Earning a Living

What You Can Expect
Cancer Survivors as Employees
Tips for Dealing with Coworkers
Your Protection Under Law
Tips for Changing Jobs After Cancer Treatment
Options for Handling Job Problems
Resources

What You Can Expect

Many cancer survivors wonder whether having a cancer history will make a difference in their job prospects. Common questions include: Will I be able to return to work? Take time off for more treatment if I need it? Work as hard as I once did? Advance in my career?

There is no one answer to these questions. Some people choose not to go back to their jobs while others are not physically able to return. But most work-able cancer survivors do return to work. Sometimes it takes a year or more before survivors are ready to return full-time, but once they go back, they almost always are back to stay. Cancer survivors have included professional and Olympic athletes, business executives, artists and musicians, film stars, and world leaders.

When cancer survivors return to work, some have highly supportive employers who help ease the change from patient back to employee. Others get back to the routine without much help from their company or organization. And at some workplaces, wrong ideas and false fears about cancer cause job-related problems that survivors must overcome.

The following stories reflect the workplace experiences of cancer survivors.

"After I had my colostomy, my employer asked me to quit my job because the cancer was upsetting my fellow workers. He said a demotion or transfer was possible if I didn't agree. Except for my wife, that job was my whole world. So rather than quit, I decided to fight for it. "-Jon H.

"My employer denies that my treatment last year for cancer had anything to do with my not getting a promotion and raise. My boss said I was being defensive when I suggested that I was being discriminated against because of my illness. He said he just didn't feel I was ready for the responsibility at this time. I don't know what to believe, but I'm looking into my options."-Betty C.

"When I went back to work, my boss was honest with me. She said that my situation had been discussed at a managers' meeting. Some people had questioned what impact my coming back would have on the company's insurance rates. Her boss asked how she planned to get the job done with an employee she could no longer count on to stay healthy. Fortunately she did some research and found out that the turnover rate, absenteeism records, and work performance of people with a cancer history are very much the same as unaffected workers. Her facts helped correct management's wrong ideas."-Roy P.

"I wasn't happy with my job before my cancer was diagnosed, and I'm no happier with it now that I'm finished treatment and back to work. At first I was just grateful that they took me back. I stopped job-hunting for fear that my cancer history would lock me out of better chances. But a friend convinced me that I shouldn't give up before I started. I haven't found the job I want yet, but I have found employers who've given me fair consideration."-Jean D.

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Cancer Survivors as Employees

• 80% of people with cancer return to work after diagnosis.
• Research shows that cancer survivors are as productive on the job as other workers and that they aren't absent from work any more often.
• About 1 in 4 cancer survivors experience some form of employment discrimination.

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Tips for Dealing with Coworkers After Cancer Treatment

When your coworkers hear about your illness, many of them will want to help, but they won't know how. Others may be frightened by your situation, especially when they don't know much about cancer and today's potential for treatment and cure. Here are some ideas for helping them -- and you -- to resume a good working relationship.

• Plan how you will deal publicly with your cancer when you are back on the job.

There is no "right" way to interact with others about your illness. Once they are back at work, some cancer survivors don't want to focus on their cancer or to be associated with the disease in people's minds. Others are very open with coworkers about their experiences. They may have a frank discussion with their manager or close coworkers to air concerns, correct wrong ideas, and decide how to work together. The best approach is the one that feels comfortable for you.

• Keep up contacts during your treatment and recovery.

Your coworkers will be concerned about you. If they have information about your treatment and progress, they will be less anxious and frightened.

It is also important to stay "connected" to the people with whom you work. Talk by phone. When you are able, have lunch with friends or stop in for an office party. Plan to rest before and after if necessary. Your return to work will be easier for you and your coworkers if you have stayed involved.

• Ask your employer to educate company employees about cancer.

Research has found that people believe three major myths about cancer that sometimes affect their attitudes towards cancer survivors:

Myth #1-Cancer is a death sentence.
Myth #2-Cancer is contagious.
Myth #3-Cancer makes workers less productive.

When coworkers learn the facts about cancer, they realize that these myths are untrue. Open discussion calms concerns and resolves fears. You may want to invite a speaker to discuss the issues such as an expert from a local cancer support organization, or a doctor, nurse, or social worker who specializes in cancer.

