Thriving at Work: Occupational Therapy Strategies for Cancer Survivorship

Vanessa Grijalba, OTD, OTR/L, CHT;

Lyvette Carrasquillo, OTD, OTR/L, M.Ed., MHA

Abstract

Cancer survivorship can have a substantial impact on work participation due to persistent fatigue, cognitive changes, physical limitations, and psychosocial stressors. As the population of cancer survivors continues to grow, occupational therapy practitioners play an essential role in supporting functional recovery and return-to-work readiness across the cancer care continuum. Evidence-based occupational therapy interventions address barriers to participation by promoting energy conservation, cognitive compensation, sleep hygiene, graded activity, and workplace accommodation. Through client-centered and collaborative intervention, occupational therapy supports survivors in rebuilding occupational performance, resuming meaningful roles, and improving quality of life during survivorship. 

Introduction

The American Cancer Society (ACS) (2025) defines cancer as a disease characterized by the uncontrolled growth and spread of abnormal cells that can be life-threatening if untreated, with both genetic and lifestyle factors contributing to an individual's risk. A person is considered a cancer survivor for life from the time of diagnosis (Mollica et al., 2025) and in the United States approximately 22.5 million people will be cancer survivors by 2032 (ACS, 2023). Cancer survivorship is a chronic condition and a complex state of being that includes the physical, cognitive, emotional, social, and environmental challenges that influence participation in daily life for both survivors and their caregivers (Mollica et al., 2025).  Cancer care spans prevention, diagnosis, treatment, survivorship, and end-of-life care, with occupational therapy practitioners (OTPs) supporting function, participation, and quality of life across each stage as individuals' needs evolve and addressing the long-lasting impacts of cancer-related impairments (Baxter et al., 2017 as cited in Newman et al., 2024, Mollica et al., 2025). Palliative care, often misunderstood for end-of-life care, is an interdisciplinary approach that can begin early alongside curative treatment, focusing on symptom management, quality of life, and participation in meaningful occupations regardless of prognosis (Mollica et al., 2025). Hospice care is a subset of palliative care for individuals nearing the end of life, with OT emphasizing adaptation, energy conservation, environmental modification, and engagement in meaningful occupations despite functional decline. 

Cancer Survivorship Statistics in Working-Age Adults in Florida

The ACS (2025) projected 171,960 new cancer cases in Florida for 2025. Female breast cancer was at the top of the list (23,920) followed by colon and rectum (12,330). Florida’s overall age-adjusted cancer incidence rate was 467.6 per 100,000 (higher than the U.S. rate of 448.6). Rates were higher for males (500.5) and for the working age population (238.3) compared with the all-ages rate. Breast cancer survival rates are high, with 91% of women surviving at least 5 years after diagnosis, compared to 64%-15% colorectal cancer varying by stage. (ACS, 2025). 

Impact of Cancer on Work Participation

A common source of financial toxicity during cancer survivorship is wishing to go back to work but not being able (Fleischer & Sayers, 2025; Mols et al., 2020). The long-term impacts of cancer survivorship, including ongoing chemo treatment, can result in chronic absences, reduced work participation, need to switch type of work and early retirement (Mahumud et al., 2020). Return to work (RTW) outcomes vary by cancer type, individual health status and workplace factor. RTW are higher for people with breast, prostate or colorectal cancer (50%-90%), compared to 47% for people with brain cancer (Haider et al., 2020) and rates of success vary greatly (8.7%-100%, mean 66.91%) (Chan et al., 2024). 

Returning to work or having paid-leave led to reduced stress and greater self-identity in cancer survivorship (Mols et al., 2020). Studies show unemployment in persons with brain cancer can lead to acquiring depression and anxiety, as well as difficulty with performing activities of daily living (ADLs) and decreased attention and learning (Nugent et al. 2014).

Barriers
Work-related barriers commonly experienced by cancer survivors that make a big impact in RTW success include the physicality required for the position (e.g. prolonged standing, lifting, or driving), stressful work or workplace, lack of workplace accommodation, limited sick leave, unsupportive work environment and demanding schedules. Most cancer survivors are underprepared for returning to work and addressing these barriers, highlighting the need for OT intervention to focus on RTW.

Facilitators
Facilitators for RTW success include workplace accommodations that adjust the task or environment, organizational support and resources, having an employee assistance program or RTW coordinator, flexibility in schedules, open communication, positive and inclusive workplace culture. Cancer survivors with paid leave or RTW success reported reduced anxiety, a greater sense of belonging. (Chan et al., 2024). 

