As part of its Speaking Out video series, CURE spoke with Joanna Fawzy Morales, Esq., from Triage Cancer, about working during a cancer diagnosis and its treatments, and what rights individuals have when it comes to employment and insurance.
Kristie L. Kahl: What are some challenges that you see with patients when it comes to work and working throughout their cancer journey?
Joanna Fawzy Morales, Esq.: I think the biggest challenge is that most patients who are trying to figure out what their options are at work after being diagnosed is that they don't know their rights as an employee. And they don't know what's available to them, either to help them work through treatment, or take time off to be able to get treatment or even to return to work after treatment. And not knowing what your rights are and the way the law protects you means that you don't know how to tap into some of those benefits. And unfortunately, that means that we see patients struggle through their work experience, but also, in a worst-case scenario lose their job, because they're not tapping into those benefits and protections.
Kahl: With that, how are patients protected against discrimination?
Morales: There are federal and state fair employment laws, like the Americans with Disabilities Act, that do protect people because of their medical condition at work. And so we want people to understand that it isn't just a federal law, like the ADA, but those protections may also exist at the state level, and cover smaller employers to protect people from being treated differently at work because of their medical condition.
Kahl: Whether it's the cancer itself or its treatment, we know patients deal with a lot of side effects. What options do patients have if they are dealing with side effects that might affect their ability to work?
Morales: In that case, we want people to be aware of reasonable accommodations in addition to providing employees protection against discrimination at work because of their medical condition. Those fair employment laws also provide access to reasonable accommodations. And those accommodations are really any change at work that could help someone continue to do their job or return to work or even take time off. So on a practical level, accommodations can be anything that is helpful. Whether it's a schedule change, or additional breaks, or maybe working from a different location or working from home, it could be utilizing technology to be able to help someone keep doing their job, or maybe even a change in a workplace policy or moving to an open position. The way that the law is written is that it says that it's any change, and rarely is the law, but that broad and give that many possibilities. But it basically means that everything's on the table. So employees with cancer can be really creative in thinking about changes that could help them continue to work and manage their side effects at work, and it just has to be reasonable. So based on their job responsibilities, it means to be a reasonable change to help them.
Kahl: Following a cancer diagnosis, it's hard to talk about, obviously, even with friends and family. So do you have any advice on how patients can talk to their employer about their diagnosis?
Morales: Disclosure is a really important issue when someone is thinking about what they want to share at work, who they want to share it with and when. And it's a very personal decision, everyone feels very differently about how they want to share information about their medical condition. But what we want people to know is that you have legal protections there, where you don't have to share any information about your medical condition with an employer or a potential employer if you're looking for a new job. But if you want to tap into some of the legal protections, like if you need a reasonable accommodation, or you need medical leave, for example, you do have to share some information about your medical condition that shows why you qualify for those things. But that doesn't necessarily mean you have to share a cancer diagnosis if you're not comfortable doing that at work.
Oftentimes, the reason someone needs an accommodation or leave is actually not because of the cancer diagnosis. It's about side effects from treatment. And often you can talk about those side effects without ever tying them back to an original cancer diagnosis. So things like fatigue or neuropathy, you could talk about those things without sharing that the reason you're experiencing those things is because you've been diagnosed with cancer, and you're going through cancer treatment. And so we really recommend that people understand their rights in this situation, so that they feel like they do have choices, and that they feel like they can make a choice that's best for them. And that requires having a conversation with your health care team, if they're the ones filling out the paperwork for accommodations or medical leave, so that they know how to frame what you're experiencing, because that information is being shared with an employer. So we just want people to know what their options are around disclosure so they can choose best for them.
Kahl: We talked about health insurance a little bit earlier, but if a patient does lose their health insurance through their employer, what options do they have next?
Morales: They could potentially have a lot of options. So depending on the size of the employer, they might be eligible for COBRA, which is a federal law that allows you to keep your employer coverage after you leave work. There might also be state COBRA laws that apply if you work for a smaller employer. So that's one option. You could also look to see if you're eligible for insurance through the marketplace in your state and to see the plans that are being sold as individual plans in your state. You could also potentially qualify for Medicaid or Medicare depending on your other circumstances. And then you may also be eligible for another group health insurance plan. So if you're under the age of 26, could you go back to your parents’ plan? If you're married, could you go on your spouse's plan? So there are some other potential options that are going to depend specifically on your situation. But at Triage Cancer, we have a lot of resources that explain your options when you're losing insurance at work and how to compare those options.
Kahl: Can you offer some additional resources for our patient audience who might be going through challenges with working through cancer?
Morales: We have a resources by topics page on our website at triagecancer.org. And there is an entire topics page about employment and understanding all the laws that might protect someone at work, and then how to tap into those laws and actually use them on a practical level. And then to understand the health insurance options that could be helpful when someone is thinking about losing their insurance at work and what comes next. And so all of that can be found on our website at triagecancer.org.
Transcription edited for clarity and conciseness.
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