Cancer workplace FAQs

A cancer diagnosis doesn’t mean that your work life comes to a halt, but it will require some adjustments. From the ins and outs of managing side effects to the secrets of traveling with cancer, these tips will help you work through treatment. Taking time away from the office? We’ve got information on working from home, returning to work, and rethinking career goals and priorities.

Ask Us Anything…
Question: I’ve just learned that I have lymphoma. I will need several months of chemotherapy. My doctor says my prognosis is excellent and that I can continue to work, even during treatment. Would it be better if I take time off from work and concentrate on getting well? Answers: Dr. Ruth …

ADVICE FROM WOMEN WHO KNOW
Well-earned tips and suggestions from our readers’ personal experiences with cancer.

HANDLING DISCRIMINATION AT WORK
If you are working and feel you have encountered discrimination, there are steps you can take prior to legal action.

JOB HUNTING AFTER CANCER TREATMENT
When your cancer treatment is finished, and you’re eager to get back to work, you can begin to feel anxious and alone. That’s especially true if you have left your former job and you’re looking for a new one.

KEEPING OPEN COMMUNICATIONS
Regular communication will help prevent your co-workers and supervisors from questioning your value and productivity as a staff member. Everyone will need reassurance that you’re still part of the team. A lack of communication can result in confusion and anxiety – or even mistrust and suspicion – …

RE-ENTERING THE WORKFORCE
If you are reentering the work force after an absence due to cancer, you will need some tips on how to avoid discrimination.

RETURNING TO WORK
After your medical leave is over, gear up for the next challenge: making your re-entry to your job as comfortable as possible. For cancer survivors, returning to work often brings mixed emotions: relief, trepidation, hope — and perhaps awkwardness. Even if you are sure you’re ready to return, you …

SELF-EMPLOYED, WITH CANCER
Being self-employed is itself a feat, as any of the more than 14 million Americans who are their own bosses can attest. Add to the mix a diagnosis of cancer, and the days can seem suddenly overwhelming. If you’ve just gotten a diagnosis of cancer, and you’re self-employed, here is a game plan for …

TAKING TIME OFF
At this point, everyone at work who needs to know about your cancer diagnosis probably does. Now you need a game plan for taking time off successfully. Here are some points to consider, depending on how much time you have before starting treatment: Look at the Workload Consider the workload. …

TRAVELING WITH CANCER
Throughout your experience with cancer you will have reason to travel, perhaps for treatment itself, and probably for work and pleasure too. The good news is that many cancer patients are able to travel comfortably and safely as long as they take proper precautions and use common sense. Here are …

WHAT’S NEXT: BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?
Once your cancer treatment is complete or nearing completion and you’ve been cleared to return to work, at least part-time, more challenges await. Here, what you need to know about how your cancer history may affect you on the job and how to take full advantage of the protections afforded you under…

WORK AND YOUR DIAGNOSIS AND TREATMENT
Before you approach colleagues, talk to your doctor specifically about how your illness can affect your career. Here are a few helpful tips to smooth the process: Tell your doctor exactly what your job is and any unique circumstances you’ll be coping with. Let your doctor know that it’s …

WORKING THROUGH TREATMENT
If you plan to continue working while undergoing treatment, you can make the process easier for yourself – as well as your employer and co-workers – through planning, preparation and communication. Systemic chemotherapy for cancer treatment has always been associated with intravenous (IV) delivery. …

Working with Chemo Brain
How to cope when “chemo brain” slows you down at work

Talking to your employer about your cancer

Talking to your employer about your cancer

Many people worry about telling their employer that they have been diagnosed with cancer and need to have treatment.

You may worry that your employer may not support you and that they may be prejudiced or discriminate against you. Some people worry that their employer will sack them or find an excuse to make them redundant if they say that they have cancer. However, employers should not do this and research has shown that it very rarely happens.

Anyone who has cancer is protected by the Disability Discrimination Act, which prevents employers victimising or discriminating against people with a disability. The Act also states that employers are expected to make reasonable adjustments to support employees in the workplace. You may want to make suggestions for adjustments that could help to support you.

To consider any reasonable adjustments, an employer may ask for your permission to write to your doctor or a medical professional to get their advice on steps that need to be taken. Your employer cannot do this without your permission. You also have the right to see any medical report before it is sent to your employer.

