A sustainable career path for cancer survivors returning to work: new theorising from an inductive qualitative case study Open Access

According to the World Health Organisation, the number of cancer survivors worldwide in 2012 was more than 32.6 million (Bray et al., 2013). The American Cancer Society reported 18.1 million cancer survivors in the United States in January 2022, and predicts a 23% increase in this number by 2032 (American Cancer Society, 2022).

In the European Union, 42.8 million people of working age with disabilities are in employment, and more than one-third of this population reported chronic health issues in 2021 (Jones and Maucher, 2024). According to Jones and Maucher (2024), chronic diseases cover a wide range of long-term health conditions including cancer, cardiovascular diseases, long Covid, musculoskeletal disorders and work-related psychosocial issues. Similarly, some cancer survivors experience long-term or side effects (due to the treatment itself or to the severity of the cancer) that can become chronic (NCI, 2021). Half of the estimated 3.2 million new cases of cancer diagnosed in Europe each year affect individuals of working age, which obviously has important consequences in the workplace (Tikka et al., 2017).

The figure for cancer survivors in Europe published by the European Commission (2020) is 12 million, and the Spanish Society of Medical Oncology (SEOM, 2022) reports close to two million survivors in Spain (Medsir, 2022). In Spain, specifically, around 295,000 new cases of cancer are diagnosed every year, and over 110,000 people with cancer are of working age (Spanish Association Against Cancer, 2024 ). These numbers illustrate the crucial importance of providing support for cancer survivors on their return to work. Furthermore, given that fatigue, depression, sleeping problems, anxiety and/or cognitive limitations are common effects of cancer (Kollerup and Ladenburg, 2021), employers must explicitly take these factors into account when managing cancer survivors.

However, to date very little research linking cancer survivors and work has been conducted in the fields of management, business or industrial labour relations. A search in the Web of Science (WoS) database using combinations of cancer or survivor with the work-related keywords of workplace, employment, human resource management, return to work and work productivity as search criteria yielded 1,570 articles and reviews, of which 870 correspond to the oncology category, 271 to the public, environmental and occupational health category and 206 to the psychology-related categories, namely psychology, multidisciplinary psychology, social psychology and applied psychology. Notably, only 0.4% of the studies identified in this search have been published in the WoS categories of management, business or industrial labour relations. These results highlight the need to approach the phenomenon of cancer survivors’ return to work from a management perspective. We posit that a better understanding of the role of HR and line managers in the management of cancer survivors can make a significant contribution to the scientific literature.

Specifically, we argue that organisations striving for inclusiveness should pay attention to employees with a history of cancer, who are often a hidden, disadvantaged group. Management should create a positive socio-cognitive work environment in which all people are respected and valued in order to protect and motivate working cancer survivors (Zheng et al., 2023). Unfortunately, according to Innocenti et al. (2024), the chronically ill workforce, which includes a considerable number of cancer survivors, constitutes a minority group that to date has been neglected in HRM research. In particular, the possible added value of HRM practices to accommodate severe and persistent medical conditions, such as cancer, is largely overlooked (Branicki et al., 2021). This study emphasises management’s responsibility to adopt a human resource perspective, in particular stressing the need for sustainable HRM (Chillakuri and Vanka, 2020) thereby adding to the large body of existing research on the medical and psychological challenges this group of workers faces. By stressing the need to implement sustainable HRM practices, we also contribute to protecting and enhancing their career sustainability (De Vos et al., 2020; Van der Heijden et al., 2020).

To fill this gap in the scholarly literature, this study explores the challenges that cancer survivors face when they return to their workplace and analyses what employees with HRM (human resources management) responsibilities can do to protect and motivate them. In doing so, our research addresses two main questions: (1) What are the main challenges cancer survivors face when returning to work? and (2) What actions can HR managers undertake to help cancer survivors cope with these challenges and to protect and motivate them? To respond to these questions, an inductive qualitative case study was conducted in the Spanish context.

This study offers three main contributions on the phenomenon of cancer survivors returning to work, and the scholarly knowledge on how HRM can help to manage this situation: (1) we propose a menu of HRM practices classified into HR planning, job design, career development, compensation, performance evaluation and training; (2) we introduce an integration and learning perspective in organisations on how to manage this vulnerable group as a way of acknowledging cancer survivors’ talents, and to reinforce an employment relationship of mutual investment aimed at sustainability and (3) we propose a sustainable career model for cancer survivors. Management of cancer survivors returning to work needs to consider their full integration within the working organisation, rather than treating their return to work as a taboo subject or simply a matter of fairness and justice.

The next section presents a review of the literature on cancer survivors returning to work and the role of HR and line management in this regard. The methodology section then describes the context for the case study and the sample and data collection. The results of the interviews are then presented. The final discussion and conclusion section reflects on the outcomes, the study’s limitations, recommendations for future research and implications for practice.

It is widely recognised that as human beings live longer, more health problems arise, such as cancer (Kulik et al., 2014; Van der Heijden et al., 2021). Likewise, with an increasingly older population and growing medical expertise, a higher prevalence of cancer diagnoses and a corresponding increase in cancer survivors are to be expected. As the focus of this article is the management of cancer survivors in the workplace, we will explore this topic in more depth in this theoretical subsection.

Cancer survivor-related issues are most often studied under the label of chronic or long-term illness. Although this is still an underrepresented research area, the existing scholarship tends to focus on the management of long-term illness (Innocenti et al., 2024). As chronic illnesses become more prevalent, it becomes paramount to address workplace environment factors that support employees’ return to work and their retention (McGonagle and Bardwell, 2022), beyond simply managing the illness stage (Innocenti et al., 2024). Innocenti et al. (2024) have identified specific HRM practices that can boost engagement among chronically ill employees and reveal how perceived illness-related discrimination can undermine these potentially constructive HRM efforts.

In a specific study focusing on workers with cancer from an HRM perspective, Henderson (1997) highlighted four types of possible counselling interventions: educational counselling (to manage late physical consequences), stress management (to help cope with fear of recurrence), cognitive restructuring (to raise awareness about one’s situation) and career counselling (to avoid job discrimination). In the case of career interventions, cancer survivors should be offered a career plan in accordance with their abilities, motivations and physical conditions, and job analysis plays an important role in this endeavour (Henderson, 1997; Rubin and Roessler, 2007). The identification of different types of counselling interventions represents a significant development in the job-related research on cancer survivors.

