanding exists among patients and clinicians. One patient may return to work 1 week after a hysterectomy while another is absent for 5 months. Advice on returning to work after surgery should be based on knowledge of tissue healing processes, along with adverse effects of smoking and obesity, perioperative infection, and co-morbidity. Medical issues are often confounded by inconsistent advice, inappropriate beliefs, and unhelpful motivators. There is a recognized limitation in the evidence base. However, consensus is available from a number of guidelines drawn up by various expert bodies, which are covered in this chapter.

Rehabilitation and return to work

Rehabilitation and return to work is not a straightforward clinical problem of assessment, diagnosis, and treatment. The chapter explores the concept of worklessness and its impact on life expectancy, what barriers there are in returning to work, why work is good for health, and the relationship between work and health. Common work-related health problems are explored along with disability benefits and most prominent health problems in this area. The chapter details the current UK government system of assessing fitness via the Employment and Support Allowance assessment programme. Models of disability are discussed, focusing on the biopsychosocial model and psychosocial flag system. Workplace management including current UK initiatives of the ‘fit note’ and ‘Fit for Work Scheme’ are further explored. Common workplace adjustments that may assist in a return to work are explored.

Haematological disorders

In recent years, there have been major advances in the management of many haematological conditions. As a result, there have been real improvements in long-term survival and workability, particularly among patients with haemoglobinopathies and haematological malignancies. Work is often not possible for many months during major treatments such as chemotherapy or haematological stem cell transplantation. However, more of these patients will return to the employment market after treatment than previously. With the exception of a few jobs that are contraindicated (including some in heavy or dangerous industries and commercial aviation), adjustments to work will enable most patients with haematological disorders to work efficiently and safely. Generic issues that should be considered for work adjustments include fatigue, impaired immunity, and bleeding tendency.

Blood-borne viruses

Hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infections have particular implications for fitness for work. These include the impact of symptoms and disease, the transmissibility of infection in the course of specific work activities, and, in the case of HIV, vulnerability to other infections arising from immune deficiency. This chapter focuses on HBV, HCV, and HIV because these are the most common blood-borne viruses that have particular implications for work. Blood-borne viral infections can affect people of any age. In the UK, HIV infection is specifically mentioned and automatically considered as a disability, from the point of diagnosis, by the Equality Act 2010. HBV and HCV infections may also qualify as disabilities, if associated disease causes impairment. There are therefore practical, legal, and ethical issues to consider when assessing fitness for work in people with blood-borne viral infections.

Hearing and vestibular disorders

Hearing and vestibular disorders are prevalent in working populations and may heavily impact a worker’s ability to perform and work safely. It is frequently incumbent on the occupational health professional to assess the extent and impact of these disorders on the workplace. This is optimally executed by careful examination and assessment and using a knowledge of the conditions and treatment options. The employer may also be requested to perform a risk assessment in the workplace. The occupational health professional should have a good understanding of noise-induced hearing loss and audiometry programmes. They should also be able to assess and advise about the impact of hearing loss in the workplace and may also be required to manage a health surveillance programme.

Mental health and psychiatric disorders

Mental health disorders significantly impact well-being and productivity in the working age population. They affect around 17% of the population and their economic cost has been estimated at £70 billion or 4.5% of gross domestic product in the UK. Mental health conditions are a leading cause of sickness absence with 70 million working days lost per year. Over half of disabled people who are out of work have a mental health and/or musculoskeletal disorder as their main health condition. This chapter considers how work and mental health interrelate, how employers can ensure that their workforce mental health needs are managed, opportunities for productivity maximized, and psychiatric morbidity minimized.