Environmental and Occupational Health Practice
Online ISSN : 2434-4931
Original Article
Development of a support tool for balancing cancer treatment and work in small and medium-sized enterprises
Noriko Nishikido Minako SasakiEtsuko YoshikawaMichiyo ItoHitomi AbeNoriko Sakiyama
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2019 年 1 巻 1 号 p. 13-19


Objectives: The purpose of this study was to develop a practical support tool to promote activities for balancing cancer treatment and work in small- and medium-sized enterprises (SMEs) and to evaluate its validity and feasibility. Methods: Based on good examples of the support at SMEs from our prior study, researchers discussed the basic structure and details of such a tool and developed its first version. The validity and feasibility were examined in a focus group interview with management experts and a mail survey to human resource (HR) managers in SMEs. The final version of the support tool was prepared based on their opinions. Results: The basic structure of the developed tool comprised two parts: an assessment part for self-checking the degree of balancing treatment and work and an information provision part offering an explanation of the assessment results and tips for improvement. We prepared 24 items for checking six fields that were strongly related to balance activities. Assessment results were displayed in a radar chart so that the strengths and weaknesses of one’s own workplace could be visually determined at a glance. Management experts and HR managers evaluated this tool and found it easy to understand and useful. Conclusion: This tool seems to offer visible assessment of current activities for balancing cancer treatment and work and tips for improvement, resulting in increased motivation of employers and HR managers. We expect that this practical support tool will contribute to promote activities for balancing cancer treatment and work in many workplaces, including SMEs.


There is an accelerating social movement to strengthen support for cancer patients among the working generation to balance their work and treatment. In February 2016, the Ministry of Health, Labor and Welfare published “Guidelines for Supporting Balance between Medical Treatment and Work in the Workplace,” and the implementation of measures to support this balance in various companies has become an issue1).

Those afflicted with illnesses, especially with cancer, bear a tremendous psychological burden; therefore, support measures have been in consideration to help their continuation of work, since the cancer treatments, such as chemotherapy and radiation treatment, come with side effects and often need to be continued for a considerable amount of time after operations2).

In recent years, the chance of getting cancer in one’s lifetime has reached nearly 50%, and approximately 300,000 among the working are newly diagnosed with cancer annually3,4). Advancements in early detection and treatment technologies have contributed to an increase in the 5-year survival rate of cancer sufferers overall, to approximately 60% on average3), and cancer is no longer seen as “an illness linked directly to death,” but instead has become “an illness to live with for a long time”2). Many studies have been conducted to investigate epidemiologic features for work and life of cancer survivors by outpatient or internet survey5,6).

Creating a workplace environment that can balance work and treatment directly affects the quality of life and the economic situation of cancer sufferers who are still working, and it is thus a social issue for which countermeasures should be taken immediately, since this also affects their families tremendously7).

Whether one can get proper support in the workplace is a major issue that affects whether one can continue working. Given this situation, the Secondary Cancer Countermeasures Promotion Basic Plan incorporated “Enriching Cancer Countermeasures Among the Working” as a focal issue, and each prefecture has begun to work on surveys of actual conditions overall and corporate trainings, along with granting recognition to those companies with best practices for balancing between cancer treatment and work, as well as public awareness activity for those supporting practices. Many studies have been done on such initiatives in large enterprises8,9), although there have not as yet been many reports on best practices in small- and medium-sized enterprises (SMEs).

Because of this dearth, we had collected best practices from SMEs that have implemented ideas and countermeasures supporting workers diagnosed with cancer and identified the current state of balancing cancer treatment and work in SMEs10). Based on those previous results, we conducted new research to promote balance between cancer treatment and work in SMEs. The purpose of this study was to develop a practical tool that could be easily used in SMEs and to evaluate its validity and feasibility.


Development of a practical support tool

Based on our previous interview regarding best practices for supporting balance between cancer treatment and work in SMEs, as well as on results of various types of research done to date, five researchers who are studying the current support for balance between cancer treatment and work and who have practical experience as occupational health nurses (OHNs) at a corporation have debated the future state of easy-to-implement activities for balance between cancer treatment and work in all companies, including SMEs, along with critical countermeasures. The aim was to develop a practical support tool that is useful for initiatives to support balance between cancer treatment and work in SMEs (hereinafter “tool to support balance”) and can be broadly adopted. Discussions concerned who would use the support tool, where it would be used, and how the basic structure and details of it would be arranged. The first version of the tool was developed after repeated modifications.

