Workers with cancer

One day about 15 years ago, Michael Feuerstein was walking across a street when he suddenly became dizzy. He held onto a tree until his light-headedness subsided.

Later that day, he visited his primary care physician and a neurologist.

After undergoing several tests, Feuerstein was diagnosed with a malignant brain tumor. His doctor told him he had three months to live.

After aggressive treatment involving radiation and chemotherapy, Feuerstein overcame the cancer and returned to work as a professor and researcher. He continues to deal with balance and cognitive issues, including difficulty remembering information. He requested accommodations from his employer and was offered a note-taker for meetings.

People diagnosed with cancer from 2004 to 2010 had a five-year relative survival rate of 68 percent – an increase from 49 percent in 1975 to 1977 – according to the American Cancer Society, which credits improved detection and treatment. About 14 million Americans with a history of cancer are living today.

“That’s what I think employers need to realize – things are changing among individuals who have been diagnosed and treated for cancer and still living,” said Feuerstein, professor of medical and clinical psychology at Bethesda, MD-based Uniformed Services University of the Health Sciences. “Most want to get back to a normal life, which can include work.”

Here are six ways employers can help workers who are dealing with cancer return to work.

Become familiar with the law

Individuals with cancer or who are in remission have a disability based on the Americans with Disabilities Act, the Equal Employment Opportunity Commission states. The act, which applies to employers with at least 15 workers, forbids discrimination against workers with a disability, and states that employers must provide reasonable accommodations that do not cause “undue hardship.”

Generally, individuals do not have to disclose their diagnosis to an employer.

An employer may exclude a worker with cancer from a job for safety reasons only when that worker poses a direct threat, defined by EEOC as “a significant risk of substantial harm to the individual or others that cannot be eliminated or reduced through reasonable accommodation.”

An employer also may require a worker on leave due to cancer to submit documentation or have a medical exam before allowing that employee to return to work. However, the employer may obtain only the information necessary for an assessment of the employee’s current ability to perform the job “and to do so safely,” the commission states.

Understand the challenges

According to ACS, a cancer patient’s ability to work during treatment depends on the following factors:

• Type of treatment
• Stage of cancer
• Overall health
• Type of work

Cancer patients can experience side effects of treatment, such as concentration issues and nausea, that may affect them at work, experts state. Respondents to a 2015 survey from nonprofit organization Cancer and Careers said frequent challenges for patients who worked while undergoing treatment include fatigue (42 percent), pain from side effects (26 percent) and taking more time to finish work (23 percent). About one-third of workers said they had to miss work.

Side effects may linger past treatment, so recovery can take time, notes Rebecca Nellis, chief mission officer at Cancer and Careers. Both the employer and employee can benefit from patience and understanding.

“We hear all the time from survivors – their return to normal is a slower and more complicated process, and it may never be exactly the same as before they were being treated,” Nellis said. “Similarly for the employer, we’re so excited at the idea someone makes it through treatment and survives. We assume that’s the end of it, but it isn’t really. They’ll have follow-up appointments where scans happen and make sure cancer hasn’t returned. They’re also facing residual effects of intense medication.

“I find that’s one of the bigger ‘aha’ moments for people who haven’t experienced this with a loved one, a co-worker or themselves – you don’t just switch back. The more a workplace can be OK, aware and supportive of that, the more the person coming back regains confidence.”

Offer help

Sixty-one percent of patients and survivors who participated in the Cancer and Careers survey said resources are necessary for dealing with workplace issues.

Possible accommodations include:

• More frequent breaks
• Flexible hours
• Working from home
• Part-time work
• Paid time off

Employers should have a quick resource guide available for workers who are diagnosed to help them understand available benefits and programs, said Brenna Shebel, director of the Institute on Health Care Costs and Solutions at the Washington-based National Business Group on Health.

“It’s a very stressful, trying time when an employee is first diagnosed,” Shebel said. “Just having something an employee can go to is helpful so it’s all in one place.”

Some workers returning to the job after treatment may struggle to keep up with the pace of work. Therefore, their tasks may need to be adjusted or they may need to move to a different position, experts say. For example, a truck driver dealing with fatigue after undergoing chemotherapy could be accommodated with shortened hours.

“That would be a conversation that would definitely need to take place between HR, the supervisor and possibly the employee assistance program to ensure employees are receiving the support they need if they’re going to stay in that existing position, or is there another position in the interim they can ease into while recovering from treatment or side effects,” Shebel said. “It really comes down to maybe looking at a different position or how can you structure the position so the truck driver isn’t driving longer distances. Maybe [it’s driving] shorter distances or [working] shorter shifts.”

EEOC provides the following example about accommodations: A janitor’s leg has been amputated due to bone cancer. He can perform all of his key job tasks without accommodations, but he has trouble climbing to an attic to change an air filter. His employer can give this task to another janitor to help ensure it’s done safely.

Be proactive and flexible

Nellis said employers should consider developing and implementing policies that can aid workers with cancer and other conditions, and explain accommodations before a crisis arises.

In addition, employers can offer programs and resources to educate employees about wellness and preventing illness, including some types of cancer. Cancer cases vary depending on diagnosis, treatment and recovery, and one worker may need different accommodations than another worker needs, Feuerstein noted.

“There’s no single magical approach we can consistently implement for cancer survivors,” he said. “At least with back pain, for example, in the workplace, people have been studying these accommodations for a long time, like chairs, lifting devices and other types. With cancer survivors, there doesn’t seem to be a consistent accommodation strategy, so one thing that is consistent is the flexibility of the employer.”

Feuerstein points out that a patient’s health effects may be temporary and a worker can eventually bounce back, so accommodations and adjustments do not have to be permanent.

“[As an employer] you want productivity to be up and so on, but this doesn’t have to be forever. This can be reduced, altered over time,” Feuerstein said.

Remember: Doctors play a role

A worker’s doctor would be involved in determining whether the worker can return to work and what he or she can safely do, Shebel said. For example, the doctor will help decide if the worker can handle an eight-hour shift or should be assigned a shorter one.

An occupational physician may be more familiar with the employee’s work and workplace than a primary doctor or oncologist, and therefore better equipped to evaluate the worker’s case, Feuerstein noted.

Conversations among the worker, doctor, human resources department and disability case manager should continue after the worker returns because the worker may be overly ambitious about the tasks he or she can handle, Shebel added.

“It very much depends on what someone’s job is and what treatment they had and how they respond,” Nellis said.

Recognize that many people with cancer want to continue working

Nearly 75 percent of cancer patients and survivors want to work, according to the Cancer and Careers study. Of the approximately 1,000 patients and survivors polled, 2 out of 3 said working gives them purpose and is part of their identity. In addition, 73 percent of employed survivors said working during treatment helped them cope.

“Employees want to return to work, generally. They want to return to a sense of normalcy,” Shebel said. “Employers can play a huge role in helping employees get to that point they want to get to, which is seeing their co- workers again, contributing to the company and the greater good.”