At a time when you want your main focus to be your health, your job is the last thing you want to worry about. Whether you’re considering temporarily leaving a job that you love and/or a source of income that you rely on, there is incredible stress that a cancer diagnosis can cause for your employment.
Telling your work that you’ve been diagnosed is a crystallization of this stress. So, we talked to experts to get advice about how to navigate these workplace dynamics (and how to assess your legal rights).
As cancer rates are increasing in younger populations, there is a higher proportion of working age people that are being diagnosed. In fact, studies have shown that about 45% of people diagnosed with cancer in the U.S. are of working age, between 20 to 64 years old. Furthermore, about half of cancer patients make adjustments in their employment, whether that be time off, accommodations or job changes, according to the American Cancer Society.
But legal protections are complicated to understand and juggling employment uncertainties is difficult. Some major steps:
Know Your Rights
Disability protection laws are complicated, as they can vary widely depending on what state you live in and the size of your company. There are several online resources that explain your legal protections and how to navigate job changes during treatment. Some of our favorites are Cancer+Careers and Triage Cancer. Cancer+Careers provides several resources from knowing your rights to how to have conversations with your employer to what to do if you are self-employed. Triage Cancer offers a Cancer Rights Law Book to download for free. Their action plan toolkit provides a detailed list of steps to take to prepare for job adjustments.
Laws in the U.S. are becoming more inclusive of individuals affected by cancer, says former University of Richmond law professor and breast cancer survivor Ann Hodges, who is also the founder of CancerLINC, a support program for people with cancer and their families in Central Virginia.
“Courts are more readily recognizing that cancer is a covered disability and the law today is better than it was previously in terms of protecting individuals with cancer,” Hodges says.
There are two main laws in the U.S. that protect workers undergoing medical treatment: the Americans with Disabilities Act, commonly known as the ADA, and the Family and Medical Leave Act, or FMLA. The ADA entitles workers to disability accommodations–also referred to as productivity enhancers– in the workplace, such as reduced hours or remote work, and also protects from discrimination due to one’s medical condition. The FMLA offers unpaid leave and job security protections to workers and their close family members.
(Also remember, Jadey is not equipped to give you legal advice! These are complex situations, there are lots of exceptions, and these situations always require a case-by-case application. We always recommend you consult with an employment attorney about your own personal circumstances.)
Under the FMLA, workers are entitled to 12 work weeks of unpaid leave, whether it be consecutive or intermittent. For example, two days off for chemotherapy would count as two-fifths of a week. However, the FMLA only applies to employers with 50 or more employees, and job security protections – meaning that after your leave, the employer must return you to the same or nearly identical position – only last for those 12 total weeks.
The ADA requires that once an employee has proven their disability to their employer, the employer must provide “reasonable” accommodations–as in, arrangements that adequately help the individual fulfill their responsibilities and maintain equal opportunity in the application process. This law applies to employers with at least 15 employees and requires that the employer work together with the employee to craft appropriate accommodations.
Because of the stipulations surrounding workplace size, some of these provisions may not apply to smaller businesses. Many states have their own laws that offer additional workplace protections. For example, the New Jersey Law Against Discrimination applies to private employers of any size. This guide from Bloomberg Law describes state-specific laws. Triage Cancer also outlines state-by-state employment protections on their website.
“You want to avail yourself of those protections, understand the laws, understand what you need to ask for,” Hodges says. If you work in a smaller business that doesn’t have a robust human resources department or may not even be legally obligated to provide accommodations, you may want to talk to trusted work colleagues or friends who are lawyers about how you think your boss may react to the news about your diagnosis. This can help you think through how to explain your needs and discuss any accommodations that your boss may be willing to provide.
Discuss with Your Doctor
In addition to understanding your legal protections, experts say it is also important to discuss your job and potential accommodations with your doctor.
Barbara Hoffman, a law professor at Rutgers and expert in disability law, says the most important task is to be aware of what your rights are so that you know what specific questions to ask your doctor. You should ask “not only about…medical treatment, but what is the impact of that treatment on day-to-day activity so you can make an educated plan based on what your doctor says you can expect.” Hoffman, who dealt with her own cancer diagnosis, is the founding chair of the National Coalition of Cancer Survivorship, which also provides resources on employment rights, and helped advocate for specific ADA protections for cancer survivors.