Your company medical department, personnel office, union, or employee assistance program are possible sponsors for an educational program. Information efforts might include making written materials available, holding a brown bag lunch discussion, or correcting wrong ideas at staff or union meetings.

• Join (or form) a workplace support group for cancer survivors.

Such groups may include only cancer survivors or both people with and without cancer. Depending on what members want, support groups can be anonymous or open. They can provide mutual emotional support for members, or they can make active efforts to stand up for the rights of cancer survivors.

• Consider talking to other coworkers who learn they have cancer.

Share your experiences and insights. Let people who have just found out they have cancer know that they are not alone. Offer to do something for them that you wish someone had done for you.

• Get help if you need it.

If coworkers' attitudes about cancer are making it hard to do your job, your first step may be trying to resolve the situation informally with the people involved. Correcting others' wrong ideas, without being defensive, can be difficult. But a direct approach may help things change for the better.

When your own efforts don't work, you may want to get help. Your manager, shop steward, employee assistance counselor, or personnel office may be able to change coworkers' ideas, procedures, or the way your job fits in with others' to lessen problems. It is a good idea to have a workable solution to suggest when you raise a problem.

Most survivors understandably hesitate to "rock the boat," calling company attention to personal problems. When hurtful remarks or actions get you down, talking to a friend or counselor may help you put things in perspective. When coworker attitudes get in the way of doing your job, however, it becomes an issue that management needs to address.

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Your Protection Under Law

On July 26, 1992, the employment provisions of the Americans with Disabilities Act (ADA) went into effect. The ADA bans discrimination by both private and public employers against qualified workers who have disabilities or histories of disability. While the ADA does not specifically include cancer survivors, it is expected that survivors will be included based on past legal rulings.

For two years, the ADA will cover private employers with 25 or more workers. Thereafter, it will cover employers with 15 or more workers. Under this law, employers:

• Cannot require you to take pre-employment exams designed to screen out people with disabilities such as histories of cancer.
• Can ask you medical questions only after you are offered employment and only if the questions relate specifically to the job.
• Complaints filed under this law are handled by the field offices of the Equal Employment Opportunities Commission (EEOC). These offices can be located by calling 1-800-669-4000.

Other protection will continue to be provided by the Federal Rehabilitation Act of 1973, which states that federal employers or companies receiving federal funds cannot discriminate against handicapped workers, including cancer survivors. This law protects cancer survivors in hiring practices, promotions, transfers, and layoffs at the federal level.

In addition to federal protection, you may be eligible for employment protection under state laws. To learn more about your legal rights, check with:

• Your local American Cancer Society office. They have state-specific information pamphlets about cancer and employment discrimination.
• Your social worker, who may know about laws in your state. He or she also can tell you which state agency is responsible for protecting your rights.
• The National Coalition for Cancer Survivorship. This group offers information and some legal referrals.
• Your Congressional representative or senator. Staff working for these officials can give you information about federal and state laws. If you aren't sure who represents your district, call the library or local chapter of the League of Women Voters.

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Tips for Changing Jobs After Cancer Treatment

When you look for a new job after cancer treatment, it is important to anticipate the concerns that your cancer history may raise. Here are some ideas to help you prepare for the job search.

• Don't discriminate against yourself. First, take an honest look at your current skills and capabilities. Then, apply for jobs you know you can do. Don't try to do more -- or settle for less -- than you are able to handle.
• Organize your resume to your best advantage. For example, a chronological resume may raise questions if cancer treatment or recovery interrupted your career. To avoid pointing out those gaps, you might organize your resume by skills or achievements instead of by dates of employment.
• Get a letter from your doctor (on office or hospital stationery) that explains your health situation for employers. Have the doctor talk specifically about your physical ability to perform the type of work you are seeking. If you are in good health now, ask the doctor to verify your good health in the letter. The doctor also may include statements about the documented work ability of cancer survivors nationwide.
• Don't lie about your cancer history if an employer or an application asks you directly.
• Always qualify your "yes" with positive statements about your current health (including the doctor's letter noted above).
• Don't volunteer health information if no one asks. You have no legal responsibility to mention your cancer unless it directly relates to the job you seek.
• Practice answering possible questions about your health history before an interview. Be confident and avoid sounding defensive.
• Consider working with a job counselor who can help you prepare fully for your job search.

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Options for Handling Job Problems

Decide what you want to do about an employment problem.

• Do you still want to work there?
• Are you willing to take action to correct a problem?
• Would you rather try to find a different job?