In addition, negotiations between line manager and employee are highly subjective, individual and grounded on employee performance before their diagnosis, their behaviour and the perceived deservingness of cancer (Remnant, 2021). Hamzah et al. (2020) recommended that HR management should put in place support measures for cancer survivors coping with reduced career engagement in order to improve their job performance. These authors studied the relationship between quality of work and career engagement using the validated Quality of Working Life (QWL) of cancer survivors scale developed by De Jong et al. (2017). Some management-related articles have also analysed cancer survivors’ return to work from the perspective of sustainability. In this research line, Branicki et al. (2021) conceptualised the term “responsible return to work”, and analysed the factors that influence responsible return to work practices. For instance, in relation to HR selection practices Martinez et al. (2016) reported lower callback rates among individuals who acknowledge that they are cancer survivors. However, and perhaps surprisingly, cancer survivors usually disclose their medical history in selection processes, even though they may face discrimination for it.

Furthermore, Liu et al. (2021) identified job productivity loss and level of job stress as crucial predictors of quality of life among cancer survivors, thus highlighting the importance of properly managing job stress and job productivity loss. Swanberg et al. (2018) analysed differences between working poor and working non-poor cancer survivors in terms of workplace challenges. Specifically, they found that working poor survivors often resort to unpaid time off, shift from full-time to part-time, acknowledge cancer-related psychological job stress, report problems on job productivity and are less likely to acquire health insurance. De Boer et al.’s (2009) meta-analysis showed that cancer survivors present higher unemployment rates than healthy control individuals. In the same line, Mehnert (2011) studied the return-to-work challenges of cancer survivors, identifying attributes such as perceived employer accommodation, flexible working arrangements, counselling or training and rehabilitation services, among others, as factors that contribute to “a greater likelihood of being employed or return to work” (Mehnert, 2011, p. 109).

From an employment relations perspective, adopting an industrial labour relations approach to chronic illness is also in its infancy (Akgüç, 2021). Armaroli and Akgüç (2024) examined the scarce research on social partners’ involvement (i.e. trade unions, work representatives and other institutions) in return-to-work processes in Italy and Belgium and proposed involving these social partners in developing a comprehensive policy framework for early, adaptable and collaborative reintegration following chronic illness. According to Akgüç (2021), most countries lack specific policies for returning to work and reintegrating people with chronic illnesses. Instead, their policy frameworks primarily focus on individuals with officially recognised disabilities, as determined by medical assessments. As a result, people with chronic diseases typically only receive support under disability provisions if their condition significantly affects their work capacity. While it is insightful to shed more light on the Spanish chronic illness policy framework to further understand the challenges cancer survivors face in this country, this study specifically focuses on their workplace conditions and the implications for their return-to-work processes.

Furthermore, Kollerup and Ladenburg’s (2021) study on cancer survivors indicated that they prefer to accept a lower wage in exchange for psychological support and reduced working hours during the first 18 months after returning to work. This finding is highly relevant to HR management, as it underscores the importance of good communication between employers and cancer survivors in accommodating individual preferences (Kollerup and Ladenburg’s, 2021). According to Greidanus et al. (2019), fostering mutual understanding is crucial for a successful return-to-work process, where open dialogue enables employees to share their needs and to keep employers informed. Providing communication skills training for employers could further enhance workplace collaboration, enabling them to better support cancer survivors’ unique requirements during the return-to-work process. An employment relationship of mutual investment aimed at sustainability (Lopez-Cabrales and Valle-Cabrera, 2020; Tsui et al., 1997) represents a strategic, long-term partnership where the company offers attractive benefits and opportunities in exchange for high employee commitment and, ideally, exceptional performance. This long-term partnership aligns with the conceptualisation of sustainable careers (De Vos et al., 2020; Van der Heijden et al., 2020) that emphasises the importance of health, happiness (i.e. reflecting the well-being or employee perspective) and productivity (i.e. reflecting the performance or employer perspective) (Van der Heijden, 2005) across the career span. This approach aligns with theorising on the individual’s career sustainability by addressing the challenges cancer survivors face, in an attempt to improve long-term career outcomes for the individual employee and also to enhance benefits for the organisation.

From a sociological perspective, the convergence of demographic changes (i.e. ageing of the population), medical advancements, evolving work structures and diminishing social welfare systems has led to an increased prevalence of employees with serious and chronic illnesses in the contemporary workforce (Branicki et al., 2021). As cancer survivorship rates continue to rise, there is a growing need to address the societal implications of this disease, for instance in the workplace where perpetuating stigmatisation occurs (Moffatt and Noble, 2015). According to Trusson and Pilnick (2017), cancer survivors are often encouraged to behave as if nothing has happened, and as though everything is fine when they return to work. Only with close individuals they are able to express their fears of recurrence or talk about the physical and psychological problems they face.

Although cancer survivors often experience long-term functional limitations such as fatigue and cognitive decline, their classification as “disabled employees” remains context-dependent. According to Grönvik (2009), disability is conceptualised through three lenses: functional definitions (rooted in medical models linking impairments to daily limitations), administrative definitions (based on benefit eligibility, varying across welfare systems) and subjective self-identification as voluntarily claimed. These frameworks often diverge in educational and workforce contexts. In this sense, survivors may not qualify under rigid disability thresholds (e.g. Spain’s 33% rule) (Spanish Government, 2013), if residual effects are deemed to be non-limiting, or they may resist the label due to stigma (Moffatt and Noble, 2015; Trusson and Pilnick, 2017), despite facing disabling workplace practices (e.g. biased assumptions about productivity). Magasi et al. (2022) found that when questioned about their disability identity, cancer survivors described varied reactions, such as denial or distancing themselves from this aspect of their identity. In other contexts, such as the US or UK, legal protections like the Equality Act 2010 and ADA Amendments Act broadly cover cancer survivors, yet workplace categorisation hinges on functional impact assessments rather than diagnosis alone (UK Government, 2010; US Government, 2008).

