How do lifestyle factors and exposure to environmental substances affect our cancer risk?
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
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
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
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
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
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
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