Objective Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well‐being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement. Methods At the beginning of rehabilitation, we asked cancer patients to respond to occupation‐related and health‐related questionnaires. We used t‐tests, chi‐square tests, and logistic regression analyses to address our research questions. Results A total of 477 patients participated in the study. Of these, 19% were occupationally stressed, and 26% reported subjective need for occupational rehabilitation. Patients who reported work‐related stress had a diminished quality of life, were more likely to report subjective need for occupational rehabilitation (OR = 2.16), and had a higher risk of early retirement (OR = 5.44). Furthermore, cancer patients reported deficits in both active coping abilities and mental stability at work. Conclusions Because occupational stress is associated with a higher risk of early retirement, both patients and physicians should take work‐related problems seriously. Screening patients for occupational stress may help physicians identify patients who are at risk of experiencing problematic work re‐entries. Furthermore, the results of the study suggest that cancer patients might have problems maintaining confidence in their abilities to solve work‐related problems. Therefore, facilitating the development of a perception of self‐efficacy might be an important treatment goal. Copyright © 2012 John Wiley & Sons, Ltd.