Examining the validity and feasibility of the tool

In order to examine the validity and feasibility of the developed tool, a basic configuration of the support tool and its details were explained to five experts who have been researching the management of SMEs and who have experience in corporate management. Their opinions were obtained in a focus group interview about the ease of understanding and relevance of the details involved, the potential for use, and other points to be kept in mind. In addition, materials on the configuration and the details of the support tool and a simple questionnaire were sent to ten human resources (HR) managers in SMEs to get their opinions on ease of use, ease of understanding, whether the tool was helpful, and other matters. The support tool’s final version was prepared based on the opinions obtained.

Ethical considerations

This study was conducted with the approval of the Tokai University Health Science Department’s Ethics Committee (16-01). Upon explaining that cooperation with this study was based on free will of the individuals involved; that personal and organizational information would be protected; and that individuals could withdraw, participants were asked for their opinions on the support tool. Further, the names and organizations of those participating in the study were anonymized, upon which data were recorded and analyzed.


Development of a practical support tool

It was decided that executives and HR managers would be the primary targets for the support tool, in order to promote its adoption among SMEs for the support of balance between cancer treatment and work. As to the purpose of using the support tool, the focus was placed on increasing interest in “supporting balance” among executives and HR managers and on promoting and supporting initiatives in the workplace based on what would currently be possible. We developed the “Checklist and Tips for Balancing Cancer Treatment and Work”. The aim in developing a support tool as a result of this study was (1) to be able to actually check the level of support for balance in the workplace; (2) to quickly understand the strengths and issues of each workplace by showing the results of checking the level of support for balance on a radar chart; and (3) to be able to easily obtain information on the importance of six fields and hints for their improvement. Therefore, we decided to incorporate a self-check for level of support for balance, a tool that can display the results of the checkup, as well as a tool to provide information, such as explanations of the results of determinations and tips for improvement.

Checking the implementation level for balance and displaying the results

Based on the six major categories extracted from the results of our previous interviews with SMEs with best practices and future issues10), 24 questionnaire items in six fields regarding support for balance have been created (Table 1). The first field is “management policy and philosophy,” which is to clearly demonstrate the president’s policies emphasizing the health of employees in the management philosophy and company mission. The second field is “mutual support and communication in the workplace,” which is to reinforce employee ties and communication to mutually support employees and families during their illnesses. The third field is “taking time off and cancer-screening,” which refers to the ease with which employees can take time off to manage hospitalizations and health and the encouragement to obtain cancer exams through special time off and cost subsidies. The fourth field is “flexibility in work time and content,” which is to change employee positions for shorter work hours and lighter workloads and to coordinate the ways that employees work in order to ensure that there is no negative impact on their health. The fifth field is “detailed consultations by managers,” which means that supervisors and HR managers provide consultation and institutional information on working in a reasonable fashion. The sixth field is “collaboration with outside resources and information use,” which means that companies can have consultations with outside healthcare professionals regarding support for balance. The last domain was made using contents extracted as a future challenge in the former interview study.

Table 1. The Checklist of Support for Balancing Cancer Treatment and Work in SMEs
A. Management Policy and PhilosophyYesNo
1. The company policy and philosophy include employees’ health and happiness.
2. The president explains how employee health leads to good managment.
3. Employee health-oriented messages by the president have fully reached the employees.
4. There are daily opportunities for the president to talk to employees.
A:   points#
B. Mutual Support and Communication in the WorkplaceYesNo
1. Employees can usually talk freely about their health.
2. There is a climate to support each other when employees get sick.
3. There is an atomosphere that the company appreciate each of the employees.
4. There is a consultative atmosphere even when employee’s family members get sick.
B:   points#
C. Taking Time Off and Cancer ScreeningYesNo
1. It is possible to take paid leave on a half day or hourly basis.
2. Emploees can take sick leave
3. The company subsidizes expenses making it easier to receive cancer screening.
4. There is regular consultation during workhours and a special leave policy that encourages cancer screening visits.
C:   points#
D. Flexiblity in Work Time and ContentYesNo
1. Employees can request to adjust work hours according to their health condition.
2. If so desired, employees can be flexibly reassigned, when they return to work.
3. Employees can ask for adjusting the task to be able to control the physical condition.
4. Employees can ask for increasing the worklord, according to the status of recovery
D:   points#
E. Detailed Consultations by ManagersYesNo
1. Supervisors tell employees to work while maintaining their health.
2. Human resource officers consult about how to take the sick leave or how to arrange the working conditions, when employees get sick.
3. Supervisors and human resource officers recommend not to retire but continue working without difficulties and having treatment properly.
4. Personnel makes clear to the cancer survivor and coworkers that they are being assessed fairly according to the quality of their work.
E:   points#
F. Collaboration with Outside Resources and Information UseYesNo
1. The company can obtain information supporting balance between cancer treatment and work.
2. The campany is aware of the guideline for supporting the Work-Treatment Balance.
3. The company has consulting routes with healthcare/medical professionals.
4. The company knows how to contact the physician in charge of the worker with cancer.
F:   points#