In academic discourse, disability is increasingly conceptualised through biopsychosocial frameworks that recognise both medical impairments and societal barriers (Santuzzi and Waltz, 2016), alongside legal definitions such as the ADA’s emphasis on conditions that “substantially limit major life activities” (e.g. cancer-related cognitive or physical impairments). Furthermore, self-reported health limitation rates are shaped by a range of health, demographic and socio-economic factors, alongside cancer survivorship. Short- and long-term health challenges associated with cancer are frequently driven more by the effects of treatment than by the disease itself (Short et al., 2008). This situation renders broad generalisations in workplace policy adoption inadvisable under these circumstances, and instead calls for tailor-made HR proposals (Bilodeau et al., 2022). Additionally, cancer survivors are in practice often equated to older workers (Wang et al., 2024), as they might undergo accelerated ageing, resulting in chronic illnesses and age-related health complications. Thus, while cancer survivorship often aligns with disability frameworks, systemic gaps in accommodation policies and evolving definitions of impairment complicate universal categorisation, compounded by survivors’ avoidance of being labelled as disabled due to stigmatisation.

To conclude this sociological perspective to cancer survivors at workplace, we contend that raising awareness of the importance of managing cancer survivors in the workplace from an HRM perspective contributes to eradicating the perception of cancer as a taboo topic and to combating discrimination and health inequalities in the workplace (Allen, 2019). In addition, according to Trusson et al. (2021), HRM strategies must evolve to address the complex realities faced by employees returning to work during and after cancer treatments. This necessitates the implementation of individualised workplace accommodations and differentiated absence recording systems that distinguish between general illnesses and cancer-related disabilities. Such comprehensive approaches can enhance the effectiveness of employee reintegration and support.

Despite the advances in the literature, more research is needed from an HRM perspective. This empirical study therefore aims to enhance understanding of HR planning, job design, career development, performance evaluation, remuneration, training and staffing (Schuler and Jackson, 1987) for cancer survivors returning to work.

The following key issues are central to this study: (1) main challenges affecting cancer survivors returning to work; (2) HRM practices adopted (HR planning, job design, career development, compensation, performance evaluation and training). An inductive qualitative case study approach is adopted (Ghauri et al., 2020), as qualitative methods are recognised as enabling an integral perspective in research in the field of HRM (Mayrhofer, 2009; Ridder and Hoon, 2009). Indeed, case studies have previously been used to develop new theory on a range of themes (Eisenhardt and Graebner, 2007; Gioia et al., 2012; Smith, 2014).

In this study, we consider it crucial to examine the personal experiences of individuals in order to gain insight into the HRM practices affecting cancer survivors. Based on Yin’s (2009) classification, this research employs a single embedded case study design, focusing on Spanish cancer survivors and their managers, from various public and private companies in Spain. Focusing on the country context is in line with similar methodological approaches followed by Lee Rhodes et al. (2012) and Urzelai and Puig (2019). Because the focus in this research is not on the companies themselves, their anonymity has been preserved. Rather, the emphasis lies in identifying patterns in HRM challenges and practices that are characteristic for the Spanish cancer survivor’s work context.

Spain is a suitable context of analysis for our study as the absolute number of cancer cases diagnosed in the country has increased due to population growth, population ageing, exposure to risk factors and, for some types of cancer, increasing rates of early detection. The Spanish Society of Medical Oncology (SEOM) estimated that 286,664 new cases would be diagnosed in 2024, that is, 785 cases of cancer every day, or about 33 every hour (SEOM, 2024). Survival rate is the most important indicator of the effectiveness of the healthcare system in treating cancer, and in Spain this rate is similar to that of neighbouring countries. It is estimated to have doubled in the last 40 years, and is likely to continue to rise slowly in the coming years (SEOM, 2022). In Spain, 55% of men and 61% of women recover from cancer, which amounts to almost two million survivors (Medsir, 2022), some of whom, in the best-case scenario, will return to work and resume their professional careers.

This study is based on a sample of 28 interviews conducted with two groups: (1) cancer survivors, and (2) HR managers and line managers with people management responsibilities. Data were collected from these two categories of sources to enable data triangulation (Eisenhardt, 1989). This sample provides a solid foundation for deepening our understanding of the phenomenon. Interviews with respondents from these two groups were conducted in parallel to enrich our understanding of the main challenges that cancer survivors face when returning to work, as well as the actions HR managers take to support their adjustment, protect and motivate them.

For all categories of participants, the snowball method was used to recruit the sample (Goodman, 1961). This technique is widely used in qualitative studies where the topic is especially sensitive (Parker et al., 2019). Initial contacts, or “seeds”, drawn from close social or professional connections were invited to participate and, in turn, they invited their own contacts to join. This recruitment approach facilitated access to a highly relevant sample.

The data were analysed following a structured approach, which enables theoretical interpretations of the information gathered (Gioia et al., 2012; Smith, 2014). The three steps were: (1) developing a detailed case study for the Spanish context (see the Case description section); (2) identifying patterns in the main challenges facing cancer survivors, HRM practices and HRM practices and employment relationships (see the Empirical results section), when analysing key problems and activities of Spanish cancer survivors returning to work and (3) integrating findings to develop a theory (see the Discussion section). Data on challenges, HRM practices and HRM and employment relationships for cancer survivors were assimilated to describe overall approaches, and existing theory was applied to better understand how the constructs under study were interrelated. The analysis was conducted iteratively to enhance our insights and generalisability. This process led to the development of an HRM practices menu tailored to specific challenges and the role of employer-employee relationships in this regard. In addition, the data and literature led us to develop a sustainable career model for cancer survivors.

Inclusion criteria required that participants be either (1) cancer survivors who had completed primary treatment and were returning to work, or (2) HR managers overseeing a cancer survivor in the workplace and line managers with people management duties. This method ensured a sample that was well-aligned with our study’s objectives. Most of the interviewees were employed in educational and health institutions, although several worked for private companies. Following the snowball method, the first recruited interviewees suggested other candidates, which yielded a total of 28 interviewees (See Tables 1 and 2 for an overview of all the interviewees).

Primary (i.e. interviews) and secondary data were gathered. Interviews lasted between 30 min and one hour and information on the main challenges and HRM practices adopted was collected using a written form. Moreover, some interviews were extended using face-to-face conversations between survivors and their managers. In addition, archival information was collected through informal conversations, document analysis, available legislative material and newspaper articles. The archival information included a live conversation that was fully recorded and subsequently posted on YouTube to mark World Cancer Day (Spanish Association Against Cancer, 2024 ). In this recording, a cancer survivor and the HR manager of her company discuss HR management practices for cancer survivors. This collection of primary and secondary information enables a triangulation process based on multiple sources of data to provide stronger substantiation of the constructs and propositions in our research, used as a means of grounding emerging theory (Eisenhardt, 1989).

