With about 12 million cancer survivors living in the US, cancer affects millions of working Americans. Improvements in early detection and treatment have resulted in a significant number of newly diagnosed and long-term survivors of working age. Approximately 4,180,000 people—38% of all cancer survivors—are 20 to 64 years old. The majority of these individuals want to and are able to return to work after diagnosis and perform their jobs.
Cancer treatment limits the ability of only a minority of survivors to work as they had prior to diagnosis. Surveys in the 1980s reported that approximately 80% of survivors return to work after diagnosis. A survey of 10 studies that assessed return-to-work rates of a total of 1,904 cancer survivors from 1986 to 1999 found that a mean of 62% returned to work. A study of 1,763 survivors who were first diagnosed between January 1997 and December 1999 found that of the 1,433 who were working at diagnosis, 73% returned to work within 1 year of diagnosis and 84% returned to work within 4 years. Bradley et al. interviewed 253 long-term survivors in 1999 and found that 67% were employed 5 to 7 years later.
Nonetheless, cancer can have a significant negative impact on survivors' employment opportunities. Although the majority of cancer survivors are able to continue working or return to work without limitations resulting from their diagnosis or treatment, some survivors experience significant physical or mental limitations that affect their ability to work.[5–8] An analysis of the 2000 National Health Interview Survey found that cancer survivors have poorer outcomes across all employment-related burden measures relative to matched control subjects. One estimate is that 16.8% of working-age survivors (compared with 5% of matched controls) are unable to work because of a physical, mental, or emotional problem; of those who could work, 7.4% (compared with 3.2% of matched controls) were limited in the kind or amount of work they could do. An analysis of 36 studies of 177,969 participants found that survivors were more likely than healthy control participants to be unemployed. (33.8% vs 15.2%).
Whether a survivor continues to work during treatment or returns to work after treatment—and if so, whether that survivor's diagnosis or treatment will result in working limitations—depends on many factors. They include the survivor's age, stage at diagnosis, financial status, education, and access to health insurance and transportation, as well as the physical demands of the job and the presence of any other chronic health conditions.[5,6,11] For example, survivors in physically demanding jobs have higher disability rates than those in more sedentary jobs; survivors with advanced education have higher return to work rates than those with less education.[5,11] Medical treatment decisions that consider quality of life and the shift towards providing cancer treatment in outpatient settings have contributed to the increasing number of survivors who can work during their treatment.
Prior to the passage of laws that prohibited disability-based discrimination, a significant percentage of cancer survivors (25% to 84%) experienced cancer-related employment discrimination.[13–15] In the late 1980s and early 1990s, new federal and state laws prohibited employment discrimination based on disabilities such as cancer. Since then, survivors have reported decreasing incidences of work problems attributable to their cancer.
A 2006 national survey of cancer survivors found that most employers appear to be highly sensitive and accommodating to the needs of employees who have cancer and to employees who are caregivers for cancer survivors. Three out of five survivors reported receiving co-worker support, such as help with work or random acts of kindness. Survivors and caregivers reported very low incidences of negative reactions from their employers and co-workers. The most common negative reaction, reported by one in five survivors, was that an employer gave a survivor less work after diagnosis. Other consequences, such as being fired or laid off (6%), denied a raise or promotion (7%), and denied health insurance benefits (4%), were far less common.
1. National Cancer Institute: Estimated US Cancer Prevalence. Available at: http://cancercontrol.cancer.gov/ocs/prevalence/prevalence.html#survivor. Accessed on March 19, 2010.
2. Hewitt MF, Greenfield S, Stovall E (eds): From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC, The National Academies Press, 2006, p. 34.
3. Crothers H: Employment Problems of Cancer Survivors: Local Problems and Local Solutions, in: American Cancer Society: Proceedings of the Workshop on Employment, Insurance and the Patient with Cancer. New Orleans, American Cancer Society, Inc., 1986, pp 51–57.
4. Spelten E, Sprangers M, Verbeek J: Factors reported to influence the return to work of cancer survivors: A literature review. Psychooncology 11:124–131, 2002.