SMEs, Small and medium sized enterprises.

#:  Each item should be answered with “Yes” (1 point) or “No” (0 points), and the total score of the four items in each field ranged from 0 to 4 points.

Each item was answered with “yes” (1 point) or “no” (0 points), and the total score of the four items in each field ranged from 0 to 4 points. The assessment results were displayed in a radar chart so that the strengths and weaknesses of one’s own corporation (workplace) could be visually determined at a glance. A sample of the radar chart was shown in Figure 1.

Fig. 1.

An Example of the Assessment Result of Support for Balancing Cancer Treatment and Work

Explanation and tips for improvement

Based on the results shown in the radar chart, the tool allows users to click on each field to access pages with detailed explanations and tips for making improvements in that field, so that companies can develop some good ideas for measures to make improvements in the future. With regard to tips for improvements in each field, in order to give more detailed and practical understanding, after showing the perspective in each field, the simplest possible explanation is given as to why each item checked is important, and a hint is given for making improvements to the current state with an action phrase as an example, in order to make choosing and considering measures adapted to workplace needs easier.

Examining validity and feasibility of the tool

Our interview with the management experts and mailed survey to HR managers in SMEs regarding the validity and feasibility of the support tool indicated that it was generally easy to use and would generate interest in balance support and specific hints for improvement.

Five management experts expressed their opinions that it was easy to obtain the interest of those involved in the business, as to the basic configuration based on self-checks and tips for improvement of the level of support for balance. As to the content and expressions used in the support tool, it was thought that they were generally clear and easy to understand. There is a need to think about the order of questions and expressions and phrases depending on whether the target is an executive, HR manager, or general employee. Their opinions stated that, if the target is an executive or HR manager, the order of questions and content for this tool to support balance should start with the “president’s policies and company mission” to make it easy to understand. Some opinions stated that it was highly likely that putting information on websites regularly watched by executives and HR managers would lead to awareness through related organizations and adoption. There were also opinions that allowing only essential information to be viewed on a website would help individuals to use the information without getting tired of it.

Seven of ten HR managers in SMEs responded that the checks assessing the level of support for balance were easy to use and easy to understand. With regard to tips for improvement, it was determined that they were specific and usable, and methods for using them were understood. Some also said that the function that allowed one to move quickly from one field to another on the website to explanations or tips for improvement would make it easier to use.

Announcement of the final version of the tool to support balance

The final version was prepared after improving somewhat difficult to understand expressions and several points requiring revision. This version was then published as an online tool on the home page of our research team and as a booklet.

A web-based tool to support balance

Based on the opinions that were gathered, and after making repeated corrections to make expressions easier to understand as well as making improvements to tool operability, the research team’s website announced the final version of the support tool for balancing cancer treatment and work in SMEs11). Efforts were made to ensure 1) automatic display of a radar chart of assessment results upon completion of the check for the level of support for balance by simply clicking on selected responses to questions, allowing ascertainment of workplace strengths and issues at a glance; 2) easy access to explanations and tips for improvement by clicking on any of the headings of the six fields; 3) confirmation of the overall picture by returning to radar charts from each page as needed; and 4) the ability to print assessment results, explanations, and tips for improvement. Starting with actually checking the level of support for balance in one’s workplace, the tool was made for users to ascertain strengths and issues and easily obtain information, such as tips for improvement. The function to print the date and time of diagnoses was also added so that users could conveniently share and save the information at their workplace.

