It’s difficult to know what to expect when you’re facing stomach cancer treatment, let alone trying to determine how long you’ll need to be off work, and what things will be like when you get back.
It’s a situation many stomach cancer patients face, and yet there are no hard and fast rules for handling it, said Dr. James Ford in a phone interview with HealthCentral. Ford is a professor of oncology and genetics at Stanford University Medical Center.
For many patients, a job is a necessary part of life for financial reasons, as a way to connect with others, and for the sense of accomplishment working can bring. But it may not be an easy journey, and understanding what to expect can help you be prepared, said Steve Melen in a phone interview with Health Central. Melen lives in Northern California and is a 10-year stomach cancer survivor. Here’s what you should know if you are facing stomach cancer and wondering if you can continue working.
Let your employer know you’re facing stomach cancer
Once you’ve been diagnosed, it’s helpful to let those around you, including your coworkers and employer, know what’s going on. It may be tempting to want to keep this information to yourself, but letting others know what you’re going through will help them better understand the support and accommodations you’re going to need during this time, said Dr. Michael Choti in a phone interview with HealthCentral. Choti is chief of surgery at Banner MD Anderson Cancer Center in Gilbert, Arizona, and an expert in gastrointestinal cancers.
Treatment for stomach cancer usually involves stomach surgery, called a gastrectomy, to remove all or part of the stomach. The surgery usually requires less than a week in the hospital, but most people will need about a month at home to recover and adjust to new eating habits. Often patients will undergo chemotherapy, sometimes coupled with radiation, before the surgery. Some may need to have chemotherapy again following surgery.
It’s likely that you’ll miss work for periods of times while undergoing treatment, or you may not be able to work at all, said Dr. Ford, who was one of the doctors who treated Melen for stomach cancer.
“While on active treatment, there might be some patients who are able to work, but that’s the exception,” Ford said. “There will be interruptions in your schedule for medical treatment. Patients need support from their workplace because they’re going to need flexibility and understanding of the situation.”
When Melen, a financial advisor, was diagnosed with gastric cancer at age 37, he was a fairly new employee at Morgan Stanley (where he still works). He was determined to keep up appearances and maintain his workload.
Melen initially told his work he would miss a week of work while he underwent surgery. But he ended up having severe, life-threatening complications following a complete gastrectomy, as well the removal of his spleen, part of his esophagus, and part of his pancreas. He was in the hospital for a month.
How will stomach cancer treatment affect me?
There is no easy way to answer this question because everyone reacts to treatment differently, Choti said.
The surgery portion of treatment will often leave a patient feeling “beat up, sleepy, and sore” for a while, Choti said. Some patients are able to eat fairly normally within a few months; others find it takes a while for their newly reconfigured digestive system to adjust, and they may always need to eat a modified diet.
Some patients deal with potentially debilitating symptoms such as bile reflux or dumping syndrome.
Bile reflux can occur after a gastrectomy when digestive juices produced by your liver back up into your esophagus, causing severe pain, heartburn, nausea, and vomiting. It’s a different condition than acid reflux, which is caused by acid produced in the stomach.
Dumping syndrome can happen following a partial or total gastrectomy. After eating a meal, food may be “dumped” too quickly into the intestines, causing pain and cramping, often leading to diarrhea, weakness, or dizziness.
Patients who undergo chemotherapy and radiation will likely face some temporary side effects during and after treatment. These can include nausea, vomiting, loss of appetite, diarrhea, and fatigue.
When can I expect to go back to work?
Deciding when to resume work depends on you — how fast your body recovers, what kind of job you have, and if your employer is willing and able to allow some modifications to your schedule, at least at first. “I tell my patients to go back to work slowly. It may be that by noon, you’re asleep at your desk after a four-hour work day,” Choti said.
For those with more intensive or physical jobs, or jobs that don’t allow for a lot of flexibility, it may take longer to go back to work. For instance, a long-haul truck driver needs to have the stamina to stay awake and focused during long drives. Someone who stocks shelves will need to have the physical endurance to move and place products around a store. It may take some people a little longer to resume work, Choti said.
