One of the most important questions I ask new patients is what they do—stay at home as a mom, dad, or caregiver, or work outside the home. It not only gives me insight and feeling for who this person is, it opens up a discussion of what they are responsible for and how important that work is to them. It may be essential for financial reasons, not the least of which may be health insurance. For many, it is a source of personal pride; others may have the freedom to leave at will.
It is always difficult to answer the question they have for me, which is, “Can I still go to work while I am on chemotherapy?” My answer is, “I don’t do your job. Most of my patients are able to continue working but that is very dependent on their work place and obligations. I will fill out any paperwork you need for time off.”
I live in a Midwest city with an incredible work ethic—and I say that from personal experience with patients. It is astonishing what I have seen patients go through and still miss minimal work time. Some examples: A young single mom working as a waitress and “clopener”—she closes at night and comes back in the morning to open. She was on TCH and I don’t think she missed more than 3 days of work through the entire course of therapy. It was hard to watch her—I knew she was almost at the end of her rope, but it was so important to her to keep showing up and when it was all done she had an enormous sense of accomplishment and pride. I was as happy for her about that as I was for her to finish her year of therapy! “Happy Patty” is middle-aged and the sole wage earner since her husband is disabled. She worked in offices for years but then was hired at a plant where she is in charge of running the outdoor pipelines year-round, as well as unloading palettes from trucks! She takes enormous pride in her work and delights in describing it all to me in detail as my mouth hangs open. She said at the end of the day she just feels that she has accomplished something. I’ll say! She also was on TCH and missed only rare days. I do not know how she does it when she is perfectly well, let alone while on chemo, all the while maintaining an unrelentingly cheerful disposition. Last month I had two “older” women—one is in her 70s, works in a commercial bakery, and refuses to miss one shift! The other is on third shift at a factory and has made it clear that she has never missed a day and will not start now. Remarkable people, don’t you think?
That said, I do not expect everyone to continue to work during treatment. Sometimes it just isn’t possible. Those with office jobs seem to have more flexibility and can often work from home to keep up. If you work in a factory it is often hard to be part-time, and for those patients I advise talking to their HR department as they are often eligible for short-term disability. But, I have also written note after note for some patients who can just take a day or two off and go right back.
So, it is discouraging to read Dr. Reshma Jagsi’s study from the University of Michigan. She followed 746 early-stage breast cancer patients, all under the age of 65. Some received chemotherapy, some did not. After 4 years, about a third of the patients were not working; 55% of that group wanted to be working. In a breakdown, 38% of chemo patients were unemployed, and 27% of those who did not receive chemo were out of work.
There is no way to know why the women they followed lost their jobs. But I think we must do everything we can to help them keep their jobs. Working with their employers is part of it, but scheduling can be important as well. Timing is often key for these patients—getting the right appointment time, keeping to the schedule, not requiring unnecessary office visits. Excellent symptom management from day one is critical for all patients but could be the difference for having a job vs no job for some.
Kudos to all of our patients. Let’s all try to be more cognizant of our patient’s work—however they define it—and help them keep their jobs while providing them with the best, most efficient care.