If your employer knows that you have cancer they can help you by providing support and giving you information about your rights. They can also make sure that you have time off if you need it and that you get all the financial help and benefits you are entitled to. You can talk directly to your employer, or to your human resources manager or occupational health department.

Although it is helpful to tell your employer that you have cancer, you do not have to do so by law. However, if you do not tell your employer that you have cancer, and the cancer and its treatment affects your ability to do your job, this could cause problems. In extreme cases, it may lead to disciplinary action being taken against you. Also, if your employer does not know about your cancer and its effects they will probably not be required by law to make any necessary adjustments for you at work.

If carrying on as normal is important for you, you should say this to your employer so that they can support you in continuing with your work. However, if you cannot go on working normally, due to the cancer or its treatment, then let your employer know. This will mean that arrangements can be made to alter your work or give you time off if necessary.

Looking for work

If you are looking for a new job, you may wonder whether you have to tell prospective employers that you have or have had cancer. Employment law does not prevent an employer from asking you for information about a disability. However, this information should not be asked for unless it is needed to enable a recruitment decision or for a related purpose, such as equal opportunities monitoring. Disability-related questions must not be used to discriminate against a disabled person and an employer should only ask such questions if they are, or may be, relevant to the person’s ability to do the job.

During the recruitment process, if you are asked directly whether you have a health condition, legally you should say that you have (or have had) cancer. Even if it won’t affect your ability to do the job, you still have to tell a potential employer.

It is important that you do not lie to an employer or potential employer. If you give false or incomplete information and it is found out at a later stage, your employer could reasonably assume you were hiding the information. This can lead to a breakdown in trust and confidence between you. On that basis the employer could potentially fairly dismiss you.

Many people with cancer do not consider themselves to be disabled and if asked in general terms whether they consider themselves disabled will say no. However, if you are asked if you are disabled for the purposes of the Disability Discrimination Act you should say yes. This is because everyone with cancer is covered by the Act and the term disabled has a specific meaning under that Act.

If you are asked how much sick leave you have taken, you should give an honest answer, but you do not have to say it was due to the cancer, unless you are asked directly.

Many people understandably worry that telling an employer about the cancer may put them at a disadvantage during the recruitment process. If the process allows you when to tell them about your health, it may be best to wait to discuss it until a decision about the applicants has been made. This may reduce the risk that it could affect your chances of getting the job.

BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?

BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?

Once your cancer treatment is complete or nearing completion and you’ve been cleared to return to work, at least part-time, more challenges await. Here, what you need to know about how your cancer history may affect you on the job and how to take full advantage of the protections afforded you under the law. Our panel of experts: Page Tolbert, a social worker at the Memorial Sloan Kettering Cancer Center’s Post-Treatment Resource Program, New York; Randye Retkin, an attorney and the director of LegalHealth, part of New York’s Legal Assistance Group; Kimberly Calder, manager of Health Insurance Initiatives for the National Multiple Sclerosis Society; Barbara Hoffman, an attorney and the founding chair of the National Coalition for Cancer Survivorship.

Easing back into the routine
After you return to work, you will probably need to take time off for follow-up visits and checkups, or maybe for remaining chemotherapy sessions. Be aware that you’re entitled to the benefits of the Family and Medical Leave Act (FMLA) if you work for a company with 50 or more employers. Under that law, you can take the leave in small increments, even as little as one-hour blocks of time. It’s explained in more detail at http://www.dol.gov/esa/whd/fmla. If you work for a company with fewer than 50 employees, you might still be covered for medical leave under a state law. Check with your HR department, or your state labor department.

Your cancer history and your insurance
If you were employed and had health insurance before the diagnosis of cancer, took approved time off, and are back to work, there will be no effect on your group health insurance at all, experts say. If you are covered by a group plan, you can’t be singled out for your cancer history. Your premiums can’t go up higher than others’ premiums, and you can’t be dropped from the group plan due to the cancer. The federal law known as HIPAA (Health Insurance Portability and Accountability Act of 1996) protects the rights of people in group health plans. See the details at the government website, http://www.hhs.gov/ocr/hipaa/

