Task Force: Tackling Work After a Cancer Diagnosis

After cancer, dealing with employment issues is all in a day's work.

Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.
High school math teacher Mark Nelson never questioned whether he would work after cancer. After receiving a diagnosis of colon cancer in 2011, Nelson had surgery in June and started chemotherapy just two weeks before the school year began in his hometown of Mondovi, Wis. He had a round of chemotherapy on Wednesday afternoons and taught during the rest of the week using a portable infusion pump. Nelson, now 59, says he needed his job for the paycheck and health insurance. But it went beyond that. “Teaching the kids was saving me,” he says.

Nelson was on a half-day schedule during treatment—the result of a declining student population and budget cuts—but now teaches six periods a day, sometimes from a chair, because of neuropathy.

While he’d like to work more hours, he says the shorter day helps him manage treatment-related fatigue. A former basketball coach at his school, Nelson is looking forward to regaining enough energy to attend night games. “I want to slowly build up to that,” he says.

An estimated 4.8 million people of working age are survivors of cancer. Most successfully return to work after treatment, but some do not. Even those who do go back to work after, or even during treatment, can face a variety of challenges stemming from the physical and psychological effects of their disease and treatment. The good news is that experts say it’s often possible to overcome those challenges, with some planning and employer support.

The nonprofit Cancer and Careers and the market research firm Harris Interactive recently released the results of a poll of 400 people working before and after cancer treatment on what motivated them to continue working. Nearly half (48 percent) said they continued working because they wanted to keep things as normal as possible, and more than one-third (38 percent) said that they wanted to feel productive.

“Most people would say that their greatest source of identity is their job,” says Cathy Bradley, professor and chair of Virginia Commonwealth University’s Department of Healthcare Policy and Research in Richmond, Va. “It provides self-esteem, a distraction and a social outlet.”

Most people would say that their greatest source of identity is their job.

Not everyone returns to work after treatment. Some can’t, while others don’t have to, or decide they have other priorities, says Michael Feuerstein, a professor of medical and clinical psychology at the Uniformed Services University of the Health Sciences in Bethesda, Md., and a survivor of brain cancer.

Residual symptoms can make returning to the workplace, and staying there, a challenge. A study published this year in the Journal of Cancer Survivorship found that patients whose cancer was non-metastatic were less likely than those who were less affected to be working at least six months post-diagnosis if their symptoms interfered with work at least moderately. And those who can’t work at all may merely represent just “the tip of the iceberg,” with many others working part-time when they’d rather be working full-time, or who can’t work at their previous level or rate, says Amye Tevaarwerk, an assistant professor of hematology/oncology at the University of Wisconsin-Madison and a lead author of the study.

Some late effects of treatment are physical and can be long-standing or permanent. Lymphedema, for example, might not occur until years after treatment, yet it can be a challenge for people whose jobs require physical activity, such as heavy lifting. A 2010 study of patients with newly diagnosed breast and prostate cancer, co-authored by Bradley and published in the Journal of Cancer Survivorship, found that about 36 percent of women and 17 percent of men reported a physical disability 18 months after diagnosis.

Fatigue is also a problem for many survivors, and sleep often isn’t a solution. The insurance company Unum offers practical applications to employers, such as workstation flexibility, time and space for breaks, and the ability to plan productive work to avoid the cycles of fatigue. Research also suggests physical activity can help, says Patricia Ganz, a medical oncologist and director of the patients and survivors program at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. She co-authored a 2012 study that found Iyengar yoga improved fatigue in survivors of breast cancer.

Chemotherapy and radiation also can cause memory and cognition problems that can make functioning at work tough for some people. In Bradley’s study, even 18 months after diagnosis, 22 percent of the women and 7 percent of the men reported cognitive disability—and they were more likely to leave the workforce as a result. Ganz is now leading a randomized trial examining whether homework assignments and 10 hours of group sessions can improve attention, memory, multitasking and encoding in survivors of breast cancer.

[Infographic: See how cancer survivors are changing the face of the workforce]

Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.
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