Coping With Cancer in the Workplace

When Joanna Buzaglo was diagnosed with Hodgkin lymphoma in 1988, she was a 28-year-old working to establish herself as a dancer and choreographer overseas. The diagnosis quickly sidelined her career plans and sent her back to the United States, where she underwent chemotherapy in Philadelphia, her hometown.

"I was just beginning my life, I was not quite yet married and I didn't have children -- and that was all put into question," says Buzaglo, now 54. "I also felt much more alone because none of my peers had been diagnosed with cancer."

Although her prognosis was grim, Buzaglo survived and eventually found a new calling in clinical psychology, which gave her the skills to support people who are facing a cancer diagnosis.

Then, it happened again.

A couple years ago, Buzaglo was diagnosed with breast cancer. Again, she underwent aggressive chemotherapy. Again, she survived. But this time, the experience was much different. Thanks to more targeted therapies with fewer side effects and better medications to treat those side effects, she was able to work the entire time.

"We did not skip a beat in terms of meeting our goals and deliverables," says Buzaglo, the senior vice president of Research and Training at Cancer Support Community, an international nonprofit that provides support, education and hope to people affected by cancer. "I think that if I had to take time off or take time away, it would have been more difficult for our organization to meet its goals."

While some people don't want to work during treatment or can't for health, financial or other reasons, others find that work can help them maintain their identity or provide a distraction, not to mention supply a paycheck and health insurance.

For Buzaglo, working through treatment was not without its challenges, but doing so paid off: It boosted her self-esteem, social connectedness and sense of purpose. "It was much better for me to be able to focus on my work, to have the support of my colleagues and for me not to focus on any of the side effects or my fears," she says. "I [could channel] my energy in a productive way."

A Changing Prognosis

In early 2012, there were 13.7 million cancer survivors in the United States -- a number that is expected to grow 31 percent to 18 million by 2022, according to a 2013 American Association for Cancer Research study.

"The view of cancer is shifting more toward chronic illness," says Holly Mead, an assistant professor of health policy and management at George Washington University's Milken Institute School of Public Health, who is studying standards of care for cancer survivors. In effect, both the health care system and employers need to shift how they treat patients now that they're "living longer with cancer or surviving cancer, but still really experiencing pretty substantial health and certainly psychosocial issues that are stemming from cancer or their treatment," she says.

For example, some cancer survivors grapple with infertility, fatigue and a sort of brain fog dubbed "chemo brain" for years -- or even for the rest of their lives. "Certainly the health care system is trying to keep up," Mead says. "Employers need to be thinking about it in the same way."

When Cancer and Careers was founded 14 years ago, "there was still very much this idea that the whole goal was to help someone take time off. If you could get them out on disability, that's all anybody wanted," says Rebecca Nellis, the nonprofit's chief mission officer. "But in this country, our identity is tied to our work." Her organization focuses on providing people with cancer the resources to help them succeed in their jobs.

That support is necessary: According to data from nearly 400 metastatic breast cancer survivors collected for the Cancer Support Community's Cancer Experience Registry, a database of about 7,500 people affected by cancer, of the 50 percent of people who left their jobs after their cancer diagnosis, half them did so involuntarily. Even among those who continued to work, 12 percent experienced "involuntary changes to their work schedules," like a reduction in work hours, and about 20 percent reported some kind of job discrimination. At the same time, 46 percent experienced a decline in their ability to work, Buzaglo says.

"If we think that having a job is one of the best predictors of overall health outcomes and quality of life, this becomes very significant," she says.

Bringing Cancer to Work

When Cindy Cisneros moved from Boston to the District of Columbia about 10 years ago, she did not tell her supervisor about her uterine cancer diagnosis, for which she had recently undergone the first of three surgeries.

"Once you tell somebody you're diagnosed, there's actually quite a stigma," says Cisneros, now a 50-year-old nonprofit executive. "I didn't want to be viewed as an employee who was not capable of performing her job, seen as weak and couldn't be relied on to complete her work over the course of the year. I didn't want to chance any other negative implications."

That choice is perfectly legal, although many cancer patients and survivors don't realize they don't have to disclose their condition to their employers, says Joanna Morales, a lawyer and CEO of Triage Cancer, a nonprofit that educates and supports cancer survivors, caregivers and health care professionals.

"It can make or break someone's situation if they have an understanding of their rights because so many of these systems -- whether it be the employment arena or insurance or disability insurance -- it's really antagonistic and it's set up to really keep people from accessing their rights," Morales says. "And it's only the people who are persistent and understand what their rights are that are more likely to get what they need and what they're entitled to under the law."

One of those entitlements is protection under the Americans with Disabilities Act, which protects cancer patients and survivors against discrimination in the workplace and requires their employers to provide "reasonable accommodations" such as an altered work schedule or space to allow them to do or return to their jobs. An office worker going through treatment, for example, might experience numbness in his or her fingers and request voice technology that reduces the need to use a keyboard. Another employee whose doctors warn against riding public transit with a compromised immune system might try to work remotely. Survivors with difficulty concentrating might adjust their hours to take advantage of their most productive time of day.

Another protection for people with cancer -- as well as other people including pregnant women and family caregivers -- is the Family Medical Leave Act, which allows employees to take up to 12 weeks of unpaid leave over the course of a year. The law also protects your job and your health insurance, says Morales, who recommends that people with cancer should consider taking even just a small amount of time off under FMLA -- as opposed to only using paid leave -- so that they can benefit from that job security.

While it's not necessary to disclose the full details of your diagnosis in order to take advantage of such legal protections, "if you want to access accommodations or medical leave, you have to share some information about your medical condition to show why you're entitled," Morales says.

For Cisneros, that meant working with her human resources department and telling her supervisor she had a medical condition that would require her to take some time off. She ended up using her short-term disability benefits, which paid 60 percent of her salary after two weeks, to take two months off for a surgery to remove an ovary.

"It was extremely stressful," Cisneros says. "Not only are you going through something major and traumatic, but on the financial side of the equation too, knowing you have less financial resources contributed greatly [to the stress]."

For Buzaglo, disclosing her condition to her supervisor and colleagues -- who work in cancer care, after all -- was beneficial. She ended up taking off two days every three weeks for six months to undergo chemotherapy. She and her colleagues were able to plan around the days she expected to feel bad and some of them even donated their sick leave to her.

"I can't say enough about what it meant to have the support of my workplace," Buzaglo says. "I didn't have to worry that I may lose my job or that I may have to diminish the number of hours. And I had good health benefits. All those things made it possible to be productive."

Not all workplaces are so accommodating, but there's good reason they should find ways to support employees with cancer and survivors, Buzaglo says.

"Our workplaces are going to have to adjust to this," she says. "The more supportive we can be to each other -- because it impacts us all -- and the more we can plan and be able to accommodate whatever changes we need to make, I think that in the end, that will benefit both the workplace and the individual."