Vanessa Sallows, Group Protection Claims & Governance Director, Legal & General, interviews Kelly McCabe, Co-Founder and CEO, Perci Health, the virtual cancer survivorship clinic, with which Legal & General Group Protection has partnered. They discuss the challenges faced by employees living with and beyond cancer, the support available to Legal & General’s Group Income Protection (GIP) clients, and what good workplace support looks like.
Vanessa: What led you to come up with the idea for Perci Health?
Kelly: My background is in clinical care. I managed a large team of cancer specialists. I was also Chief Operating Officer for seven private cancer clinics across the UK.
Throughout my experience, I found that people typically felt well supported during cancer treatment. But, after treatment, that support falls away, often leaving people feeling abandoned.
Patients enter what we call a ‘supported self-management pathway’. In other words, any follow-up needed is through the individual’s GP. This kind of patient initiated follow-up only works if you know what to look out for. And it only works if you can access primary healthcare when needed. Accessibility can vary hugely depending on where you are in the UK.
Also, it’s important to bear in mind that GPs aren’t specialists. So, they’re not picking up on late and persistent effects.
All of this leaves people feeling cured of cancer, but left with the chronic effects of treatment.
We believe these chronic effects are often treatable. And cancer allied health professionals are best placed to help.
Vanessa: Can you please provide an overview of the typical work-related challenges that employees diagnosed with cancer face?
Kelly: Challenges largely fall into two buckets. Firstly, the practical barriers, such as line managers not being equipped to provide adequate support. This might include a lack of checking-in to see how you’re doing. Or not being able to get the necessary adaptations to help you do your job.
Secondly, the psychological impacts of cancer. Typically, you can have cancer treatment for a long time. During treatment, there’s a sense of adrenaline and no time to really think about the effects of this life-changing diagnosis.
Then, treatment ends. You have time to think and, at that point, the psychological impact increases. This, at the exact same time that access to support decreases. This can be a big barrier to returning to work.
Take breast cancer, for example; the most prevalent cancer for working age women. It’s now considered much more survivable. The risk of death from breast cancer was just over 1 in 7 in the 1990s. Now it’s 1 in 20.
But the treatment is intense. Patients generally have all the different types – radiotherapy, chemotherapy, hormone therapy. So, the after-effects are massive.
With steroids, patients can gain an extra 15-20kg. They might have had a mastectomy. They might have lost their hair, eyebrows and eyelashes.
You just don’t feel like you, which makes a return to work very challenging. Individuals might feel they need to disclose a certain impact of treatment – because it’s physically apparent – but, at the same time, they might not want to.
And, of course, there are over 200 different types of cancer. Some – the lesser talked about ones – are likely to come with more stigma than others.
Vanessa: Only recently, the group risk industry body GRiD reported that only one third (30%) of employers offered support to help employees with serious illness, such as cancer, to stay in or return to work. They found that in most cases, employees want to remain in work when diagnosed with cancer, if they’re physically and mentally able to. So, how did (or still does) traditional support – from both healthcare providers and employers – fall short, when an employee is diagnosed with cancer?
Kelly: On top of the kind of things I’ve outlined already, I think there’s often an over-reliance on charities after cancer treatment. Charities have a strong role in education, but they can’t plug the hole in individual support.
Also, an indirect challenge for healthcare providers is the phenomenon of survivor guilt. Individuals might not want to go to their GP to ask for help with things like pain, fatigue, or digestive problems, because they consider they’re the lucky ones, so they just need to get on with it.
Then, looking at this from the employer perspective, cancer is definitely high impact but still low incidence in the workplace.
Most employers won’t see a cancer case every year. So, they don’t build in the support like they might for something like employee mental health or back pain.
Support is also lacking, in all quarters, for the knock-on effects of cancer. For example, someone with cancer who’s also looking after a child. Or someone who’s caring for a parent, or other loved one, with cancer. There’s very limited consideration for such instances.
Then, when it’s back to work time, colleagues will probably celebrate your return, then won’t talk about it again. This is probably because they think it’s for the best. But, the fact is, this leaves people feeling really unsupported.
