By Anne Katz, PhD, RN
This Monthly Survivorship Series, written by CKN Survivorship Editor, Anne Katz, is provided by CKN with permission from ONS. We hope this series will become a useful resource that will help to facilitate dialogue between cancer patients, their loved ones and their physicians with a view towards improving the quality of life for cancer survivors.
Some time after treatment, cancer survivors are faced with the need or desire to go back to work. Of the 12 million cancer survivors in the United States today, an estimated 4 million of those are adults who were employed at the time of their diagnosis and return to work after treatment; some may even have worked throughout treatment.
Continuing to work is important for many reasons, including financial need, self-esteem, and social support. Returning to work means that one has gotten through treatment. But many cancer survivors have to work to retain health insurance coverage. On the other hand, a life-altering diagnosis can also prompt a reevaluation of priorities; some people may choose to leave a job they do not enjoy and seek more satisfying employment or take early retirement.
It is not all smooth sailing, however. Discrimination, both subtle and overt, may occur. Employers may assume that someone with cancer is no longer capable of carrying out their work as well as they did before. Cancer survivors have reported being dismissed, passed over for promotion, denied benefits, and experienced hostility in the work place. All of these contravene the 1990 Americans With Disabilities Act (ADA). Because cancer is regarded as a disease that impairs or limits a major life activity, those with the disease are included under this protection. Some courts have identified a weakness in the act: if a person with cancer is well enough to work, then they are not considered disabled. In addition, there is not blanket coverage with this act and whether an employee is covered is decided on a case-by-case basis.
Cancer survivors who return to work may need certain aspects of their job or the workplace modified to enable them to carry out their duties. They may be protected by the ADA, but only if there are more than 15 employees in the workplace. Similarly, they may be protected under the Family and Medical Leave Act (FMLA) that allows for 12 weeks of unpaid leave in a 12 month period, and the employee must be allowed to return to their same or equivalent position after the leave.
Going back to work requires advanced planning and, at minimum, a discussion with the immediate supervisor about any modifications that need to be made. What is to be shared with coworkers about any modification is also a consideration.
Do you talk to your patients about this? Who do you refer them to for help and advice? These are important issues to discuss with our patients — and I’m not sure we do this well at all.
Related: Cancer and Careers