A recent study conducted by the Well-Being and Cancer at Work (WeCanWork) project showed that men who worked in physically demanding jobs needed additional well-being support during and after cancer treatment.1
Cathy Bradley, PhD, dean of the Colorado School of Public Health and deputy director of the University of Colorado Cancer Center, was an author on this study.2 She spoke to CancerNetwork® about how these findings can be used to design future trials and support the needs of cancer survivors with physically demanding jobs.
The median survivor age was 51.48 years, 84.0% were White, and 25.6% reported having physically demanding jobs. Additional characteristics showed that 62.7% of survivors were married, 43.4% were college graduates, 73.7% worked full time, and 67.6% had an annual household income of less than $85,000.
The highest reported employer accommodations included allowing workers to change their start and stop time (84.2%), allowing more breaks and rest periods (73.7%), and giving shorter workdays (51.3%). However, the lowest reported employer accommodations included arranging transportation (5.3%), providing special equipment (13.2%), and providing rehabilitation services (15.8%).
The well-being scores highlighted that patients with physically demanding jobs had poorer wages (P <.001) and satisfaction with their benefits (P = .04), less autonomy (P = .03) and flexibility with work (P = .004), and greater financial insecurity (P = .002). Additionally, they experienced more negative job attitudes (P = .0003), workplace safety concerns (P <.001), less sleep (P = .05), and less support outside of work (P = .03).
What was the primary motivation behind initiating this study on cancer survivors and physically demanding jobs?
It’s based on prior evidence and work that people in physically demanding jobs have a harder time returning to work [after cancer]. We know that a lot of physically demanding jobs tend to be those without paid sick leave. They may not have health insurance. They may also be smaller employers, or if it’s something like a construction company, that doesn’t have to comply with the Family Medical Leave Act, or the Americans with Disabilities Act. We felt like this was an area of investigation that had not received enough [attention]. We wanted to understand that relationship, in particular. A lot of the prior work, and a lot of its mine, has been on women with breast cancer, and they, too, report that if they’re in physically demanding jobs, it’s harder for them to go back. Just not much work had been done on men, especially those in harder labor jobs.
What were some of the most surprising or significant findings from the study?
If [survivors] did have health insurance, they would continue to try hard to work and keep that financial barrier between them. Particularly, if they don’t have health insurance, they could be financially at risk. If they had health insurance, they were more likely to keep working at an hour threshold where they could qualify for health insurance. If they didn’t have these benefits, they were more likely to stop working.
It’s interesting because you wonder what sacrifices those with health insurance are making to continue to work. Maybe they have other benefits; if you work for an employer that offers health insurance, that employer may also offer accommodations or things like that. The reverse may be true. You also wonder if they’re doing it strictly for health insurance or trading off some of their health. Then, you think about people at the other end who are just leaving work because perhaps they don’t have the sick leave benefits or other things that would allow them to keep working. We just don’t know that underlying mechanism.
How did these findings challenge or confirm existing understandings of cancer survivorship and employment?
They challenge it in the way that we’ve started to believe that people just go back to work. We’re seeing that that isn’t necessarily the case, and that if they do, they need to have a lot of support.
Beyond the general impact, what are some of the specific challenges identified such as lower satisfaction with wages, less job autonomy, and financial insecurity for those in these job situations?
The challenges are around paid sick leave, being able to take time away, and accommodations. Being able to get them in physically demanding jobs may be hard. If you’re in a desk job in an organization, it might be easier to change, be more flexible, and come in at 10 AM instead of 8 AM. If you’re doing construction, you’re probably going to be on the job site around 5 AM; there aren’t a lot of alternatives. [The challenge is giving] the support that’s required for them, and to be able to give them time away from work or just to be off until they’re ready to come back.
How has the WeCanWork project evolved from a research study to its current implementation phase?
In studying this, we started to think about what is it that could be helpful to everybody. We’re not going to be able to get paid sick leave passed as a national policy, but what’s something that we can do? One component is to have oncology practices start thinking about referring patients to occupational medicine for assistance. That can be enormously beneficial in the sense that somebody who is in occupational medicine could sit down and work with the oncology team to understand exactly what it is that the person needs, like more time away from work. I’m thinking about women with breast cancer who have surgery, have lymphedema, and can’t lift. For somebody who’s doing physically demanding work and may only be able to put in a half day, they can negotiate on that patient’s behalf with the employer to say, “Here’s what this person needs [while being treated for] cancer.” Oncology practices have been disconnected from occupational medicine. They fill out disability forms, but that’s not the same as being able to work with that person, ensuring that they have rehabilitation, understanding their benefits, and advocating for them.
How does the study highlight the critical need for integrated support systems that bridge the gap between oncology care and the workplace?
Our goal is to provide evidence-based information to show that this is helpful to people, and that it helps them continue to work. If employers know they can keep a good employee, they might be more enthusiastic about [these accommodations]. I imagine insurers would be as well. Just for oncology, it’s to give them additional support. They don’t necessarily understand sick leave policies or what a person needs at work the [same] way they understand that chemotherapy slows tumor progression. They’re focused on a very different component. Our goal is to be able to show that evidence base; that it’s a worthwhile thing to do. Also, we’re trying to understand the billing [aspect]. What code could they use for the referral and to help get reimbursed?
The investigators called for additional longitudinal studies. What specific long-term implications do you hope to explore with such studies?
I can see, in the future, being able to study who goes back to work in the long term. How long do they stay at work? What happens when they get there? [We want] to understand that, both with men and women in a variety of different jobs. We tend to find that people who are in good jobs are okay; if they work for a big employer, and it’s a job that offers a whole array of benefits, they tend to find their way and be okay with that. What kind of things can we do to provide support for people who aren’t in that situation? Over half of Americans are employed in small businesses.
Is there anything else you would like to highlight?
This is just an ongoing area of inquiry that we need to spend more time with as we start to develop these new therapies to treat cancer. I’m thinking about these oral targeted agents; they have longer-term [adverse] effects, and we need to know how that affects somebody who’s employed over time, especially if they’re going to take them for a long time. It’s not just chemotherapy for 6 months and they’re [finished]. They take them to evidence of disease progression, and that could be years. We do have to keep people working because those drugs aren’t cheap. It’s an interesting dynamic, and like I said, a place for more study.
References
- Schwatka NV, Dally M, Dye-Robinson A, et al. WeCanWork study: well-being of male cancer survivors working physically demanding jobs. BMC Public Health. 2025;25(1):2025. doi:10.1186/s12889-025-23147-8
- Zarella O. New study reveals cancer survivors in physically demanding jobs face greater challenges. News release. Colorado School of Public Health. June 23, 2025. Accessed July 1, 2025. https://tinyurl.com/4k6hmk4u
