Fit For Duty: Cancer prevention in the workplace

How organisations can help workers prevent and detect cancer

Early intervention in action

Kathy Gill and Iyliomene Saint-Louis live a world apart and share almost nothing in common. Gill is a quality control auditor with a mortgage company in Baton Rouge, Louisiana; Saint-Louis sews T-shirts at a garment factory in Port-au-Prince, Haiti. Yet both were diagnosed with treatable cancer during screenings at their workplaces.

When Gill’s employer offered on-site skin-cancer screenings, she decided to have a red dot on her nose checked out, even though she’s a faithful sunscreen user. In a Baton Rouge Business Report story, she said, “I told the doctor, ‘I’m probably wasting your time.’ But with them just being across the hall, I thought, ‘Let me check this out.’” The spot turned out to be a basal-cell carcinoma, a cancer she was able to have completely removed within two weeks.¹

Saint-Louis stepped away from her sewing machine long enough to have a cervical exam in her factory’s rudimentary clinic. The exam, provided by a midwife from the non-profit group Innovating Health International, found precancerous cells that were quickly burned away by a heat gun. Called “see and treat,” the process saved Saint-Louis from needing to take time off work to have a Pap test — a test that would have cost a week’s pay based on Haiti’s daily minimum wage. “I’m happy I found out early,” she told The Miami Herald.²

“For decades, organisations around the globe have recognised that they have a moral, and often legal, obligation to promote health and safety among their workers,” says Dr Mitesh Patel, Medical Director, Aetna International. “Now, many are realising that the obligation and opportunity extend beyond simply enforcing safety rules and providing hearing protection and ergonomic chairs. They’re also realising that successfully embedding holistic health and safety policies and programmes depends on leadership buy-in, policies that encourage total well-being, long-term commitment and authentic employee engagement.”

Like Gill and Saint-Louis’s companies, many organisations are discovering that they can play a role in fighting cancer — and that such efforts benefit employee and employer alike.

Cancer and the workplace

Before we look at how organisations can help combat cancer, it’s important to consider how they can contribute to cancer. Some jobs expose workers to environmental hazards, and even shift patterns can heighten the odds that a worker will develop cancer.³ But workplace cancer risks are much more widespread, because many modern workplaces contribute to lifestyles that increase people’s odds of developing cancer. According to the American Cancer Society, 42 percent of cancer cases (and 45 percent of cancer deaths) are linked to modifiable risk factors, chief among them smoking (and second-hand smoke), alcohol, excess body weight, diet, physical inactivity, exposure to ultraviolet radiation and a handful of infections, including the virus that causes cervical cancer.⁴

Modern office work contributes directly to three of those risk factors — excess body weight, diet, and physical inactivity — so much so, in fact, that experts now talk about “sitting disease.” How widespread is this “disease”? One survey found that the average office worker in the UK sits for 10 hours a day, with nearly 70 percent of that sitting taking place at work.⁵ According to the website Very Well Health, “Research has shown that sitting for as little as 30 minutes at a time without standing up or otherwise engaging in physical activity causes the beginning of a cascade of events throughout the body, a chain reaction that includes poor circulation, inflammation, and endothelial dysfunction (dysfunction of the lining of the blood vessels). This translates, in the longer run, into higher rates of cardiovascular disease, overweight and obesity, and possibly even cancer.”⁶

“The impact of the working environment on employee health in general and cancer in particular may come as a surprise to leaders of white-collar organisations,” says Aetna International’s Dr Lori Stetz, Senior Medical Director. “Nonetheless, the impact is real, serious, and — most importantly — manageable.”

In a 2014 essay in the journal Preventing Chronic Disease, experts from the Centers for Disease Control and Prevention (CDC) listed workplace practices that can contribute to cancers of the bladder, blood, breast, cervix, colorectum, endometrium, eye, gallbladder, kidney, larynx, liver, lung, oesophagus, oral cavity, ovary, pancreas, pharynx, prostate, skin, stomach and thyroid — more than 20 cancers in all. “Some examples are specific to the work environment, such as exposure to known carcinogens (e.g., diesel exhaust), higher levels of which are often permitted in the workplace compared with the general environment,” the authors note. “Others are behaviours (e.g., tobacco use) or chronic conditions (e.g., obesity) that may increase cancer risk.”⁷

Organisations can address the social determinants of health that employees can control, such as whether they use tobacco products, as well as those the employer can control, such as the working environment. Dr Lori Stetz says, “It’s important for employers to take a holistic approach to fighting cancer in the workplace. Workers can spend upwards of 30 percent of their day in the workplace – which may mean hours of exposure to hazardous materials, cigarette smoke or high-risk behaviours, like inactivity and poor eating habits. But that time can also provide an opportunity for that employer to educate, inform and even screen for health issues for their population.”

