Work and Cancer

By Mia James

Anyone affected by a cancer diagnosis knows that life doesn’t stop to accommodate illness and treatment. Managing your responsibilities and realities is yet another challenge you must confront as a patient, and, for many, work is a part of this often-complicated puzzle.

Many factors determine the impact that a diagnosis will have on your work life. The nature of your job, the policies and the culture of the company you work for, and your relationships with supervisors and coworkers— all come into play. And of course disease severity, treatment schedule, and how symptoms and side effects affect you will also influence how you balance work and cancer.

Though your situation may be complex, expert guidelines and resources can help you keep your job and stay on your treatment schedule.

Sharing a Diagnosis at Work

If and how you choose to share health information in the workplace is a personal decision. According to Rebecca Nellis, director of programs for Cancer and Careers (cancerandcareers.org), not everyone discloses a cancer diagnosis at work, and it’s not required in all cases. The only situation in which you must share is if you want to benefit from the Americans with Disabilities Act (ADA) (discussed later in this article).

Before disclosing a diagnosis, Rebecca recommends that you consider how the diagnosis will affect your ability to work, how important it is to continue to work (personally and financially), as well as strategies for managing the demands of your job and treatment schedule. Also, know how your employer is likely to handle the situation. “Gather any details about leave policies or flexible work options that may exist,” she says. “A good place to look for that kind of information is the employee manual.”

Also consider whom you feel you need to tell. Are you most comfortable telling only your direct supervisor, or do you want to share with your co-workers as well? If you work for a larger company with a human resources (HR) department, you also have the option of approaching HR, where someone may have experience with similar situations.

Rebecca recommends enlisting your health care team to help you make decisions about working during treatment. “The health care team can also help you map out times of likely fatigue or other side effects so that you can factor that in to any decision about working,” she says.

If you decide to disclose a diagnosis in the workplace, you’ll also want to think about what information you want to share and what you want to keep private. This matter, Rebecca explains, will also depend on your individual circumstances. “If the patient is the kind of person who sees the workplace as an extended family, he or she might want to tell the whole story,” she explains. On the other hand, if you’re typically more reserved, you may be more comfortable sharing only key details. “It is also important to identify what kind of environment you work in,” Rebecca says. “Is it a small, family-run, close-knit workplace or is it more corporate and formal?” This will factor into whom to approach when disclosing an illness.

Your Legal Rights

There are certain federal laws in place to protect workers in the event of major illness. Monica Fawzy Bryant, Midwest regional director of the Cancer Legal Resource Center (disabilityrightslegalcenter. org/about/cancerlegalresource.cfm), explains that both the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act can help you retain your job during treatment.

The FMLA mandates that eligible individuals can keep their jobs and take up to 12 weeks of unpaid leave while retaining benefits. You can use this leave to care for yourself or a seriously ill spouse, parent, or child. You can take your leave all at once or in smaller increments that total up to the 12 weeks.

Monica explains that to be eligible for the FMLA for your own serious health condition, “you must be unable to perform your job,” and your employer must have 50 or more employees who work within 75 miles of your worksite. Also, she says, “you must have worked for your employer for at least a total of 12 months and worked at least 1,250 hours during those 12 months.” The latter amounts to a little more than part-time.

The FMLA also requires your employer to give you back your position when you return or to give you a position that is equivalent in pay, benefits, and responsibility. “In other words, you cannot be demoted when you return to work,” Monica says. Additional provisions of the FMLA include one that requires your employer to continue to pay for health benefits for up to 12 weeks of your leave and another that requires other benefits (such as life insurance and retirement contributions) to be reinstated when you return to work (although these other benefits don’t need to be covered during your leave).

The ADA, Monica explains, “was intended to eliminate discrimination in the workplace against people with disabilities,” including cancer patients who are disabled as a result of the disease or treatment. As a cancer patient, this law entitles you to reasonable job accommodations or measures that make it possible for you to work even if you have impairment. Monica explains that these accommodations will vary depending on the impairment and the job in question. “Some types of accommodations,” she says, “may include telecommuting, flexing your days [working full-time but changing hours as needed for your appointments], a different position, or technological aid.”

Monica adds that to request a reasonable accommodation, you need to tell your employer about your diagnosis, and your employer has the right to ask for medical documentation showing that you need the accommodation or that you can perform your job safely.

Consider the Impact on Your Health

If you’re in a position to choose whether or not to work during treatment, Kurrie Wells, PhD, director of mind-body medicine and clinical health psychologist at Cancer Treatment Centers of America® (CTCA) in Philadelphia, Pennsylvania, suggests that you think carefully about the impact that this decision will have on your health and well-being.