Vanessa: So, how does Perci Health’s service, now included in Legal & General’s Group Income Protection (GIP) proposition, help meet the kind of bespoke support needs that you’re describing?
Kelly: When someone is referred to us, we would typically provide three months’ intense support, where appropriate; everything from personalised care plans created by a team of cancer nurses, to access to our multi-specialty team.
Individuals are assigned a dedicated cancer nurse. They’ll carry out an initial 60-minute appointment – a structured holistic needs assessment – where all factors will be considered: physical, psychological and social.
As part of this, we’ll assess whether the individual is ready for a return to work. If they are, we’ll work in partnership with the employee, the employer and Legal & General case manager to support a return. The dedicated cancer nurse would continue to check in every two weeks during that initial three month period, and also refer in to other specialists over that time as appropriate.
Alongside this, we’d educate the individual on what to expect over the coming months. And they can access our digital platform for as long as they like. This includes expert-created articles and video based learning programmes to help them build confidence to manage their condition in the long term.
Vanessa: What are the most useful aspects of Perci Health’s services, according to your users?
Kelly: Our nurses receive the most feedback. Users often report that the support their nurse provided, made them feel like a person and not just a cancer diagnosis. They feel it’s the first time someone has really listened to what’s important to them.
For example, our nurses often hear “It’s the first time someone has asked me that”. This could be in relation to all kinds of things, such as: the impact of their cancer diagnosis and treatment on their family; problems related to sexual dysfunction; or experiences of treatment-induced menopause symptoms.
Vanessa: What more can employers do to support employees living with cancer?
Kelly: First and foremost, be more human. Be more open when it comes to talking about cancer. And, if an employee has a cancer diagnosis, check in with them when they’re first absent and throughout absence.
Secondly, there’s no one-size-fits-all solution. People with a cancer diagnosis often need the tailored intervention and support provided by a specialist such as Perci Health.
Large companies often think they’re covered if they have Private Medical Insurance (PMI) in place. But ask yourself, does it cover the whole workforce? And does it support with return to work? It’s important to do a mapping exercise to optimise what’s available across all benefits.
Also, line manager training. There’s lots of legal stuff you have to be aware of when it comes to cancer [Equality Act 2010]. On the one hand, you don’t want to force people back. But saying “take as long as you want” isn’t always the most supportive approach either.
Finally, ensure a focus on prevention. Help promote the importance of a healthy lifestyle, in terms of reducing known cancer risk factors. Focus on things like: giving up smoking; reducing alcohol intake; exercising and maintaining a healthy weight.
Vanessa: How does Perci Health dovetail with existing support and services available via Legal & General Group Protection?
Kelly: Legal & General’s outcomes-focused framework Be Well. Get Better. Be Supported. is completely aligned with our thinking at Perci Health, in terms of taking a whole person approach, ensuring mental wellbeing underpins everything, and being guided by an understanding that ‘good work is beneficial for health’.
Perci Health sits in the ‘Get Better’ and ‘Be Supported’ pillars. It’s within these pillars that Legal & General’s in-house clinical team provides direct and bespoke support to employers and employees with respect to early intervention and vocational rehabilitation. The Legal & General clinical team will liaise with us to provide specialist support in instances of a cancer diagnosis and subsequent GIP claim.
Vanessa: To what extent do you think intermediaries should be communicating Group Income Protection (GIP) support and services, such as Perci Health, when discussing the product to clients?
Kelly: To answer that, let’s take breast cancer as an example again here. A recent report from Breast Cancer Now, evidences that supporting people with breast cancer has an economic impact.
They calculated that in 2024, the total cost of breast cancer to the UK economy is estimated to be £2.6 – £2.8 billion. In terms of productivity loss alone (from patients and informal carers), that equates to £776-951 million.
All this has a knock-on effect on individual business success. And it’s something that employers need to hear about.
Also, it’s worth intermediaries taking the top three causes of GIP claims – mental health, musculoskeletal conditions and cancer – and then, for each, asking: what’s the most effective support with regards to return to work; and which providers include that as part of their proposition.
We have a Duty of Care to support people with cancer. And people with cancer want that support. A 2022 survey of cancer patients who had not yet completed their treatment found that 86% planned to return to the same job.