Cancer is expensive for employees and employers alike. According to Sun Life, which provides stop-loss coverage to self-insured employers, various forms of cancer accounted for 26.8 percent of reimbursements it made to 70,000 claimants from 2015-2018, with many claims exceeding US $1 million. Cancer was responsible for the #1 and #2 highest-cost claim positions. Moreover, the company says 57.9 percent of employers made a cancer claim in their study year — 2017.⁸

Of course, costs rise when cancer is detected late. According to the Colon Cancer Alliance, the cost of treating a cancer that’s detected late can be quadruple the cost of treating one that’s detected early. As Corporate Wellness Magazine has noted, “Depending on the size of the company, the cost savings resulting from just diagnosing and treating one cancer at an early stage relative to delayed diagnosis may well cover the related program costs.”⁹

Promotion plus intervention

That CDC essay quoted above argued for the integration of the distinct practices of health promotion and health protection: “Traditionally, workplace health promotion programs have focused on health-related behaviours (e.g., tobacco use cessation), while health-protection programs have focused on addressing safety and health risks and hazard mitigation. New research provides evidence that integrating these two approaches may enhance program effectiveness to improve employee health, safety, and well-being.”¹⁰

A report in the American Journal of Public Health offered an insightful perspective on the benefits of adopting a blended approach to health, wellness and safety in the workplace. “Simply stated, workers may perceive changes in their individual health behaviours to be futile in the face of significant occupational exposures that have considerable bearing on their health,” the authors wrote. “Conversely, management and labour efforts to create a healthy work environment may contribute to workers’ motivations to modify their personal health behaviours, and they may foster a climate of trust that supports workers’ receptivity to their employer's messages regarding individual health behaviour change.”¹¹

These findings are echoed by the CDC: “Efforts to promote cancer prevention in the workplace may need to take an integrated and comprehensive approach by addressing individual behaviours, organizational culture, policies and other environmental factors that influence cancer risk.”¹²

According to recent global research conducted by Aetna International, 40 percent of employees are worried about their long-term health but haven’t had a health check in the last year. A quarter (23 percent) of employees cite lack of time as the reason they don’t have health checks, with nearly half (46 percent) saying the ability to take time off work for an appointment would encourage them to make an appointment for a health check.¹³

Dr Mitesh Patel says: “Organisations need to make a concerted effort to remove barriers — real or perceived — for employees around taking time off to look after their health. Implementing policies to promote flexibility around personal well-being and communicating those along with sick leave policies could have a significant impact on the holistic health and wellness of populations.”

Benefiting employers and employees alike

“It stands to reason that fostering a climate of trust can benefit employers far beyond health improvement,” says Aetna International’s Dr Mitesh Patel. Increasingly, researchers are quantifying the benefits.

A meta-analysis of 36 studies found that for every $1 spent on wellness programs health care costs drop $3.27 while absenteeism costs drop $2.73, yielding a six-fold return on investment. Moreover, the authors noted that wellness program set up tends to carry the bulk of investment costs in terms of time and resources, “wellness program costs are likely to be front-loaded — that is, more costly at the start”, they also noted that “health benefits are likely to accumulate gradually. Therefore, to the extent that program costs decrease over time, we may be understating the true return on investment.”¹⁴

What’s more, a separate study by researchers at University of California (UCLA) determined that wellness programs lead to roughly one additional productive day per month for the average worker who participates. (In the study, workers were offered a simple health exam that included a health survey, blood work, and a blood-pressure check. This was followed three weeks later by an educational seminar featuring personalised health guidance from a registered nurse.) Although the researchers didn’t determine specific reasons for the productivity gains, they made some educated guesses. "By showing concern for workers, organizations can strengthen employees’ loyalty and commitment to the company,” said lead researcher Timothy Gubler of the University of California, Riverside in a ScienceDaily report. “When workers discover unknown health problems through the program they may feel increased gratitude toward their employer and reciprocate that by increasing their efforts. Additionally, when programs help employees make healthy choices, this can positively impact their wellness, mood, energy, and ultimately increase their productivity through increased capability.”¹⁵

Of course, the biggest benefit accrues to those workers who discover potentially life-threatening health conditions or are motivated to improve their lifestyles thanks to worksite health programs. If those workers offer their employers stronger loyalty or higher productivity as a result, that’s a bonus.

Preventing discrimination

Talking about cancer in the workplace raises the difficult question of discrimination against cancer patients and survivors. According to the UK charity Macmillan Cancer Support, 18 percent of people with cancer who’ve returned to work say they’ve faced discrimination in the workplace, such as lack of accommodations, being passed over for promotions, and feeling pressured to reduce their work hours or quit work altogether. That’s despite the fact that UK law requires employers to make reasonable accommodations. “Staying in work is important to the majority of people as it helps to retain a sense of normality that is essential to their emotional and physical well-being during cancer,” says Liz Egan, Working Through Cancer Programme Lead, Macmillan Cancer Support. “Employers must be aware of their legal obligations under the Equality Act and ensure that there are appropriate policies and processes in place to best support their staff.”¹⁶

Aetna International’s Dr Lori Stetz agrees: “Employers have a responsibility to make accommodations for workers living with cancer, much like they make accommodations for people with permanent disabilities. It’s helpful to remember that cancer is not the death sentence it once was — and that huge numbers of working-age people have experienced cancer.” (In the U.S., for example, almost half of adult cancer survivors are under the age of 65.¹⁷)

The Partnership to Fight Chronic Disease frames the situation like this: “Remaining at work through cancer treatment or returning shortly after offers much more than financial security to survivors. It enables employees to achieve a sense of normalcy, to engage with co-workers, to make meaningful contributions to their company’s business goals and to regain confidence as valuable citizens.

