When work is the best medicine

Without it, they can feel isolated, missing the social aspect of life around the water cooler. Work is bound up with many people's sense of self and purpose. And more than anything, getting it back is about getting back a sense of normality.

"That can put people under pressure," Fee says. "They are told, That's you finished your treatment,' and think everything is back to normal. Some people go back and after a few days are off sick again. Too often they don't have realistic expectations."

People like Glasgow nursery teacher Gloria Grossman, who was so devoted to her work in one of the city's primary schools that she feels her employer - Glasgow City Council - should have done more to protect her from herself.

After being diagnosed with breast cancer in 2003, she had radical surgery in July of that year. But she delayed her reconstructive surgery, so she could return to work and settle in the year's new intake of pupils. After that, she took nine months of sick leave.

At the end of her course of radiotherapy, she returned to the nursery she had worked in for 13 years, disregarding medical advice that it was too soon. Her employers made some effort to phase her back into work, and she was supposed to avoid heavy lifting, but she found it hard to limit what she did - she didn't want to be a burden on her small team of colleagues.

"I was ecstatic about going back to work," she says. "I didn't ask for a medical or anything - I was beating the cancer and getting my life back and I didn't look outside that box. But I struggled for two years, getting worse and worse."

Grossman would go in early to give herself more time to prepare the classroom at her own pace. But she developed Lymphodema as a side-effect of her surgery and eventually both her GP and her surgeon ordered her to go off work. She soon ended up seeking early retirement on the grounds of ill-health.

Having made the decision, however, her application for early retirement was stalled for the best part of year. Eventually she met human relations staff who asked her a series of questions. "They said, who conducted your risk assessment, when you came back to work after this major illness? Who arranged for your medical?' I said nobody had. After that they kept saying, we are terribly sorry, you have been badly treated'."

Grossman still feels aggrieved and robbed of the end of her career. She and her husband have had to move from their southside home into a smaller flat to pay off their mortgage. She was 53 when she was diagnosed, 56 when she retired. "If they had treated me properly I may have been working until I was 60," she says.

Although she had requested it, and expected it, the letter confirming that the council agreed she was no longer fit to do her job, came as a bombshell, Grossman explains. "I know I'm the luckiest person alive to have survived this. But I miss the job, miss the children and my colleagues. I expected the cancer to rob me of my breasts. But I didn't expect to lose my career and all those other things."

Glasgow City Council told the Herald that Grossman's experience had been unfortunate. A spokesman added: "We do have very clear procedures for managers to follow when someone is returning to work after a long term illness. We have to be guided by medical opinion and in this instance it was felt that retiral on the grounds of ill-health was the course of action that had to be taken.

"The health and well-being of our employees is a key priority for the Council and we believe our policies do provide the kind of support required during and after long term absences."

The experiences of cancer patients in the workplace can very enormously, according to Maggie's Centre benefits advisor Carol Scott. She sees a lot of people soon after their diagnosis, when the initial shock has worn off and they are starting to worry about paying the mortgage, and what help they may be entitled to.

Some continue with their jobs, Scott says. "Some work because they want to, others because they feel they need to - there's a difference." But from listening to people talking about their work, she believes it is the simple things that matter. "A lot depends on where they work and who their line manager is."

Within the public sector too, experiences can be vastly different. Eleanor Mulholland is a forensic chemist with the Scottish Police Services Authority (SPSA), which took over forensic testing work from Strathclyde Police last year.

When she was diagnosed with breast cancer in 2006, she had surgery, followed by six months of chemotherapy and five weeks of radiotherapy. She had extensive sick leave - eleven months in all. But she was back to work within a year of her diagnosis. "From the word go, it was what can we do for you?'" she says of her employers' attitude.

She believes that one factor that helped was that her job was a skilled one, "they had a lot of training invested in me', but the basic support she received from colleagues was tremendous, she says. She was also kept in the loop about organisational changes via e-mail.

She was only entitled to full pay for six months, but when she was advised that her income was about to be cut in half, a personnel officer contacted her directly. "He said, I want you to appeal it," she says. She did, and the appeal was successful.

When she went back to work - now employed by SPSA - her duties were phased in gradually, from three days a week to four then five, with the actual workload gradually increased too. She had occupational health support , psychological support and took up salsa dancing.

Mulholland felt completely able to say if she was feeling overtired or overwhelmed, she says, and adds: "People were under strict instructions to look after me - even those working in other services, such as the fire service."

A little over a year later she is back on full duties. But the phasing in was essential, she says.

Every workplace is touched by cancer eventually, but employers can prepare themselves to support colleagues, Fee says. Glasgow's Maggie's Centre has held successful sessions for HR professionals who want insight into the experience of workers who are going through treatment. They can also find out about other services the centre runs, such as sessions on managing stress, and learning relaxation.

More than anything, though, employers shouldn't forget the basics. Fee says. "People are busy at work, but just dropping someone a card to let them know they haven't been forgotten is important. Also, it is important to have an idea of what cancer treatment involves. There is still a lack of understanding of what patients endure and its long-term effects."

What steps should employers take when an employee falls ill with cancer? Employer-employee dialogue Employees should be able to have regular meetings to discuss the impact of their diagnosis on their job, return to work after time off, and any changes needed in their workplace. Money matters Employers should provide clear information on an employee's financial entitlements, including sick pay and other relevant company benefits, and direct the employee to sources of specialist financial advice. Prejudice-free workplace Employees affected by cancer have the right to work in a sympathetic environment, free from prejudice. Listening An employer should take the time to listen to and understand the employee's individual treatment plan and decisions about work, and accommodate individual needs where possible. Off-work time Employees should not have to use annual leave for medical appointments, treatment and recovery from treatment. They should be able to attend other support services through flexible working arrangements. Your responsibilities under disability law People with cancer are covered by the Disability Discrimination Act and employers are required to make reasonable adjustments to help them at work. (source: Breast Cancer Care)