For example, it can be helpful to discuss treatment schedules and anticipated recovery time with your physician so you can know how much time to request off. Adjustment in work hours or the option to work from home are also possible accommodations to conserve energy or keep yourself safe if immunocompromised. The Job Accommodation Network outlines a variety of proposed accommodations for cancer patients and other resources to share with your employer in case they are less informed about disability protections.
Under the ADA, your employer can ask your physician for a letter describing your specific needs. Describing your work responsibilities, treatment schedule and side effects will help your doctor deliver a strong and supportive statement to your employer.
“Sometimes you really need to educate the doctor about what needs to be in that statement…You can share what is your job like and how might your job be impacted by this treatment, so that the doctor can understand and write something that is helpful and supportive,” Hodges says.
Larger cancer centers may have designated nurses and social workers to help craft these letters. Importantly, doctors are not required to disclose the details of your diagnosis to your employer.
“It's in a smaller family practitioner, not necessarily an oncologist, or a single practice oncologist, we just want to impress upon the doctor they don't have to say everything. They just need to say enough that will support why that person is seeking that particular accommodation,” Hoffman says.
Approaching Your Supervisor
Sometimes it can be difficult to determine who is the best person to approach for a request for leave or accommodations. If your workplace has an HR department, they will likely have a designated contact that is well versed in disability protections. In smaller offices, workers may have to educate their bosses.
“If you’re armed with the knowledge of what your rights are, then you can communicate with the HR department, or whoever the right person is, to explain, ‘I’m seeking an accommodation. This is the medical reason for that accommodation,’ and also to come armed with some proof. Doctor’s records, medical notes, something to back up your right to get an accommodation,” Hoffman says.
While it can be uncomfortable, Hodges says in most cases, disclosing your diagnosis will help protect you against potential future pushback.
“In terms of thinking about it in a need for accommodation or the potential for some sort of discrimination claim, you need to make that disclosure. You don't want the employer to be able to come back and say, ‘Well, I didn't know she had cancer. I just knew she was taking a lot of time off work.’ So I think probably in most cases, it's better to be upfront,” Hoffman says.
Hodges also says she recommends talking with trusted coworkers, family and friends, or legal or HR experts you may know about how to disclose your diagnosis to your boss to hear advice and get more comfortable saying the words. Cancer+Careers has several guides about how and whom to tell.
Another protective strategy: get everything in writing. If you have a conversation in person or on the phone with HR, or a supervisor, follow-up with an email outlining what you discussed, so it’s on paper that everyone’s on the same page, in case you need to refer back to it. You can be elegant and subtle about it; something like ‘thanks so much for your call granting me these accommodations. To recap our discussion…’.
Discuss Accommodations
After approaching your supervisor, the Equal Employment Opportunity Commission recommends that workers and employers engage in a collaborative discussion about accommodations.
“There’s supposed to be an ‘interactive process’ by which they determine what accommodations can be made and what are reasonable,” Hodges says.
This is where it can be helpful to come prepared with notes from your doctor about what appointments and side effects you can expect and recommended accommodations.
“Have an educated, open discussion with people. Employers don't want to be sued, and people going through cancer, the last thing on their mind is to file a lawsuit,” Hoffman says.
Keep Them in the Loop, but Don’t Feel That You Have to Share Every Detail
Treatment plans can change, which may impact your need for accommodations.
“You only have to reveal what's absolutely critical that will impact your ability to do the essential functions of the job. Everything else is personal information, and you don't need to disclose it,” Hoffman says. “It's a very individualized choice, and nobody should feel compelled to have to share all that at work.”
What If I Need More Than 12 Weeks?
In states where there are limited additional protections, you may be entitled to extended unpaid leave as an accommodation under the ADA if it is deemed reasonable. Experts say that courts have been mixed on when extended leave is considered reasonable, as any additional accommodation cannot cause undue hardship to the employer.
In most cases, with proper support from a medical provider, an additional month or two is considered reasonable, Hodges says. If you feel that you have been wrongfully terminated from your job, organizations like the National Cancer Legal Services Network and the Patient Advocate Foundation can help connect you with legal assistance.
You can also check your employee insurance benefits to see if you have short-term or long-term disability insurance coverage. This can cover part of your salary if you are unable to work for a certain length of time. You can then submit a claim to your insurer to see if you can use it. You may also be able to purchase disability insurance directly through your insurance provider.
For further reading
We recommend checking out the resources mentioned:
– National Coalition of Cancer Survivorship