Are you being treated fairly?
Legally, your cancer history can’t be used against you in the workplace. But it can be difficult to determine if your cancer history is being used unfairly, because discrimination can be subtle. Some hints: If someone clearly less qualified is promoted, you should suspect the cancer history. If you hear disparaging comments, you are being treated unfairly. One woman (who filed a lawsuit) told of the day the office staff had to exit the building during a blackout and her boss said others should just follow her, since her radiation therapy made her glow. If tasks you used to do competently are being given to someone else, that might be a clue your supervisor thinks you’re not as capable. If your assignments or projects are not as challenging or time consuming as they were before your cancer treatment, that might be a clue. But the evidence is very “fact-specific” for each workplace situation. Fortunately, most employers are savvy enough to know they have to watch their step when dealing with employees or potential employees with health problems. And as more employers experience cancer and other serious health problems in loved ones, many are growing more compassionate towards employees with a cancer history. Conditions may be improving, in a study published in 2004 in the Journal of the National Cancer Institute, researchers surveyed more than 1500 women, including 646 breast cancer survivors, and found “little evidence” that survivors faced discrimination at work due to their cancer history.

What to do if you suspect discrimination
First, discuss the situation with your boss, if you can. He or she might be trying to lighten your load and have the best of intentions. Decide first if that is the case. You might simply ask, in a cordial tone: “Are you trying to make it easier on me? I appreciate that, but I’d welcome the challenge of travel to meetings again.” If your talk with your supervisor doesn’t solve the problem, go next to your HR department and discuss the situation. If you can negotiate and solve the situation informally, that’s better and cheaper than getting a lawyer. Your HR person may have a talk with your boss and resolve the situation quickly. If you do need to take legal action, first sit down and focus on what your goals are–Back pay? To get back your former assignments or clients? Promotion? To stay at the company or not? With those in mind, you can proceed with a clearer head. And your efforts will be more focused.

Moving to another company
Perhaps you’re unhappy enough to look for another job, you’ve decided to go after your “dream job” or you just have an opportunity for an interview with another company. Going on a job interview is always challenging, but if you have a cancer history it might be more so. If you decide to look around for a new job, experts recommend squashing that natural urge some cancer survivors have to talk about it, at least right away, with a potential new employer. Also, you should know that your potential new employer does not have the right to ask about your medical history. The employer only has a right to know if you are qualified to do the job. Legally, potential employers are not supposed to ask about your health, but if they do, answer as of that day. And if you’re well enough to be at a job interview, your health could definitely be described as good. Further into discussions, you may need to tell a potential new employer that you will need an accommodation, if that is the case. But that discussion can wait even until after you get the job offer Nail the job first, experts suggest. Then, if you will need, say, an afternoon off every three months for follow-up care, mention it then, before you accept the position.

Presenting yourself well
You can put a positive spin on things, as all job hunters try to do. One woman, after her cancer treatment, stayed off the job awhile but helped her church computerize their office. Her counselor asked if someone there might vouch for her work, and say that she had been a consultant for them. And that worked out fine. Keep the focus on your present ability to work. Legally, that is all a potential employer has a right to know. During the job interview, keep the focus on yourself as a job applicant, and the best one they will interview, not on yourself as a cancer survivor. Not telling may be hard for some cancer survivors, who often feel they have a “guilty secret.” Experts advise you to get over that apologetic, confessional feeling. Of course, there are always exceptions to these guidelines. Some bold cancer survivors have gone to a job interview and said, “Hey, I made it through cancer.” Their upbeat attitude is, If I can handle cancer, I can handle this job and all its challenges. Experts say it takes a certain type of person to pull this off but that you know who you are.

Handling the paperwork and ticklish questions
While you don’t have to share your cancer history, you can’t lie about a gap on your resume. While potential employers legally can’t ask, “Did you have cancer?” they can ask “What about this gap in your resume?” Still, you can be discrete but truthful. Something like: “I had family issues that are now resolved” Or “I had medical issues that are now resolved” is truthful and provides enough information.

Insurance if you switch jobs
Even if you leave one group health insurance plan, you have protection in transitioning to another group plan. Another law called COBRA (Consolidated Omnibus Budget Reconciliation Act, passed in 1986) provides continuation of group health coverage that might otherwise be terminated. It offers the right to temporary continuation of health coverage under certain conditions. For questions and answers, visit the U.S. Department of Labor page that addresses COBRA at http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html. If you decide to switch jobs, plan for your health insurance transition. Inquire first about COBRA. Understand when it starts and ends, how much it will cost you (typically expensive since you will be paying both employee and employer portions), and if you have dependents whether they too are covered. Trying to get health insurance on an individual basis can be more difficult if you have a cancer history, especially if your treatment has occurred in the past five years. While it may be tempting to omit the cancer on an application for insurance, do not. That is fraud, not worth the risk, and dishonest. Ask your HR person or insurance representative about preexisting conditions under the group health plan and how they are handled. Under HIPAA, limits have been set for excluding pre-existing conditions, the period during which a specific medical problem may not be covered.