The twenty-eight interviews with cancer survivors (N = 14) and HR and line managers (N = 14) represent an adequate sample to extend our understanding of the phenomenon (Eisenhardt, 1989; Urzelai and Puig, 2019). The interviews took place in January and February 2024. The cancer survivors were between the ages of 37 and 61. All participants except one were women. Eleven of these women had had breast cancer once; one had had two types of cancers, namely thyroid cancer and melanoma. Another woman had metastatic cancer. The male participant had kidney cancer. The female breast cancer survivors took sick leave because of the aggressive treatments (in most cases surgery, radiotherapy, chemotherapy and hormonal therapy). Only one breast cancer survivor (57 years old) and the survivor of thyroid cancer and melanoma (49 years old, adjuvant treatment with radioactive iodine) continued working throughout treatment. These participants neither left their jobs nor reported their illness at work. It is noteworthy that the first of these survivors was self-employed, and that the second one had a temporary contract. The man with kidney cancer also took sick leave. In total, of the 14 cancer survivors interviewed, ten participants had a permanent contract, two had a temporary contract and one was self-employed; four of the participants worked in the private sector and nine, in the public sector. Thirteen semi-structured interviews, three of which also continued with face-to-face conversations, and a video-recorded testimony is an adequate sample size, particularly when the sensitive nature of their situations is considered.

In addition, 14 interviews were carried out with HR and line managers (three from the private sector and eleven from the public sector). In this way, the information gathered from the 28 interviews was triangulated by including responses from survivors, HR managers and line managers as well as secondary data.

Two interview protocols were prepared, one for cancer survivors and one for HR and line managers. The protocol for cancer survivors consisted of an initial block of questions asking about health issues and other personal information. In the first block of the interview protocol for managers, only personal and professional information was gathered. A second block of open questions, relevant to both groups of respondents, dealt with the following issues: (1) main challenges of cancer survivors returning to work, and (2) HRM practices for cancer survivors returning to work (HR planning, job design, career development, compensation, performance evaluation and training) (see Table 3). The authors analysed the qualitative data gathered from the interviews by identifying responses related to the main challenges and HRM practices experienced by both cancer survivors and HR management, with an emphasis on recurring patterns and insights across both participant groups.

In Spain, approximately 38% of cancer diagnoses occur among working age individuals, thereby affecting around 110,000 patients (Spanish Association Against Cancer, 2024 ). According to GEPAC (2012), cancer incidence is increasing and mortality is decreasing, but cancer still affects many people, not only the patients, but also their family, friends and colleagues. When a salaried person is diagnosed with cancer, they have the right to sick leave due to temporary disability (Fundación Josep Carreras, 2018). Under Spanish law (Spain, 2015), the maximum duration of sick leave is twelve months with a six-month extension, which is managed by the National Social Security Institute (INSS). The law also contemplates incapacity for work due to cancer for the self-employed and unemployed, but the focus of this study is on employed workers. The Spanish social security system provides benefits for parents of minors with cancer, allowing for reduced working hours with financial compensation (European Commission, 2024).

The scarce regulations that do exist deal with questions of aid, subsidies and career promotion, and mostly apply to public sector institutions. For example, the Spanish National Agency for Quality Assessment and Accreditation’s (ANECA) regulations, as established under Royal Decree 678/2023, now include provisions for evaluating the job performance of university lecturers with long-term illnesses. In addition, the European Parliament adopted recommendations for a comprehensive and coordinated EU strategy to fight cancer entitled the BECA initiative (European Parliament, 2022). This initiative provides the framework for Member States to develop policies (including labour policies) in the fight against cancer. Spain recently approved the Right to Forget Cancer Law (Royal Decree 5/2023), although it refers only to financial and insurance issues and has no bearing on employment questions (Iraola, 2023; Moncloa, 2023). Finally, the Spanish Statute of Workers covers non-discrimination in the workplace. However, much remains to be done in establishing guidelines to prevent workplace discrimination against workers who have had cancer. As part of the analysis process explained earlier, the secondary data collected in this study – informal conversations, document analysis, legislative material and newspaper articles – were triangulated to enhance our understanding of the main challenges facing cancer survivors returning to work and the HRM practices adopted to cope with this situation.

All the participating cancer survivors indicated that they face many internal and external challenges when returning to work: “Stress, overwhelm, fatigue, pain. Added to all this, we also must manage the fear of recurrence, which makes the burden more stressful” (S1). The cancer survivors also mentioned other challenges, such as the effects of the treatment on their body, for example, memory loss after invasive treatments (S5), or the side effects of the hormone therapy (S3). In addition, survivors shared that they struggle with their self-esteem and with their own situation (S1), as they are worried about not being able to do their job (S4).

The evidence of the main challenges facing cancer survivors ranges widely from, for example, physical pain and mental stress brought on by hormone therapy to prejudice from co-workers. There is a notable consensus among survivors, HR managers and line managers on many of these challenges. HR managers acknowledged the difficulties of cancer survivors in reconciling treatments and possible effects on the performance of their duties, as well as managing uncertainty about a possible relapse. In addition, workers may not be valued as highly as they were before the disease, which may limit their career prospects. Furthermore, when there are medical consequences, the position may not be adapted to the worker’s new situation (M3).

Interestingly, a few managers mentioned that cancer survivors return with renewed skills. The difficult situations survivors have encountered make them more creative; they have developed, and some have been promoted to top management positions (M5). Cancer survivors see things from another point of view; they know what needs to be prioritised and leave trivia aside, and thus learn from their newly acquired values, which boost their confidence in interaction with their colleagues (M9).

Furthermore, because survivors are constantly attending time-consuming medical check-ups and tests, they are susceptible to criticism from other members of the organisation, which may have reputational implications for the survivors (S5). The survivors we interviewed called for more protection and some would welcome an action protocol (S4). One survivor stated that they want to live well, not just live or survive, but have quality of life; they want to enjoy a full life, both personally and professionally (S14). For this to be possible, they need a protocol at the national level, which would help both companies and patients (S14). Moreover, some cancer survivors wanted disabilities to be clearly distinguished from vulnerabilities. On this point, S4 stated that individuals who have fully recovered from cancer and are working normally should not automatically be classified as disabled. Categorising them as such implicitly risks perpetuating the stigma for survivors even after recovery.