Practice Guidelines and Evidence Supporting OTP Interventions

OTPs can play an important role in facilitating successful RTW outcomes by addressing the physical, cognitive, and psychosocial effects of cancer survivorship and related treatment. Through the use of both restorative and compensatory approaches, practitioners can help clients manage barriers such as cancer-related fatigue, cognitive changes (cancer-related cognitive impairment (CRCI), chemotherapy-induced peripheral neuropathy (CIPN), anxiety, and depression to support work performance and participation in meaningful occupations (Chan et al., 2024; Newman et al., 2024). 

Interprofessional Collaboration

OTPs may collaborate with an Employment Assistance Program (EAS) and RTW coordinator to support graded work reintegration, symptom management, and workplace accommodation for cancer survivors (Chan et al., 2024; Newman et al., 2024). 

• Home health setting: A cancer survivor preparing to return to a desk job might use an EAS for counseling related to anxiety and a RTW coordinator to arrange a gradual schedule, while OT addresses morning routine, fatigue management, attention strategies, endurance and energy conservation for computer work, and sets up a safe home workspace before full return. 

Advocacy

OTPs advocate for clients when gaps exist between their needs and workplace regulations, while evaluating work barriers and collaborating with employers to identify accommodations that support meaningful work participation.

• The Americans with Disabilities Act (ADA) and Florida Civil Rights Act protects persons with cancer from discrimination and may require the employer to provide reasonable accommodations, unless it causes unintended hardship (Equal Employment Opportunity Commission [EEOC], 2013; Florida Legislature, 2021).
• Accommodations may include gradual return-to-work plans, hybrid work options, flexible work schedule to receive treatment, additional rest breaks, improved ergonomic workstation, and temporary lifting restrictions (Newman et al., 2024).

Cognitive Strategies

75% of cancer survivors report CRCI (Mackenzie & Marchall, 2022). Best practice is to use 1:1 and individualized compensatory strategies. Group cognitive training can also serve to increase motivation and peer learning. Cognitive strategies related to work participation include: 

• Pause and reflect before participating in meetings to organize thoughts and improve communication.
• Pace work activities to prevent cognitive overload and maintain productivity throughout the workday.
• Use timers and reminders to support sustained attention and task transitions.

Energy Conservation Management (ECM)

 Employing ECM as an individual or group intervention can improve cancer- related fatigue (Sadeghi et al., 2016 as cited in Newman et al., 2024) and increase quality of life. Strategies include: 

• Use tools and equipment such as carts, dollies and adjustable workstations to reduce physical effort. Keep frequently used items nearby.
• Alternate positions and task types throughout the day to reduce fatigue and prevent repetitive strain injuries.
• Take brief physical and cognitive breaks often, like stretching or closing your eyes momentarily

Performance and participation of meaningful occupations 

Leisure and Social Participation

 These are essential to identity, well-being, and quality of life, and OTPs support re-engagement by addressing physical limitations, establishing routines, and promoting self-management for long-term participation. Mindfulness interventions and can help address pain, anxiety, depression and address body image difficulties to promote social participation (Newman et al., 2024).

○      Use meditation or guided imagery apps during lunch breaks, before or after work (e.g. Headspace, Calm). 

Physical Activity

High-intensity physical training and a multidisciplinary approach can help maintain or restore skills, improve RTW outcomes after cancer-related treatment, and reduce CIPN. (Newman et al., 2024).

• Implement a home exercise program that fits into work and daily routines, includes modifications that consider client physical limitations 

Sleep

CS may experience fatigue, stress, pain, hot flashes, or neuropathic discomfort that interferes with restorative sleep and directly affects energy, attention, mood, pain tolerance, recovery after hospitalization and next-day work performance (Newman et al., 2024; Buysse et al., 1989). In acute care, sleep support often begins as part of discharge preparation so that clients can re-establish healthy routines at home after hospitalization. OTPs have a role in improving
self-management of sleep across the cancer care continuum (Buysse et al., 1989; Green & Brown, 2015; Newman et al., 2024). OTPs may encourage:

• A consistent bedtime and wake time, limit naps to short periods
• Scheduling exercise earlier in the day and reduced caffeine later in the day
• Create a calming bedtime routine with reduced screen use and relaxation strategies (e.g. breathing exercises or guided imagery).
• Environmental modifications like dim lighting, earplugs, and an eye mask to improve rest and reduce nighttime disruption. 

Examples of Functional Assessments Across the Cancer Continuum

OTPs use standardized and client-centered assessments to evaluate how cancer and its treatment affect function, quality of life, and engagement in meaningful occupations, guiding a holistic occupational profile and intervention planning for recovery, RTW, and long-term participation in daily life. 

Conclusion

Occupational therapy is uniquely positioned to support cancer survivors in overcoming barriers, returning to meaningful work, and maintaining participation in valued life roles throughout survivorship.

References

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Equal Employment Opportunity Commission (EEOC). (2013). Cancer in the workplace and the ADA.https://www.eeoc.gov/laws/guidance/cancer-workplace-and-ada

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