But even those who seem to have light physical duties may find they struggle with low energy and aren’t able to jump back into their normal routine.
Melen said he was anxious to get back to work soon after completing treatment, even as his doctor cautioned him to not to push himself too quickly. After he went back to work, he soon discovered even simple tasks left him exhausted.
“Even just walking from my car to my desk was really hard,” Melen said. “I went in there to try and show a presence at work, but I was not looking good.”
In the end, he needed a little more time to regain his strength. Once he had gained more weight, he was able to function better.
What restrictions will I face?
There aren’t a lot of hard-and-fast restrictions on what you can or can’t do following stomach cancer treatment,
Choti said. It mostly comes down to your comfort level and what you can tolerate.
Choti tell his patients to do no heavy lifting for about two months following surgery, which may delay resuming work for those whose job requires substantial physical activity.
Patients who undergo surgery may need to meet with a nutritionist to learn more about how and what to eat. They also will need to learn to “graze” throughout the day, eating five or six small meals and snacks. Those who work jobs where you can only eat at set times could face difficulties going back to work right away, Choti said.
But for the most part, if a person is feeling up for returning to work, there’s no reason they can’t.
It’s even possible for patients to work while they have a feeding tube, Choti said. This is a small tube which is usually taped to the patient’s abdomen and inserted into the small intestine, which allows liquid nutrition to be introduced directly into the gut. Some surgeons place a feeding tube during a total gastrectomy as a precaution to help patients maintain their weight and nutrition levels, but not all patients find they need it, Choti said. However, if a person is severely underweight or malnourished they may not have the energy to resume normal work duties, Choti said.
Eating and drinking at work – the nitty gritty
Most people initially lose weight following a gastrectomy. One issue many face is being able to eat enough calories throughout during the day to keep their energy up. And for some, eating can result in discomfort and digestive problems, such as diarrhea. These issues usually lessen over time and most people are able regain weight as their body adjusts, Choti said.
For some patients, like Melen, weight loss may be significant following treatment. Melen, who is 6-feet 1-inch tall, dropped down to less than 100 pounds at one point. Even now, he finds he isn’t able to gain weight beyond his current 127 pounds.
At first his gaunt form left him feeling self-conscious, especially when meeting with clients. And if he ate too much, he was left feeling sick and either running to the bathroom as things moved too quickly through him, or feeling “stopped up” and constipated. He also dealt with nausea and vomiting from bile reflux.
At first, the discomfort of meal times made him want to avoid eating at work altogether.
“I couldn’t do office lunches like I used to,” Melen said. “Going to client lunches was really hard. I had to nibble or have half of something. I felt insecure about how I looked and the fact I couldn’t eat like other people.”
But things eventually got better, he said. He can pretty much eat whatever he wants now, but he’s still careful about what he eats at work to avoid unwanted side effects. He has also come to terms with his thinness and has learned to use humor to put people at ease.
“Sometimes I’d make it a joke. Like saying, ‘I bet you never had lunch with someone who doesn’t have a stomach?’” Melen said. Melen now is now a patient mentor with Debbie's Dream Foundation, a non-profit organization which in part seeks to provide education and support for patients and families who are dealing with stomach cancer. As a mentor, Melen's goal is to offer the kind of support and resources he would have found useful when he was going through treatment and grappling with these issues.
Getting back to a “new normal” life
Choti said that of his patients who are cured of stomach cancer, most of them go back to work and continue doing the things they loved and enjoyed before they had cancer. But many patients will have a “new normal” following stomach cancer treatment.
You’ll likely need to make some adjustments to your routine as you continue to recover, such as watching how much sugar you eat, as sugar can trigger dumping syndrome. Or remembering to drink fluids separately from eating, otherwise you’ll fill up on liquids and won’t have room left for food. But after a while you’ll get used to these adjustments at work, Ford said.
“There are some people who have no restrictions after this is over with—they basically go back to normal,” Ford said. “But you’re going to need to be open to how you adapt to this.”