The agreement across categories of respondents in the challenges facing cancer survivors is such that even line managers acknowledged the need to pay more attention to managing the obstacles, such as gradual incorporation in terms of the number of working hours or days, greater flexibility and teleworking and adapting certain infrastructures (M2). However, the reality is that “when cancer survivors come back, they are required to do the same level of work as their colleagues when their bodies have not yet fully recovered” (S11).

Therefore, from our analysis we can conclude that cancer survivors encounter various challenges, including physical issues such as muscle pain, memory loss, fatigue and changes in self-identity; psychological factors like stress, fear of relapse and diminished self-esteem; time-consuming medical check-ups and criticism from colleagues. Additionally, they are often stigmatised as disabled when in fact their condition is one of temporary vulnerability. All these additional challenges primarily stem from insufficient organisational awareness about the disease and its side effects. For survivors, returning to work is an unknown quantity, with uncertain expectations and emotions, and this step is typically met with enthusiasm because going back to work symbolises progress in their recovery. Organisational and governmental interventions that frequently designate survivors as “disabled” are problematic, since most cancer survivors do not experience genuine disability. Critically, the distinction must be made between temporary vulnerability and permanent disability, and the nuanced medical and professional implications of cancer survivorship must be recognised.

Indeed, each case of cancer differs in its aftermath and treatment, necessitating a broad understanding of potential challenges alongside the prioritisation of individualised considerations. Effective communication is vital to assess baseline circumstances and to design optimal vocational pathways. Crucially, not all survivors identify as disabled (S4); many experience sequelae resembling age-related limitations, which older individuals similarly reject when labelled as disabilities. The classification of “disabled” often serves as an institutional shortcut, leveraging pre-existing legislation for support. Similar to the Right to Forget Cancer Law (Royal Decree 5/2023) for oncological oblivion, states should avoid framing post-cancer recovery as a disability, instead addressing it directly to prevent compounding the stigma of cancer with that of disability. It is important to call things by their proper name and not soften cancer by immediately associating it with the term disability (S1, S4).

Cancer survivors said that they would have welcomed HR planning practices that allowed for flexible or reduced hours, at least in the first 18 months after returning to work, similar to policies implemented in some Spanish organisations for female employees with young children (S1). In addition, they recommended arranging interviews when cancer survivors return to their workplace in order to find out what tasks and responsibilities they can take on (S1, S4). Moreover, offering options to work from home or select their work schedule and tasks would greatly help survivors returning to work (S2, S4). In contrast, one of the survivors (S9) stated that: “the only thing that wasn’t done well was my superior manager asking me to change my appointment times, as if that was even possible”.

Normally, it is the survivors who take the initiative to try to improve their return to work, as illustrated by S14: “I went to talk to my HR manager and told him that I didn’t want to give up my professional career, but that I was going to need time for my medical check-ups. I needed flexibility”.

However, there are positive signs that managers are becoming more aware and acting accordingly. Some of them reported that their organisation offers flexible solutions for people undergoing treatment, enabling those who can work during their illness to do so. In addition, M3 advised assigning a specific monitoring plan for people who have returned after treatment, to ensure that they can adapt to their position.

In most of the cases studied schedules were not adapted, although, from an HRM perspective, the organisations expressed their intention to introduce measures to deal with this increasingly prevalent situation. Some of the ideas they would like to implement, or that they have already introduced, are incorporated totally or partially into the workload for certain periods. Measures such as reducing working hours or assigning functions similar to those done previously are aimed to enable gradual incorporation and to avoid survivors having to learn new tasks (M1). In addition, survivors can request a gradual return by taking on a role as backup support for other colleagues (M2), although this measure may appear controversial or discriminatory. Also, offering a fixed period of in-person attendance during which survivors work for a limited number of hours, and allowing them to take the afternoons off for recovery would help them to adapt after any illness (M9). In addition, asking beforehand what tasks they think they could perform easily smooths the process of adaptation (M11).

Finally, regarding HR planning choices, management calls for more regulation: “Specific regulations should be implemented in this regard” (M4). In the absence of overarching regulations, companies are, on rare occasions, taking the matter into their own hands by brokering agreements with survivors. Specifically, the effective management of cancer survivors’ return-to-work process necessitates the implementation of HR planning choices such as reduced working hours, flexible schedules, teleworking options, shift selection and post-treatment monitoring, as these can significantly facilitate the reintegration process. The implementation of HR planning measures for cancer survivors frequently imposes financial constraints on organisational budgets and may engender apprehension among colleagues. It is imperative to establish a government-level action protocol that serves as a framework and provides directives for employers. In addition, there is a critical need to cultivate organisational awareness about the significance of reintegrating this cohort into the workforce. The lack of knowledge and the stigma associated with cancer often mean survivors themselves are put in the position where they have to request and elucidate certain planning measures, such as shift preferences, from their organisations.

Job design is not a controversial issue for survivors returning to work in most cases, as their small requests are usually met by management. “In my case, they provided me with a chair, table and footrest adapted to my physical condition” (S4). One HR manager reported that “they have adapted jobs for people with cancer who don’t want to take sick leave”, but they recognise that “there are no written regulations or measures” (M2). However, some survivors reported fewer positive experiences; some suggested they could be relocated to the ground floor near a bathroom, or close to a lift (S2). In fact, companies seem to be unaware of adaptations to job positions in these cases, as some of the managers stated that they had not heard of any case in which a position has been adapted to new needs after cancer treatment (M3), although it depends on each case (M4).

According to M1, how or whether a position is adapted depends on the employee’s profile and the department. If some modification is deemed necessary, it should indeed be facilitated, through schedule flexibility or reduced working hours to make them compatible with survivors’ physical and mental health needs. Most survivors return to work once they have recovered, which is why they do not ask to be treated differently. Another issue is adapting a schedule at the beginning or during the illness to fit in with treatments, check-ups or situations where the person considers that they can do their job but are not a hundred percent ready to give their best as a professional.

Fortunately, large companies in particular (M5) are starting to acknowledge the need to adapt jobs to these circumstances. They are implementing prevention programmes, and they meet with the survivors, discuss what they need, and if necessary, adapt the position (flexible hours, teleworking, etc.). Organisations are therefore increasingly recognising the value of implementing job design measures for cancer survivors. Measures include adapting workspaces, enabling telework and adjusting schedules to accommodate recovery. Many of these adaptations are cost-effective. Crucially, effective communication with the employee is essential throughout the reintegration process, with job modifications potentially occurring both during treatment and upon return to work.

