In April 1998, I accepted a teaching job with an August start date. Later that same month I found out that I had inflammatory breast cancer and that I would still be in treatment in August. From that point until my retirement in 2013, I was balancing health and work considerations.
Other breast cancer survivors have had similar problems. Reshma Jagsi and her colleagues at the University of Michigan wanted to know how breast cancer treatment affects employment. They surveyed 746 women with early-stage breast cancer who were working for pay at the time of their diagnosis. They discovered that four years after diagnosis, thirty percent of the subjects were unemployed even though most of them wanted to work. The main factor that predicted whether a woman would be unemployed was whether she had chemotherapy as part of her treatment.
If you want to avoid being in that unemployed group, what can you do? Here are some suggestions to reduce the likelihood of unemployment.
Let your doctor know that employment is important to you when discussing the risks and benefits of possible treatment plans. I probably went over the top on this. My treatment plan evolved as we learned new information about my tumor. To every new plan, I asked, "Will I be able to start school in August if we do this?" The doctor even adjusted the timing of my surgery so that I would be healed by the beginning of class.
Ask your doctor about how each possible treatment might affect your ability to do your kind of work. Then ask how much that treatment will reduce your chance of recurrence. If the doctor says the treatment reduces recurrence in women with your type of breast cancer by 50%, you need to know the starting point. If your chance of recurrence is 10%, a 50% reduction would mean that you would still have a 5% chance of recurrence. It a treatment plan has many potentially serious side effects, going from a 10% recurrence chance to 5% may not be worth it to you if those side effects could make it hard for you to continue working. If you have an 80% recurrence risk, the 50% reduction that would get you from 80% to 40%, is significant.
Some breast cancer patients clearly need chemotherapy, but others are in a gray area. A frank talk with your doctor can help you decide the treatment least likely to cause you long-term problems while keeping you healthy.
Try to continue work while in treatment if possible. Unless your treatments are very minimal, you will probably need to let someone at work know that you are starting cancer treatment. I was very apprehensive about doing this because I hadn’t actually started work when I was diagnosed. But my new boss was very supportive when I told him what was going on. Depending on your work situation, it may not be wise to let all your coworkers know that you have cancer. Think the situation through carefully before you broadcast the news at work.
The American Cancer Society (ACS) has tips for people who want to work during cancer treatments. Your employer may be able to make accommodations that make it possible for you to continue doing your same job, or they may be able to switch you to other duties. You might be able to go part-time during treatment. Learn whether your job is protected by federal or state laws like the Americans with Disabilities Act.
Apply for disability if you need to. The ACS points out that it can be a mistake to continue working if you are truly not up to the job. The website says, "Keep in mind that it can hurt you to put off going on short-term disability. Some people have had to go to great lengths to prove that they can’t do their job after they’ve spent weeks forcing themselves to go to work when they could barely get out of bed. Don’t wait until your work performance suffers before you decide to take time away from work. If you are fired for doing a poor job, you can lose your health insurance as well as your income. And if you’re fired, you cannot collect disability benefits."
Talk to an physical or occupational therapist. To stay employed, you need to be able to do your job well. Therapists are fantastic problem solvers. If you are finding that there are tasks involved in your job that you can no longer do well, they may have a solution for you. My first big hurdle to getting back in the classroom was being able to lift my arm high enough to write on the board. School was about to start, and my range of motion was still not very good. I asked my doctor for a referral to a physical therapist, and soon I had a new set of exercises that increased my range of motion. Over the years, therapists have helped me figure out ways to do my job despite problems with neuropathy and lymphedema. If it turns out that you can no longer manage the type of work you used to do, they can help you assess what you can do and find a new type of occupation.
Protect yourself from possible discrimination. Unfortunately not all employers are understanding. They may be afraid you won’t be able to continue doing a good job, or they may have prejudices against people with cancer. Keep a record of whom you talk to at work. Make notes about both praise and criticism you receive as well as any formal performance evaluations. Keep your own records about how much work you have to miss for doctor’s appointments. Both the ACS and the LiveStrong Foundation have information about the laws that may protect you and resources to contact if you feel your employer has discriminated against you.
Know your rights if you decide to look for a new job. You do not need to disclose that you are a cancer survivor, and employers can not legally ask about any medical conditions you might have. They can ask if you can do specific tasks like lifting heavy objects. They cannot require that you undergo a medical exam unless everyone applying for the job has to take that same exam. Nevertheless, it might be to your benefit to explain that you have recovered from cancer treatment in some circumstances. For example, if you are concerned that your previous employer will disclose that you missed thirty days of work two years ago, it would be better to be upfront and say that your health caused you some issues with absenteeism in the past, but that now you are well. If you will need a cart to carry heavy objects because of lymphedema, then disclosing that near the end of the interview process might be a good idea.
When my husband accepted a new job, I decided not to disclose my cancer status right away. I was seven years out from diagnosis, and I had found ways to work with my side effects and still do a good job teaching. I wanted to let people get to know me first as Phyllis before talking about cancer. Being a cancer survivor is an important part of who I am. No one can truly know me well without knowing that part of me, but I preferred to be in charge of the timing of telling people.
Be optimistic. While many women in this study did face employment issues, keep in mind that 70% of the participants were working four years after treatment. Work can add joy and meaning to life. Cancer can create a work crisis, but it can also allow time to reassess and change to a new, more fulfilling career.
Jagsi, R., Hawley, S. T., Abrahamse, P., Li, Y., Janz, N. K., Griggs, J. J., Bradley, C., Graff, J. J., Hamilton, A. and Katz, S. J. (2014), Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer. Cancer, 120: 1854-1862. doi: 10.1002/cncr.28607
Mark K. Managing your life during treatment: employment issues. LiveStrong Foundation. Retrieved June 16, 2014 from https://www.livestrong.org/we-can-help/managing-your-life-during-treatment/employment-issues/ .
University of Michigan Health System. (2014, April 28). Unemployment common after breast cancer treatment. ScienceDaily. Retrieved June 16, 2014 from www.sciencedaily.com/releases/2014/04/140428074317.htm
Working During Treatment. American Cancer Society. Retrieved June 16, 2014 from https://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/workingduringandaftertreatment/working-during-cancer-treatment
Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.