“Work is, for many people, their primary stressor,” says Dr. Wells; and while this doesn’t necessarily mean that your job is a negative part of your life, it does demand a certain amount of your personal resources. “We all have limitations on our physical, cognitive, and emotional resources,” she explains, and work can deplete one or more of these areas.

The stress of placing too many demands on your resources can have a significant impact on your health, particularly during cancer treatment. Your immune system, for example, can become less effective, leaving you open to infection, which may make it difficult to stay on your treatment schedule.

On the other hand, you may find that working during treatment helps you feel good about yourself and keep a positive outlook. Dr. Wells says that if you enjoy your job, and it does not feel stressful, keeping your schedule may help you feel more like yourself and offer a welcome distraction from health-related concerns. “It can help people maintain a sense of normalcy,” she explains. Other positive aspects of work that Dr. Wells cites include “feelings of purpose, productivity, and self-esteem.” And, if you work in a social environment, your job can help you feel connected during a time when you might otherwise feel isolated.

When it comes down to making the decision about whether to work during treatment, Dr. Wells suggests that you put time and serious thought into your choice. “Don’t make an impulsive decision,” she says. Also consult your medical team to find out whether you’re healthy enough to be in the workplace. For example, some therapies may leave you more susceptible to infection, so if you’re exposed to sources of possible infection, large crowds, or young children at work, your doctors may have specific recommendations about safety precautions or even advise you about taking some time off.

Managing Your Job and Treatment

If you decide to keep working during treatment, there are some guidelines and resources to help you balance your job and treatment schedule. According to Rebecca Nellis, good communication with your supervisor and understanding the demands of both work and medical care are the keys to a successful balance.

Rebecca recommends that you remain logical when considering ways to accommodate work and treatment schedules. Telecommuting or working from home may be an option for some, but it’s possible that you have a position that requires you to be physically present. If so, she explains that there still may be adjustments you can make. You may be able to have someone cover a certain portion of your day so that you can rest or attend a medical appointment. For example, if you’re a schoolteacher, you may be able to find a co-worker to take over your recess duty as needed.

No matter the circumstances of your job, Rebecca recommends that you have a solid plan about how any accommodations you request will be covered. “When you broach the idea, you want to be prepared with an actual plan for how it would work,” she says, explaining that if, for example, you’re proposing working from home or telecommuting, this would include details such as the hours you’d be working, how you can be reached, and how you will let people know when you are away from your desk.”

Your medical team can also help you balance your job and treatment. Rebecca recommends that you ask your care providers questions such as “Are there treatment options that are likely to be as effective but would make it easier to continue to work?” and “How can I manage the side effects of treatment while I work?” They may have some practical solutions that help you meet your job demands while still getting effective care.

Dr. Wells has some additional advice for balancing work and treatment. “Easy does it,” she says. Though you have responsibilities to fulfill, it’s important to be realistic about how much you can handle without putting your health at risk. To do so, Dr. Wells recommends being honest with yourself and your supervisors about your limitations. If your job is a priority, there may be other areas of your life where you can cut back on activity to save energy for work and treatment. And, she says, “Use the social support around you”—accept help from loved ones when offered and ask for assistance when you need it.

Getting Treatment without Missing Work

You might worry that you can get treatment and see your doctor only during normal weekday business hours, which may conflict with your work schedule. You may, however, have more options and flexibility in your treatment schedule than you realize.

The weekend clinics available at all CTCA sites are one way that patients can keep up with their treatment schedule without missing work. Harry Buchman, assistant vice president of new patient experience at CTCA in Philadelphia, says that the weekend clinics exist to help patients get treatment without disrupting their regular schedules. “How do we inconvenience patients the least amount possible?” he explains of the goal of the weekend clinics. To that end, Harry says that CTCA also provides some services after business hours during the week, such as an evening infusion clinic.

Many of the same services that are available during the week are also available at CTCA weekend clinics, Harry says. Medical oncologists are on duty, and most imaging services are offered.

Harry explains that weekend clinics and flexible hours can allow patients to work full-time and maintain their regular income. These care options can also help patients maintain a sense of identity by allowing them to stay engaged with their careers and activities. The flexibility, he says, gives patients control and choice so that their care doesn’t take over their normal lives.

Know that You Can Do It

There’s no doubt that a cancer diagnosis makes big demands on an already-full work and personal life, but with the right support and approach you can keep your job and get the treatment you need to get healthy.

 

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