Promotion opportunities are usually slowed down by the sick leave “break” and later by the fatigue associated with the treatments (S3). The general feeling among survivors with regard to career development is that it would be useful to arrange a meeting between the survivor and the person in charge of assignment planning, to gauge an appropriate level of responsibility they can take on to avoid overload (S1).

On many occasions, cancer survivors have to put their professional careers on hold for a while. When they rejoin the workplace, it takes time to return to the same situation as before the illness (S8). Organisations should support survivors’ career development through adequate communication, assessment of achievable responsibility, and by not penalising them for their illness. For instance, if a person who has had cancer cannot take up a position in another country because of the physical effects (S4), their career development should not be penalised as a result. In addition, some companies have suggested interesting career development initiatives. For instance, M5’s company monitors cancer survivors, or anyone with a chronic illness, so that they do not have to put their career on hold, and the company provides psychological support for the patient and all employees (sometimes colleagues also need support to cope). Indeed, HR departments should put protective measures in place to prevent employment discrimination in these situations (as for women of childbearing age in some Spanish public health and educational institutions), but such measures often clash with the economic interests of companies and their management (M1).

In sum, career development strategies for cancer survivors should include personalised health assessments, gradual task adaptation, psychological support provisions and/or skill development action plans. Line managers must facilitate this process through transparent, flexible communication and by recognising these employees’ unique professional reintegration needs.

Cancer survivors shared that job performance evaluation does not usually take into account periods of absence or the reasons for the absence. To address this problem, they called for more concern when assessing job performance. S3 argued that medical leave periods should be considered and, once a person is back at work, their physical condition should be taken into account – at least within certain periods – as well as any treatments they are receiving, even if they are no longer on medical leave (S3). Before making comparisons with their colleagues, companies must understand that the survivors are not at the same mental and physical stage in their lives (S10).

Overall, both cancer survivors and line and HR managers said it is important to take account of the illness in performance evaluations. M5 claimed that they consider this situation when conducting job performance evaluations. In particular, if the performance evaluation is pay related, cancer survivors should not be negatively impacted in terms of remuneration (S2). Often the fact of having had cancer is not relevant to the performance evaluation (M3). Job performance assessment is a very useful tool, in that it provides feedback on how the survivors feel, what they can contribute to the company from their experience and in many cases, it helps to establish an action plan that improves and develops their skills (M1).

To conclude, job performance evaluations for cancer survivors should adapt measurement scales and acknowledge missed professional development opportunities due to illness and treatment side effects. These measures need to foster cancer and long-term illness awareness among workers, as reducing requirements for cancer survivors may be perceived as unfair by colleagues. Currently, performance evaluations do not take cancer history into account, which potentially penalises these employees, especially when evaluations are pay-related.

There is currently no specific financial support for cancer survivors. Helpful measures suggested by the survivors we interviewed include support with gym or physiotherapy expenses, or a reduction in working hours without detriment to their salary, but no action has yet been proposed (S1, S10, S6). The situation is worse for self-employed cancer patients; S10 stated that her company should have let her take sick leave, but that was not an option as she was self-employed.

The managers agreed that compensation practices should apply equally to all employees (M1, M4, M3). According to M7, M12 and M14, there are no differences from the rest of the staff and M3 added that having had cancer is not a relevant factor when assessing possible improvements to compensation practices (M3). In this latter example, the perspectives of management and survivors appear to conflict. Analogously, in an educational setting, survivors S1 and S3 advocated for some form of compensation, while their managers M2 and M3 argued for equal treatment of all employees.

However, other HR managers took a different position, stating that no action had been taken and that some measures could be considered to compensate for the economic loss of long-term sick leave (M2). One manager had considered checking the medical insurance package to see if they had updated coverage (M5).

Potential compensatory measures for cancer survivors include reducing working hours without wage reduction (similar to accommodations for working mothers), offering life insurance with cancer coverage and providing bonuses for gym memberships, physiotherapy or psychological support. We propose that HR compensation strategies should transcend the notion of strict equality and move towards integrating diverse needs within the organisation. While these measures incur costs, it is valuable to consider cancer survivors as assets rather than solely as expenses.

On the question of training, the interviewees suggested various options such as virtual training for cancer survivors on sick leave or training courses for managers responsible for these workers. One survivor considered that mandatory sick leave could be an opportunity for training, enabling survivors to use those moments when they have “more free time” to improve their job and career performance (S2). In addition, it would be advantageous to provide training on the consequences of some illnesses for management and those in charge of assigning working hours, and on how to treat colleagues who have had these illnesses (S1). Often companies implement prevention training to detect breast cancer (S11), but there is little specific training for employees on the challenges facing cancer survivors when returning to work (S10).

Although a few organisations discuss personal and professional challenges and provide training for managers and employees to raise awareness on this issue (S14), the fact is that training is still scarce and the few options offered fall under the umbrella of occupational health and prevention (such as cancer detection courses). In this respect, more could be done from an HRM perspective. While online training is becoming more common, in practice not all organisations provide options for the most vulnerable groups. As one manager (M1) pointed out, a very specific and adapted training plan should be implemented, but their company had no such plan in place. Companies do not consider offering psychological support, which can be vital; indeed, none of the companies had a counselling service or they outsourced preventive services in occupational health and safety.

Similarly, M2 noted that “nothing has been done about training” and M3 stated that “having had cancer is not relevant in the training choices”. Some comments on the lack of training options were more positive, however. M4 stated that “specific training could be done” and in another organisation, a special workshop had been developed to show managers how to provide support and to improve their understanding of the possible consequences of cancer. Awareness workshops could be run for all employees, in an attempt to normalise how it is talked about and communicated in the organisation, in order to help the survivors overcome their fears (M5).

In summary, HR training initiatives for cancer survivors include promoting online learning opportunities and providing educational programmes for management and staff to increase workplace awareness of cancer and its side effects (diversity management training).

This qualitative case study provides deeper knowledge of the challenges cancer survivors are facing when returning to work. As previously outlined, although cancer survivors returning to work seem to be recovered, many challenges still remain in their lives, several of which are mentioned in this article. These challenges include fatigue, mental and physical side effects, aggressive treatments (often continuing after returning to work), stress, pain, fear of relapse and on-going medical check-ups. Although cancer survivors may think that their colleagues and managers do not understand their situation, fortunately organisations are increasingly aware that the number of cancer survivors is rising, and that this growing vulnerable group must be properly managed as they represent a valuable pool of their human talent.

