Advanced Breast Cancer and Your Job

Balancing your breast cancer treatment with your job can be tricky business. You can expect to need more time off and some adjustments to your routine, given your treatment and everything you’re dealing with. Still, you may find work to be rewarding in more ways than one.

“I worked through most of my treatment because it made me feel stronger,” says Bershan Shaw of New York. “I went at it with a warrior mentality. I liked seeing my co-workers most days and keeping part of my life normal.” 

Should you tell your employer? Will you keep your job routine the same? Ask for adjustments to make time for your treatments and how you feel? Look into short-term disability?

It depends on what’s best for you. To make those choices, you’ll want to know what to consider first.

Before You Tell Your Boss

The first two things to consider are how private or open you want to be, and what you need from your workplace to get through this time.

“I am pretty much an open book kind of person. I told my supervisors soon after each time I was diagnosed,” says Debbie McCarron of Huntington Beach, CA. She was treated for stage I breast cancer in 2001, stage III in 2009, and stage I again in 2015. McCarron was an executive vice president at a mortgage company, and she now works as a mortgage underwriter.

“It’s going to depend so intensely on the individual person, their preferences and personality, their workplace and concerns around their workplace, how they feel about privacy, and what kind of job they have,” says Rebecca Nellis, chief mission officer at the nonprofit Cancer and Careers. “We encourage people to do a lot of fact-finding and a lot of internal thinking before they disclose.”

If you work at a small company or on a team where people share a great deal of their lives, your answer might be different from someone in a more impersonal workplace who prefers to keep her private life private.

“When I was diagnosed with stage I breast cancer in 2007, I didn’t tell a soul. When I was diagnosed with stage IV in 2009, I knew not to make the same mistake,” Shaw says. At the time, she owned a restaurant and decided to open up to her entire team about her breast cancer.  “They kept me from overworking. They would say, ‘Go home early, Bershan. You need some rest.’ ”

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Telling your workplace also isn’t an all-or-nothing proposition. You get to decide whom you tell, when, and how much.

You could only tell your immediate manager, or only your HR department.

“It was important for me to keep doing normal activities, like working,” Shaw says. “I wanted to show other people around me that there isn't one 'right' way to have cancer.”

“No matter what, you’re going to have more doctor’s appointments than the rest of the workforce not facing a life-threatening illness,” says Jean Sachs, CEO of Living Beyond Breast Cancer. “What we have found is that most women do need to go to HR or whomever their supervisor is and let them know that at the very least, they’re going to probably need more time off.”

Finding Balance

You’ll also want to think about what your treatment involves and your type of work. For instance, if you work a flexible schedule, you might feel like you could continue with your tasks. Or, if you have the option, you might choose to pause your career.

“When you’re diagnosed with advanced-stage breast cancer, you realize you now have a different life,” Shaw says. “That can be scary at first, but it can be eye-opening, too.” After treatment and learning that she was cancer-free, Shaw realized she wanted better work hours and an opportunity to help others more directly.  In 2011, she closed her restaurant. Today, she’s a speaker and coach and often works with women who have stage III or IV breast cancer.

Many people need, or want, to keep working while they get treatment, with some adjustments. In general, the law requires an employer to make “reasonable accommodations” for someone facing an illness like cancer. And that term has some wiggle room.

“It could be working from home the days you have treatment, or having a longer break for lunch,” Sachs says. “Part of it is figuring out what’s reasonable for the employee and for the workplace. Sometimes what is needed goes beyond what is reasonable, and that’s something you really want good, open communication about.”

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“During my second round of treatment, I went to a support group during my lunch hour once a week. The group ran a little longer than my break, but I told my employer that it was important for me,” McCarron says. Her employer told her to take the time she needed.

It’s wise to read up on what’s available to you legally, both under the Americans with Disabilities Act (ADA) and in your state. Keep in mind that the ADA law applies only to private employers with 15 or more workers, and state and local government employers. But there may be state laws that apply to smaller companies -- TriageCancer.org has a listing of resources by state.

Also, you should know that an “accommodation” can include simple, practical things. For instance, if your job requires you to walk up a flight of stairs several times a day to get to a printer, you could ask that a printer be placed closer to your desk.

Even if those laws don’t apply in your situation, you could still ask. “We hear from people who aren’t covered by the ADA or state law, and it’s a harder road, but it doesn’t mean an employer isn’t willing to do something simple,” Nellis says.

Know Your Benefits

Just as you should read up on what the law offers in terms of work accommodations, it’s also smart to look into your health and disability benefits to make sure you understand your plan.

Your health insurer can answer questions about your coverage and any deductibles you may have to pay. If you’re insured through a plan you bought through the Affordable Care Act, keep up your premium payments to make sure your coverage continues.

If your company has a short-term disability policy, which covers some portion of what you would make if you were on the job, make sure you know how it works:

  • How many weeks it covers
  • How much pay it covers
  • Whether there’s a waiting period before benefits kick in

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When you’re out on disability leave, whether it’s short-term through an employer or long-term on a private plan or through the government, your job isn’t guaranteed. “Unless the company has a policy in place that says they will hold your job for X amount of time, being out on disability leave is not about job protection,” Nellis says. “It’s about income replacement.”

The bottom line: Your experience and your decisions will be unique to you.  And the circumstances can change over time. “Radiation, especially, takes a lot of energy out of you, especially after the first week or two. Toward the end of treatment, there were days where I shut the door to my office, put my head down, and rested for 15 minutes,” McCarron says.

“I know many women who keep up a completely full work life,” Sachs says. “I know others who just can’t. They’re too fatigued, or the treatment is too difficult psychologically. And they just have to say, ‘I need to go on short-term disability or change careers or work part-time.’ They really need to figure out where they are in that continuum.” Once you know what you need, chances are that you can find a way to ask for it that your job can support.

WebMD Feature Reviewed by Laura J. Martin, MD on December 01, 2018

Sources

SOURCES:

American Cancer Society: “Americans with Disabilities Act: Information for People Facing Cancer.”

U.S. Equal Employment Opportunity Commission: “Questions & Answers about Cancer in the Workplace and the Americans with Disabilities Act (ADA).”

Rebecca Nellis, chief mission officer, Cancer and Careers.

Jean Sachs, CEO, Living Beyond Breast Cancer.

Triage Cancer: “United States Resources.”

Bershan Shaw, NY.

Debbie McCarron, Huntington Beach, CA.

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