Changing the conversation about work and cancer

Naomi John

In February-2020 I was diagnosed with stage 3 locally advanced triple negative inflammatory breast cancer. I was enrolled into a clinical trial and commenced the first of what I then hoped would be 4 chemo cycles. Unfortunately I did not have a complete pathological response at mastectomy and was subsequently recommended for 4 further IV chemo cycles. In total I have had 8 rounds of IV chemotherapy, mastectomy with full lymph node clearance, 16 VMAT radiotherapy sessions and, at the time of writing, I have almost completed cycle-4 of 8 oral chemotherapy cycles. Treatment has been thorough, brutal and thankfully successful. At diagnosis a positive intra-mammary node showed up on my PET-scan, helpfully behind my sternum and therefore inoperable. Reporting on my repeat PET-scan as part of radiotherapy planning, my Oncology Consultant declared “not a whiff of cancer!” (Thank you chemo!).  However, inflammatory breast cancer is aggressive and has a very high early recurrence rate, add to that the very limited treatment option for triple negative; hence I pushed for oral chemo to mop up any remaining rogue cells.

I work in pharmacovigilance and clinical research, monitoring product safety and regulatory compliance. I have managed my own consultancy for the past 9-years and was fortunate that my diagnosis did not lead to any requests for leave or permission to be ill… I just didn’t take another contract. I am privileged that I understand the drugs, am familiar with the terminology and side effects, I felt I had a head start throughout this experience insomuch that I understand the science, accepted my diagnosis and was able to approach treatment without that cancer language barrier. My work is both essential and satisfying. It feels very odd being on the other side of the safety database, now taking the products that I have previously collected adverse event information for. At least I know what I am dealing with! But it is this work that may potentially influence the availability of life extending therapies for others through the ongoing monitoring of established and newly licensed products, often in unapproved indications. I am that guinea pig with my current oral chemo; currently licensed for prostate and stage 4 breast cancers, through research I know it can significantly reduce the risk of recurrence in stage 3 breast cancer, so we’re trying it… for as long as I can tolerate it.

In the New Year a previous client contacted me to ask if I was available to cover a maternity contract; three days a week, working from home. Perfect. I was honest from the outset and told her about the events of the last year. Incidentally, there is no way I could’ve contemplated working though the intense IV chemo and treatment regime of last year. But this oral chemo is more predictable and therefore, more manageable. I have worked with this client previously and they are familiar with my work ethic and capabilities. This has buoyed my confidence; they know me already, the me I used to be. I am still me, but depending on where I am in my chemo cycle, I may not be operating at 100% me. I have told my peers about my diagnosis, but not the wider team I manage for day-to-day work. I think subconsciously I don’t want judgement or allowances. I agreed a work plan with the project director and my client reassured me that my workload and her expectations are flexible. I have balanced my days so that I have time to rest during the week; I find that I need those days where nothing is planned. Having that scheduled downtime to look forward to helps me push through the early afternoon fatigue. It is also useful to have these days where I know I have the flexibility to attend appointments without having to negotiate time off. I can quietly get on with getting better. That said it is so good to be back to work, contributing, feeling the fog lifting from my brain, not mithering about cancer and chemo and all the other stuff that takes up all the energy if you let it. I am able to manage the side effects of my current treatment with medication and patience. I think that would be my take home message; working with cancer or during treatment is achievable but you have to be patient with yourself.

I have noticed that my management style has changed since my diagnosis. These days I am less likely to take on a task and more capable of delegation! My life is actually too short to take on the mental load of project management minutiae and, in the long run, it is much better that these duties become a learning opportunity for other team members to grow.

I like working part-time; it feels like I have the best of both worlds. During treatment it affords me time to convalesce if I need it and when this chemo is done I intend to swim, enjoy our garden, walk the dogs, become fitter, stronger and take the time that has been gifted to me.