Educate your employer.

• Give management the facts about cancer survivors' dependability on the job.
• Have your doctor explain how, if at all, your personal cancer history may affect your work or your schedule.

Ask your employer to adjust to your needs.

• Start by talking informally to your supervisor, the personnel office, employee assistance program, shop steward, or union representative.
• Ask for a specific change that would make it easier for you to keep your job (e.g., flextime, working at home, special equipment at the office).
• Document your requests and the outcome for your records.

The Federal Government and many private companies are now required to make "reasonable accommodations" to meet the needs of "disabled" employees if this does not cause the employer "undue hardship." Although cancer survivors may not feel "disabled," they may be legally protected under this umbrella term.

Simple changes employers are required to make include:

• Making facilities accessible (e.g., having desks, aisles, and restrooms that accommodate a wheelchair).
• Allowing an employee to work a flexible schedule to adjust for treatment-related absences.
• Changing the way a job works (e.g., letting an employee work part-time or share a job).

The Job Accommodation Network can help you and your employer find out about accommodations that have worked for other companies. This hotline is a project of the President's Committee on the Employment of People with Disabilities. Call 1-800-526-7234 for more information.

Get help working with your employer if you need it.

• People that can support you include: your doctor or nurse; medical social workers, state rehabilitation workers; staff and volunteers at your local American Cancer Society; advocacy groups for disabled workers; your family and friends.

Talk about your legal rights with the agencies that enforce anti-discrimination laws.

• State commissions on discrimination
• State affirmative action offices
• U.S. Department of Health and Human Services, Office for Civil Rights in your region
• U.S. Department of Labor, Office of Federal Contract Compliance programs in your region

A medical social worker or your local American Cancer Society can help you find out whom to contact.

Talk to an attorney with experience in solving on-the-job discrimination problems.

• Talk to your local bar association or cancer support organization to find a qualified lawyer.
• The National Coalition for Cancer Survivorship offers limited referrals to attorneys with expertise in this area (see "Resources").
• Discuss any formal procedures your company may have for settling disputes.
• Consider filing a discrimination complaint under state or federal law.

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Resources

Information about cancer is available from the sources listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.

Cancer: Your Job, Insurance, and the Law American Cancer Society.
Answers job and insurance-related questions often asked by cancer survivors. Booklet is free. Call 1-800-ACS-2345.

Charting the Journey: An Almanac of Practical Resources for Cancer Survivors National Coalition for Cancer Survivorship (NCCS) Guides cancer survivors to resources for legal concerns, medical treatment, emotional support, self-help, and family issues. Call 301-650-8868. For NCCS members, cost is $12.00; nonmembers can order from Consumer Reports Books, 9180 Le Saint Drive, Fairfield, OH 45014, cost is $14.95.

National Rehabilitation Information Center (NARIC)
8455 Colesville Road, Suite 935
Silver Spring, MD 20910
(800) 34-NARIC(voice/TDD)

The National Rehabilitation Information Center provides information regarding job rehabilitation.

National Coalition for Cancer Survivorship (NCCS)
1010 Wayne Avenue, 5th Floor
Silver Spring, MD 20910
(301) 650-8868

The National Coalition for Cancer Survivorship is a network of independent groups and individuals concerned with survivorship and support of cancer survivors and their loved ones. NCCS's primary goal is to promote a national awareness of issues affecting cancer survivors. Its objectives are to:

• Serve as a clearinghouse for information on services and materials for survivors.
• Advocate the rights and interests of cancer survivors.
• Encourage the study of survivorship.
• Promote the development of cancer support activities.

Cancer Information Service
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients and their families and friends, the public, and health care professionals. The staff can answer questions (in English or Spanish) and send free National Cancer Institute booklets about cancer. They also know about local resources and services. One toll-free number 1-800-4-CANCER (1-800-422-6237), connects callers all over the country with the office that serves their area.

American Cancer Society (ACS)
The American Cancer Society is a voluntary organization with a national office and local units all over the country. This organization supports research, conducts educational programs, and offers many services to patients and their families. The American Cancer Society also provides free booklets on cancer. To obtain booklets, or for information about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800 227-2345), or the number listed under American Cancer Society in the white pages of the telephone book.

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Reprinted from CancerNet, a service of the National Cancer Institute.

Reviewed by Charlotte E. Grayson, MD, August 2002.