However, more explicit attention to implement sustainable HRM practices that support the return-to-work process of cancer survivors is required. One such practice concerns talent management. Here we propose that cancer survivors’ talents should be carefully taken into account through inclusive approaches and by avoiding stigmatisation (Stergiou-Kita et al., 2016), while at the same time being attentive to the challenges they face. In doing so, ample attention should be given to their career sustainability (i.e. their health, happiness and productivity; by aligning the employee and employer perspective; Van der Heijden, 2005). The following proposition is therefore presented:

Talent management should be addressed through a set of sustainable HRM practices for cancer survivors. If cancer survivors’ talents are acknowledged and managed, their motivation and, in turn, their well-being and performance will improve, which will have a positive impact on the entire organisation as well (Kaliannan et al., 2023). This research reveals an urgent need for sustainable HRM practices that help to protect and motivate cancer survivors in their return to work (see Table 4). When cancer survivors come back to the workplace, HR managers and line managers should consider not only the disease itself but also its side effects, which are often the result of hormonal treatments (e.g. for breast cancer and prostate cancer) and that often continue for years.

In addition to talent management, an HRM practices’ menu for cancer survivors (Boelhouwer et al., 2021; Kersten et al., 2024) should cover HR planning, job design, career development, compensation and performance evaluation, as well as training that addresses ways to motivate them and consideration of their specific career sustainability challenges. This leads to the following proposition:

The process of introducing an HRM practices’ menu starts with discussions between the affected parties on the importance of motivating, protecting and ideally enhancing cancer survivors’ career development. Topics covered in these initial meetings include orientation, that is, monitoring employees returning after treatment to ensure they adapt; providing access to a gym and/or physiotherapy and life insurance with cancer coverage; redesigning job tasks to accommodate teleworking, condensing working hours in certain periods (depending on the type of job) or allowing shift selection or flexible working hours; and (online) training.

Incorporating both employee and employer perspectives in the analysis of HRM practices has enabled us to obtain rich insights into the employer-employee relationship. Moreover, cancer survivors inevitably experience the paradox arising from the tension of ending treatment and relief of surviving, on the one hand, and the frustration that their body and mind have not fully recovered, on the other hand (Cantrell and Conte, 2009; Kim and Gillham, 2013). In parallel, paradoxes arise within the workplace between what cancer survivors want and the perceptions of HR managers. For example, cancer survivors feel that they are not performing at their previous level, while HR and line managers perceive that they are working even better. Cancer survivors would like more financial support with gym or physiotherapy expenses, and they also suggest that organisations explore whether they have life insurance with cancer coverage (cancer treatments can be very expensive), whereas HR managers consider that all employees should be treated the same in this respect. Similarly, in job performance evaluations cancer survivors want the time they have lost in their professional development to be taken into account, whereas HR managers maintain that all employees should be treated equally. The HR managers’ perspective aligns with Podsiadlowski et al.'s (2013) category of fairness (all humans are equal and deserve equal opportunities). However, someone who has had cancer cannot be compared with someone who has not, and the principle of fairness should therefore be reconsidered.

HR managers recognise that cancer survivors need to be integrated into the organisation, but at the same time they uphold the idea of equal treatment. Although Podsiadlowski et al.'s (2013) study explored the management of cultural diversity, its categories (reinforcing homogeneity, colour-blindness, fairness, access and integration and learning) can equally apply to other types of diversity. In what might be considered HR managers’ contradictory views on equal treatment and integration, the perspective of integration and learning should be applied when dealing with the return to work of cancer survivors. Activities designed to help integrate and learn from cancer survivors will have a positive impact on the employee and their further development, and therefore on the organisation’s performance (e.g. Inegbedion et al., 2020). Both management and survivors mutually benefit from such an approach, which makes it a win-win relationship. The organisation creates an inclusive atmosphere for cancer survivors who return to work and, in return, the survivors adapt better to work and can put their talent at the disposal of the organisation. This argument aligns with the work of Lopez-Cabrales and Valle-Cabrera (2020), who referred to an employment relationship of mutual investment aimed at sustainability.

The final proposition arising from this study is therefore:

Our study adds a sustainable HRM perspective to the return-to-work process of cancer survivors. By integrating such a perspective into the scholarly fields that have already addressed this topic, we add to the existing knowledge on dealing with cancer survivors. In doing so, the scientific insights gained can help to address the tensions and challenges that organisations experience when considering how to protect and enhance the career sustainability of cancer survivors returning to work. Specifically, the literature review conducted for this study shows that most research on cancer survivors returning to work has been conducted in the fields of oncology, psychology and public, environmental and occupational health and focuses mainly on aspects related to the physical or mental health of cancer survivors; however, studies on the role of HRM in organisations remain scarce.

The present research contributes to advancing theory in the field of HRM by first of all providing a menu of sustainable HRM practices for cancer survivors. Although these proposed HRM practices cannot be regarded as universal, they offer a solid framework for tailoring the management of the situation cancer survivors are facing in working organisations. Second, this study also contributes to the diversity management literature as it is the first to advocate adopting an integration and learning perspective in organisations when dealing with cancer survivors returning to work. Third, our research contributes to the industrial labour relations field as it suggests the need for an employment relationship of mutual investment aimed at sustainability (Lopez-Cabrales and Valle-Cabrera, 2020) in the return-to-work process of cancer survivors. Specifically, such a relationship between superior and subordinate involves a long-term approach where organisations provide incentives and support in exchange for high expected employee commitment and performance. The propositions that we put forward are intended as a basis for more theoretical and empirical investigations of research models aimed at protecting and motivating cancer survivors when returning to work. This research line should focus on investigating determinants of both cancer survivors’ well-being and their organisation’s performance (De Vos et al., 2020; Van der Heijden et al., 2020) to identify the factors that can help to foster their happiness, health and productivity at the same time (Van der Heijden, 2005).

The theoretical propositions outlined above lead to a sustainable career model for cancer survivors (See Figure 1). Recognising the main challenges faced by cancer survivors, implementing appropriate HRM practices to meet their needs and adopting an employment relationship based on mutual investment aimed at sustainability together contribute to protecting and, ideally, further enhancing the career sustainability of cancer survivors. In line with Van der Heijden (2005), the sustainable career model for cancer survivors focuses on three main components, namely health, happiness and productivity. In terms of health, it emphasises managing long-term effects of cancer treatment and addressing physical and emotional needs. As regards happiness, it stresses finding meaningful work that aligns with post-cancer values and maintains work-life balance. Regarding productivity, it involves adapting to potential limitations in work capacity and developing new skills or exploring alternative career paths when necessary. Our newly developed model aims to support cancer survivors in maintaining long-term, fulfilling employment while addressing their challenges.

