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Working During Cancer Treatment

23279079You may need to take time off from work as you are undergoing therapy for cancer. In a study with 63,949 patients with cancer, the average patient missed 18 days out of the year, with an average of four and a half hours per week, to treat side effects.6 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

In addition, cancer-related fatigue can be so severe that it disrupts the ability to do daily activities, let alone work.10, Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.11 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499. A person may be unable to perform his or her job during this time.

  • The Family and Medical Leave Act (FMLA): The Family and Medical Leave Act (FMLA) mandates that employers permit their employees to have up to 12 weeks of unpaid leave for the purposes of either receiving treatment for their own illness or to help a family member, such as a child, parent or partner.During your leave of absence, your job will be protected.In addition, your work-related benefits, such as health insurance, must be provided to you during your leave of absence.17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.

The company and employee must meet certain requirements to be allowed to have the unpaid time off. The company must have 50 or more employees.17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80. The employee must have worked a minimum of 25 hours/week for one year or more.17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.

The FMLA policy will enable you to have at least a few weeks off while maintaining both your medical insurance, if applicable, and your job.

  • The Americans with Disabilities Act (ADA): The Americans with Disabilities Act (ADA) will not allow employers to discriminate against employees that have a disability, or a health complication that may limit a person’s ability to perform daily activities. By law, from the time that you are diagnosed with cancer, you meet the criteria to be categorized as disabled and the ADA should provide protection for you.Interpretation of the ADA is challenging, however.18 Blank PD. The economics of the employment provisions of The Americans with Disabilities Act: Part I – workplace accommodations. DePaul Law Rev. 1997;46(4):877-914. The challenge is determining whether the accommodations will cause hardship to the employer.

To obtain accommodations, the employee must inform the employer of his or her disability.18 Blank PD. The economics of the employment provisions of The Americans with Disabilities Act: Part I – workplace accommodations. DePaul Law Rev. 1997;46(4):877-914. The employer decides on the best accommodations for the employee.

With the ADA, your employer is not allowed to fire you because of your cancer diagnosis or health problems from cancer that disrupt your ability to perform tasks. In addition, your employer will also be required to provide accommodations, although the type of accommodations are dependent on factors such as employment hours or job requirements, but the accommodations could include providing you with a flexible schedule so you can obtain treatment or permitting you to work from home.17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.

Whether you will be provided with accommodations or your job will be protected depends on the nature of your job and the business. If your job can only be performed by you and a temporary employee cannot perform the tasks that you did, or if it would be very costly to the business, then it will be considered a hardship for the business and they will not be required to make accommodations or even keep your job.

Depending on your employer and the ADA policy, you may be provided with an accommodation that permits you to work from home and/or have the flexibility to attend other periodic appointments necessary for medical treatment.

 

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Life starts to get back to normal, and then you have moments when you remember. You think, “Wait a second, this is not important. I’m not going to get upset about this. It’s not a big deal.”Barry W. (palatomaxillary and low grade adenocarcinoma of minor salivary gland cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

2 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

3 Pearson SE, Meyer AC, Adams GL, Ondrey FG. Decreased hearing after combined modality therapy for head and neck cancer. Am J Otolaryngol. 2006 Mar-Apr;27(2):76-80.

4 Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

5 Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.

6 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

7 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

8 Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

9 Rogers LQ, Courneya KS, Robbins KT, et al. Physical activity and quality of life in head and neck cancer survivors. Support Care Cancer. 2006 Oct;14(10):1012-9.

10 Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.

11 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.

12 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

13 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

14 Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst. 2008 Aug 20;100(16):1155-66.

15 Doyle C,Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353.

16 Ogama N, Suzuki S. Adverse effects and appetite suppression associated with particle beam therapy in patients with head and neck cancer. Jpn J Nurs Sci. 2012 Jun;9(1):28-37.

17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.

18 Blank PD. The economics of the employment provisions of The Americans with Disabilities Act: Part I – workplace accommodations. DePaul Law Rev. 1997;46(4):877-914.