Setting the tone
If you can set the tone as a relaxed, confident cancer survivor, chances are those around you may be less uptight, too. If you can see your return to work as a major step forward in your recovery, that will affect your attitude in the most positive way, too.

This Month’s Topic: Cancer in the Workplace

This Month’s Topic: Cancer in the Workplace

Featured Expert: Carolyn Messner, DSW, MSW, LCSW-R, ACSW, BCD

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November 2006 This Month’s Topic: How to Find Reliable Resources Submit Your Questions on this Month’s Topic Featured Expert: Jacqueline Zahora, CancerCare’s Program Director for Online Clinical Resources

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Q. A number of employees in our workplace have cancer. As the personnel director, I would like to organize educational programs to help all our employees learn more about cancer. How should I go about doing this?

A. Many Human Resource Departments are proactive in helping their employees cope with cancer in the workplace. They demonstrate compassion by developing educational programs to help employees with their concerns and to maintain a productive workplace.

Companies address cancer in the workplace with education and information. Some employers offer annual company-wide health fairs. Smaller companies may not be able to offer a broad-based health fair for their employees, but they might be able to work with their benefits provider to host smaller events and workshops during the year.

Another way to provide low-cost employee education is to partner with community outreach programs, cancer centers and nonprofit organizations that can provide educational materials and lunchtime seminars.

Examples of “lunch and learn” workshop topics include Cancer Treatment Updates, Early Detection of Cancer, Communicating with Your Doctor, Coping with a Co-worker’s Cancer, and Review of Employer Sponsored Health Plans, just to name a few.

CancerCare offers many resources that can assist Human Resource Departments to develop educational programs and services for their employees, including:

• A directory of resources for a comprehensive overview of all the services that CancerCare offers.
• Our Inform^® fact sheets on prevention and early detection to distribute at workplace seminars and health fairs.
• CancerCare’s staff of oncology social workers, who are available to assist you and your employees with cancer-related concerns.

Contact us at 1-800-813-HOPE (4673) to learn more about how we can help.

Q. My co-worker has told me she has cancer. We used to have lunch together and she would always listen to my problems. Now I don’t know what to talk about.

A. Many people are not sure what to say when their co-worker is diagnosed and treated for cancer. Our work relationships and friendships are an integral part of the fabric of our work lives. Many of us spend more waking hours at work than at home. Many families are scattered geographically and so for some people, the workplace is “family.” The extent of your involvement depends upon the nature of your relationship prior to the cancer diagnosis. Here are some suggestions that may help you communicate with your co-worker:

• Ask your co-worker with cancer if she wants to talk about her cancer diagnosis and treatment
• Be willing to listen
• Ask how you can help
• Tell her that you care about how she is feeling
• Keep your conversations confidential
• Try to maintain a normal office relationship with her
• Send a card, telephone her outside of work or pay a visit if she is in the hospital
• Offer to help her find resources

CancerCare also has a number of publications you may find helpful that can be ordered online or downloaded directly from our website:

• Coping with Cancer: Tools to Help You Live
• What Can I Say to a Newly Diagnosed Loved One
• Caring Advice for Caregivers
• Finding Resources in Your Community

You may also want to speak with a CancerCare oncology social worker to discuss your concerns. CancerCare’s free counseling services are available to co-workers of people with cancer.

Q. I am an employer and one of my employees has just been diagnosed with cancer. I want to be helpful but am not sure what I should say or do.

A. The most important things you can do are to listen to the employee who discloses his or her cancer diagnosis and to offer workplace support.  It is critical to let the employee who is living with cancer know about the ability of your workplace to make accommodations for their needs. The key message you as an employer can offer an employee is your willingness to work with them, if at all possible, to help them continue working as long as their doctor supports their decision to work and they are able to do the job.