Given the importance of sustainable HRM practices to support the return-to-work process in terms of cancer survivors’ career sustainability (i.e. their health, happiness and productivity; Van der Heijden, 2005), we call on line managers and HR professionals in work organisations to make concerted efforts to carefully align organisational objectives with the individual cancer survivor’s life- and work-related objectives, preferences, strengths and weaknesses, in order to protect their well-being and performance, both of which are core notions of the sustainable careers framework (De Vos et al., 2020). The return-to-work processes of cancer survivors can only be optimised if regular, sincere dialogues take place about well-being and performance, in which the need to meet future organisational and personal demands is stressed. This is not an easy task, and it requires dual responsibility (i.e. from the employer, particularly the survivor’s direct supervisor, and the cancer survivor; Van der Heijden, 2005).

Specifically, our study’s outcomes can be translated into recommendations for HR and line managers working with cancer survivors. The propositions outlined above recommend that managers acknowledge the talent of these employees and also imply that certain HRM practices must be adopted to help survivors achieve their full potential. HR planning measures could allow them some flexibility in choosing shifts, thereby helping to protect their career sustainability (De Vos et al., 2020; Van der Heijden et al., 2020). Performance evaluations should consider periods in which their illness has prevented them from continuing their professional development. Organisations should also bear in mind the financial burden of the illness and should consider providing support for gym fees or physiotherapy. In addition, managers should be aware that cancer survivors are a particularly sensitive group when making decisions about their professional career development, and demotions or removing them from their functions should be avoided.

The study also advocates abandoning the notion of universalism when managing workforce diversity. Rather, HRM should be tailored to the needs of individuals, including cancer survivors, and should be built on an integration and learning perspective (Podsiadlowski et al., 2013), which prioritises an inclusive approach in order to maximise talent development of all categories of workers in an organisation (Kaliannan et al., 2023).

Finally, organisations should implement HRM practices that allow for tailor-made agreements on flexible hours for vulnerable groups. However, as each cancer survivor’s situation is unique, mutual agreement should be reached between the cancer survivor and the organisation regarding work plans, which should be re-evaluated regularly as the recovery evolves. This can be a delicate matter and may be perceived as unfair (e.g. Huang et al., 2015) by the cancer survivor’s colleagues. Communication must therefore be transparent, while still respecting survivors’ privacy, to avoid any suspicions of preferential treatment. At the state level, governments should introduce measures to regulate return to work after cancer, particularly for the self-employed or unemployed. Current policies only provide support to cancer survivors if medical evaluations certify a significant inability to work, thereby treating them as disabled. This approach is limited. We posit that there is a need for more comprehensive state-level protocols to guide organisations in implementing measures adapted for cancer survivors, which go beyond the traditional disability framework. The HRM practices’ menu proposed in this study is intended as a basis for such regulation, as it offers an overview of the most controversial demands or aspects.

The main limitation of this case study is the generalisability of its findings, as it is based on 28 cases within the Spanish context. While it provides an in-depth understanding of the phenomenon under study, more empirical work is needed, comprising replications in other countries to advance insights on challenges and sound HRM practices in other cultures. Further research could also include cancer survivors in different occupational sectors. In addition, more gender-balanced empirical data are needed to provide greater insight into possible gender differences. It is reasonable to assume that male cancer survivors encounter distinct difficulties, as societal perceptions of illness or vulnerability often conflict with conventional expectations of masculinity. Large-scale longitudinal studies are also recommended using within-person designs to follow the career sustainability of cancer survivors over time (see Van der Heijden et al., 2020 for more detailed recommendations). Moreover, future studies should extend their samples to include broader educational levels, socio-economic backgrounds, lifestyle factors and work-life balance considerations. In addition, our study focused on the challenges facing cancer survivors when they return to work and managerial responses to them yet does not consider selection processes and job seeking after the illness. Future research could usefully explore how selection processes are managed when cancer survivor candidates are involved. Medical histories are not normally reported in selection processes but in the case of cancer survivors, managers will likely become aware of their situation when medical check-ups are required, or physical or mental health problems arise.

Last but not least, future research could examine how colleagues and supervisors perceive cancer survivors, who are often seen as disabled rather than capable workers. All in all, our study sheds light on the need to raise awareness among HR managers and line managers that, by adapting HRM practices, cancer survivors can be high-performing employees, just like other workers. We hope that it inspires both academics and practitioners to pay more genuine attention to the needs of cancer survivors.

Funding and support were provided by the Andalusian Government (Grant No. PAIDI SEJ676, Nuevos paradigmas en la Dirección Estratégica de Recursos Humanos), the Andalusian Government (Grant No. ProyExcel_00114, Transformación Digital y competencias en los RRHH: el camino hacia la sostenibilidad), and the Spanish Government (Grant No. PID2024-159904OB-I00, El futuro del trabajo y la búsqueda de legitimidad: un enfoque hacia la sostenibilidad social atendiendo a los trabajadores vulnerables). Funding for open access publishing was provided by Universidad Pablo de Olavide/CBUA.

Corrigendum: It has come to the attention of the publisher that the article, Mónica Santana, Rocío Aguilar-Caro, Beatrice I.J.M. Van der Heijden; A sustainable career path for cancer survivors returning to work: new theorising from an inductive qualitative case study. Employee Relations: The International Journal 2025; https://doi.org/10.1108/ER-06-2024-0334 did not include the complete funding Grant number. This funding information should read, “Funding and support were provided by the Andalusian Government (Grant No. PAIDI SEJ676, Nuevos paradigmas en la Dirección Estratégica de Recursos Humanos), the Andalusian Government (Grant No. ProyExcel_00114, Transformación Digital y competencias en los RRHH: el camino hacia la sostenibilidad), and the Spanish Government (Grant No. PID2024-159904OB-I00, El futuro del trabajo y la búsqueda de legitimidad: un enfoque hacia la sostenibilidad social atendiendo a los trabajadores vulnerables). Funding for open access publishing was provided by Universidad Pablo de Olavide/CBUA.”