5. Short P, Vasey J, Tunceli K: Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301, 2005.
6. Bradley C, Bednarek H: Employment patterns of long-term cancer survivors. Psychooncology 11:188–198, 2002.
7. Yankelovich Clancy Shulman, Inc.: Cerenex Survey on Cancer Patients in the Workplace: Breaking Down Discrimination Barriers (1992).
8. Ferrell B, Grant M, Dean G, et al: Bone tired: The experience of fatigue and its impact on quality of life. Oncol Nurs Forum 23:(10):1539–1547, 1996.
9. Hewitt M, Rowland J, Yancik R: Cancer survivors in the United States: Age health, and disability. J Gerontol A Biol Med Sci 58(1):82–91, 2003.
10. de Boer AGEM, Taskila T, Ojajarvi A, et al: Cancer survivors and unemployment: A meta-analysis and meta-regression. JAMA 301(7):753–762.
11. Steiner J, Cavender T, Main, D, et al: Assessing the impact of cancer
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13. Feldman, FL: Work and Cancer Health Histories. American Cancer Society, California Division (1982) (five-year study of the work experiences of 344 white collar workers, blue collar workers, and youths with cancer histories between 1975 and 1980). New York, Raven Press, 1982.
14. Fobair P, Hoppe RT, Bloom J, et al: Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol 4(5):805–814, 1986.
15. Koocher GP, O'Malley JE: The Damocles Syndrome: Psychosocial Consequences of Surviving Childhood Cancer. New York, McGraw Hill, 1982.
16. Hoffman B: Working It Out: Your Employment Rights as a Cancer Survivor, 8th ed, National Coalition for Cancer Survivorship, 2008 (discussing unpublished survey conducted by Fleishman-Hillard Research, Breakaway from Cancer, 2006).
17. Federal Rehabilitation Act, 29 U.S.C. 701-7976.
18. Americans with Disabilities Act, 42 U.S.C. 12101-12213.
19. US Equal Employment Opportunity Commission: ADA Charge Data by Impairments/Bases—Merit Factor Resolutions, July 26, 1992–September 30, 1996. Available at: http://www.eeoc.gov/eeoc/statistics/enforcement/ada-merit-a.cfm.
20. US Equal Employment Opportunity Commission: ADA charge data by impairments/bases—merit factor resolutions FY 1997– FY 2009. Available at: http://www.eeoc.gov/eeoc/statistics/enforcement/ada-merit.cfm. Sites accessed on March 19, 2010.
21. Hoffman B: Between a Disability and a Hard Place: The Cancer Survivors' Catch-22 of Proving Disability Status Under the Americans with Disabilities Act. 59 Maryland L Rev. 352 (2000).
22. Blanck P: The Economics of the Employment Provisions of the Americans with Disabilities Act: Part I: Workplace Accommodations. 46 DePaul Law Review 877 (1997).
23. Colker R: Winning and Losing Under the ADA. 62 Ohio State L.J. 239 (2001).
24. Hoffman S: Settling the Matter: Does Title I of the ADA Work? 59 Alabama L. Rev. 305 (2008).
25. Ellison v. Software Spectrum, Inc., 85 F.3d 187, 190-91 (5th Cir. 1996, holding that a breast cancer survivor did not have a disability as defined by the ADA because she successfully mitigated the effects of her cancer and returned to work).
26. Gordon v. E.L. Hamm & Assocs., 100 F.3d 907, 912 (11th Cir. 1996, holding that plaintiff's history of lymphoma was not a record of a disability because “except for a couple of days of medical testing” and a 10-day leave of absence for bone marrow testing, plaintiff was capable of working).
27. 29 U.S.C. 1630.2(i).
28. 42 U.S.C. 12102(2)(A).
29. 42 U.S.C. 12102(2)(B).
30. Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999).
31. 42 U.S.C. 12102(4)(E).
32. 42 U.S.C. 12102(4)(D).
33. 42 U.S.C. 12102(3)(A).