The following are some tips that many employers find useful:

• Know the provisions of the Americans with Disabilities Act and Family and Medical Leave Act and make that information available to supervisors and employees.
• Create a workplace culture that allows flextime or other accommodations for cancer patients who can and want to continue working.
• Educate managers to deal sensitively with employees who have cancer so that they do not make assumptions about their ability to perform job duties.
• Teach managers to maintain a dialogue with employees being treated for cancer so that adjustments in workload or work schedules can be anticipated.
• Allow employees to decide if or how they would like coworkers to be informed of their illness and honor requests for confidentiality.
• Work closely with your Human Resource Department regarding employee benefits and resources.

For additional information, listen to CancerCare’s podcast, Creating a Supportive Work Environment.

CancerCare’s Helping Hand Resource Guide is one of many CancerCare publications that can help managers and employees find useful resources. You may also find other CancerCare publications, covering a broad range of cancer-related topics, to be helpful.

CancerCare’s oncology social workers can also assist employees with cancer, their coworkers and managers. Visit CancerCare’s Consult Our Staff to learn more about our free counseling and consultation services available to employers and their employees.

Q. I was just diagnosed with cancer and plan to continue working. Do I have to tell my employer that I have cancer?

A. We see many people who continue to work productively despite their cancer diagnosis. Continuing to work can be vital to your sense of well being. Work is a source of income and, often, health insurance. Each workplace has its own unique culture. Whether or not to tell your employer about your cancer is both a personal and practical decision.

Many myths about cancer exist in our society, including in the workplace.  For instance, employers and coworkers may assume that a person with cancer or their caregivers are not able to perform job responsibilities as well as before cancer. Sometimes, these misconceptions can lead to subtle or blatant discrimination.

It is important for you to become familiar with the laws protecting you before you decide whether or not to disclose your cancer diagnosis.

The Americans with Disability Act (ADA) requires that organizations with 15 or more employees comply with ADA guidelines. These are the criteria to take advantage of ADA protection: meet the ADA definition of “disabled person,” qualify for the job and be able to perform its essential functions, and not pose a risk to your own or others’ health and safety. The ADA recommends that any accommodation that you need does not cause “undue hardship” to your employer.

Flexible work hours to meet treatment schedules and doctors appointments is the most frequent workplace accommodation required by people living with cancer. If you require flextime, it is important to disclose your cancer diagnosis to your supervisor or Human Resources to be protected under the ADA. If no reason is given for frequent requests of flextime, you could risk jeopardizing your job security. For more information, call 800-514-0301 or visit the ADA website.

The Family and Medical Leave Act (FMLA) enables the person with cancer and family members to take unpaid leave of up to 12 weeks within one calendar year. The FMLA applies to organizations with 50 or more employees. The employee must have worked with his or her employer for at least one year, and employers must continue health benefits during the leave. Leave does not have to be taken all at once, but can be taken in blocks of time. To learn more, visit the FMLA website.

The Equal Employment Opportunity Commission (EEOC) is a federal agency that enforces the provisions of the ADA and FMLA and assists citizens who feel they have been discriminated against in the workplace. If you feel you are being treated unfairly, contact the EEOC at 800-669-4000 or visit www.eeoc.gov

CancerCare’s oncology social workers provide practical resources and help with your workplace concerns. Call 800-813-4673 or visit our website. For further information, participate in our free Telephone Education Workshop, Creating a Plan to Continue Working, on June 20.

Dr. Carolyn Messner, DSW, LCSW-R, is director of education and training at CancerCare. Dr. Messner specializes in the psychosocial impact of cancer on patients, caregivers and families; methods to design educational interventions to ameliorate the distress of cancer; and cancer in the workplace. She pioneered the use of teleconference technology to bring information and support to cancer patients, their families, employers and healthcare professionals.

The questions and answers listed above are from the April 2007 Ask CancerCare feature. New Ask CancerCare topics are introduced every month.

If you have additional questions about cancer in the workplace, please contact CancerCare directly for information and guidance. CancerCare provides free professional support services, including counseling, education, financial assistance and practical help. These services are provided by professional oncology social workers. If you have a specific concern or question and would like to speak with an oncology social worker, please contact us at info@cancercare.org or 1-800-813-HOPE (4673).

For questions about medical issues, please visit Cancer.net, the patient information website of the American Society of Clinical Oncology (ASCO).