Despite these benefits, cancer survivors have higher rates of unemployment than their peers. Many do not return to the workforce, representing billions of lost dollars in disposable income, government taxes, and potential revenue to both large and small businesses. For these reasons, ensuring full employment opportunities for cancer survivors is a critical business issue — not just for the individual, but also for policymakers, the business community, and for private and public employers.” Ensuring full employment opportunities is also an important part of building a healthy community, a hallmark of which is the ability of all citizens to achieve their maximum potential.¹⁸

“A coordinated approach to cancer prevention and early detection in the workplace is timely and much needed,” says Dr Lori Stetz. “From programmes, benefits, policies and environmental support, employers have an opportunity to meet the health, safety and well-being needs of employees with direct and immediate benefits relating to cancer.”

Nine worksite cancer-fighting strategies to consider

While cancer is too big for any one organisation to defeat, here are nine ideas companies can implement to help in the fight:

1. Assess your workplace. If your workplace is smoke free, focus less on lung cancer. If your employees tend to be overweight or if there’s a high instance of pre-diabetes or diabetes, focus more on diet and physical activity. The American Cancer Society recommends a workplace health assessment to gauge how your organisation’s wellness programs compare with best practices and peer companies.¹⁹

2. See that workers can get key screenings and health checks. Ensure that your health benefits cover key screenings, such as mammography and colonoscopy, but also ensure that company policy makes screenings feasible. For example, a colonoscopy takes two days (one for prep and one for screening); workers are more likely to get screened if they can use sick days or other non-vacation/annual leave/holiday days and don’t have to recruit someone to cover for them at the office.^{20, 21}

3. Bring cancer screenings to the workplace. Hosting a mobile mammography unit or skin-cancer clinic increases busy workers’ odds of getting screened while reducing time away from work. Moreover, as noted by the Centers for Disease Control and Prevention, “On-site interventions such as these reduce the access barriers that prevent employees from receiving preventive services such as location of a screening facility, its hours of operation, and the availability of childcare.”²²

4. Go smoke-free. Smoking is the leading cause of cancer in the UK, accounting for 15 percent of cases.²³ In most developed countries, the percentage is twice as high.²⁴ Clearing the air — and providing workers smoking-cessation help — is an important way to reduce cancer risk in the workplace.

5. Help employees give up the vices. People who have 2-3 alcoholic drinks per day are 8 percent more at risk of developing cancer than teetotallers, according to Men’s Health USA. And illicit drugs such as cocaine and heroin are often mixed with cancer-causing additives called cutting agents. So chronic use of illicit drugs can increase cancer risk, particularly when mixed with alcohol or tobacco. Consider providing counselling or behavioural therapy to help employees struggling with substance abuse disorder.²⁵

6. Make healthy eating easy. If you’re encouraging workers to eat right, be sure healthier options are available in the company cafeteria and onsite vending machines. To promote healthy eating, consider posting nutritional information like calorie counts, making healthier foods the default option and subsidizing the cost of healthier foods.

7. Promote physical activity. Use onsite fitness facilities, discounted gym memberships, and incentives like step challenges to encourage workers to engage in regular exercise. One study found that people who get 1.25 to 2.5 hours of vigorous activity per week (or double that amount of moderate-intensity activity) have a 31 percent lower risk of cancer death compared with people who are physically inactive.²⁶

8. Regularly and consistently share tips and advice: Regularly sharing articles and information with employees can prompt them to make small adjustments to their behaviours, gradually helping to improve their well-being over time. As an example, read and share “A factual list of cancer-causing foods and cancer-fighting foods” and “How to support someone with cancer”.

9. Support mental health — and total well-being — at work. Chronic stress can feed cancer. Making Employee Assistance Program provisions for employees to learn about, adopt and practise stress-reduction techniques and strategies, such as Mindfulness Based Stress Reduction and therapeutic counselling, will have far-reaching benefits.

Read A factual list of cancer-causing foods and cancer-fighting foods and How to support someone with cancer or share these articles with your employees as part of your long-term commitment to providing employees with thought-provoking or educational materials on health and wellness topics.

Find more Fit for Duty materials here.

*More than 60 percent of Aetna International corporate and self-paying products, such as Aetna Summit and Aetna Pioneer, include cover for routine health checks including cancer screening as standard. Routine health checks are available as a buy-up option on the remaining 40 percent. Percentages are an approximation as the product mix varies regionally.

**Aetna International’s employee assistance services are standard to Aetna Summit plans 2500, 4000, 5000 and 5000+. Program delivery methods may vary by plan or region. Self-paying members with Aetna Pioneer plans can purchase employee assistance services at an additional cost. To find out more read the guide.

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