The tool to support balance in booklet form

A booklet version of the support tool was made afterwards, so that it could be effective to introduce the aforementioned internet version of the tool at training meetings related to supporting balance of medical treatments and work life. Accordingly, a list of information for other support tools and support organizations to be used in supporting balance was added, based on the web-based tool to support balance. QR codes of those tools and organizations were also printed in the booklet for convenience. Moreover, colorful illustrations and photographs and an easy-to-read layout were added to the printed tool booklet. It was then distributed to related parties and has actually been used in training.


Guidelines for supporting the balance of treatment and work note the need to create systems for work and time off1), though SMEs with best practices take a flexible approach to support even without such systems. This may have something to do with the proximity of company management and employees, strength of SMEs, and the fact that it is easy to communicate management policies to employees. The tool to support balance developed in this study assumed management policy and philosophy, mutual support and communication in the workplace, and encouragement for taking time off and attending cancer screening as the first three fields, even though these elements may be thought of as aspects for habitually creating a good workplace environment. Moreover, the last three fields assumed ideas for flexibility in work times and content, detailed consultations by managers, and collaboration with outside resources and information use, which were actually thought of as responses in the event that employees were diagnosed with cancer.

In our prior research on good practices in SMEs10), the current state of worker shortages in these companies, and, particularly, the difficulty in finding alternate personnel with a high level of expertise, have created the impression that company management and HR managers strongly wish to take care of the limited personnel they have. In workplaces where this policy has become prevalent, work associates often help and complement each other, and it is believed that the everyday creation of an environment is very important. In contrast, in regard to “collaboration with outside resources and utilization of information,” many do not know where to find professionals with whom they can consult, and its guidelines are not well-known in SMEs. The smaller the company was, the fewer the connections were found with occupational health professionals. When employees fall ill — not just owing to cancer — SMEs must be made aware of this, so that they collaborate and share information with outside organizations. Hence, it is hoped that the tool to support balance developed here will be useful.

The basic configuration of the support tool created in this study is appropriate for company management and HR managers, with those using it saying it is easy to understand. It is believed to be a valid support tool for management and HR managers in SMEs. In the future, it is hoped that awareness can be raised, and adoption will be increased through websites commonly viewed by company management and HR managers, as well as through various organizations. Moreover, there is much demand for a tool that can be introduced and used in workplace support, such as in training meetings for professions like occupational health nurses. Supporting all working people and their families requires social support from many angles12,13,14,15), and it is possible that this can be used as a tool for raising awareness of the healthcare organizations that examine workers and related individuals in SMEs.

Given increasingly aging workers and a growing trend for workers to be diagnosed with cancer3,4), and with many working in SMEs concerned about the lack of workers16), the findings obtained in this study can lead to not only securing the health of workers, but also securing manpower. It is thought that the understanding of company management will enable the promotion of support for balance within a company; therefore, strengthening awareness activities for management is desired9,15).

The future will require development of a structure and set of support tools that allow for the simple retrieval of specific and valuable information with which all working people — not just those involved — can support those struggling to balance work with treatment of not just cancer but all types of illnesses, disabilities, raising children, or caregiving requirements. Here, we have developed a tool to support balance between cancer treatment and work; however, many of the check items and tips for improvement used here are not only related to cancer treatment. Therefore, with a little amendment made to parts of these items, this tool could be modified to be more versatile; thus, we wish to continue our examinations of this tool.


The present study demonstrated a practical support tool that could contribute to motivating employers and HR managers and disseminating the support for balancing cancer treatment and work in SMEs.


The authors would like to express their sincere thanks to all participants in this study. This research was supported by Health and Labour Sciences Research Grants, the Ministry of Health, Labour and Welfare (H26-ganseisaku-ippan-018), Japan.


Approval of the research protocol: The Research Ethics Review Board of School of Health Sciences, the Tokai University, approved the study procedures (No. 16-01).

Informed Consent: The aims and procedures of this study were explained and consent was obtained from each participant when opinions were collected about the tool.

Registry and the Registration No. of the study/Trial: N/A

Animal Studies: N/A

Conflict of interest

The authors declare that there are no conflicts of interest.

© 2019 The Authors.

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