Introduction
A large body of anecdotal evidence indicates that individuals with a wide range of illnesses are subject to discrimination in employment. Individuals with the most serious illnesses, such as heart disease, cancer, and HIV infection, are more likely to be denied employment, treated less favorably on the job, refused promotions, or wrongfully discharged than are individuals with less serious illnesses or no illness at all [1].
Public attention to the problem of employment discrimination against people with disabilities was heightened with the enactment of the Americans with Disabilities Act (ADA) in 1990 [2]. Title I of the ADA, which took effect in 1992, prohibits employment discrimination on the basis of disability by private- and public-sector employers. To be covered under the ADA, an individual must have a physical or mental impairment that substantially limits one or more major life activities, have a history of such an impairment, or be regarded as having such an impairment. Current, former, and perceived cancer patients are covered under this broad definition.
The ADA prohibits employment discrimination against individuals who, with or without reasonable accommodation, are able to perform the essential functions of a particular job. Employers are required to make reasonable accommodations, such as building ramps, modifying equipment or devices, altering job responsibilities, and providing part-time or modified work schedules. Nevertheless, employers are not required to provide any accommodation that will result in undue hardship, which is based on the nature and cost of the accommodation and the size and financial ability of the employer.
In 1994, there were 1,092 federal complaints filed alleging cancer-based discrimination in employment. This represented 2.4% of all federal disability discrimination complaints (personal communication, David Gruenberg, Office of Information, Equal Employment Opportunity Commission (EEOC), June 14, 1995).
Although this represents a substantial number of complaints, there are three reasons why there may be considerably more cancer-based discrimination in employment. First, there are numerous potential victims of discrimination. In 1995, about 1.2 million Americans will be diagnosed with cancer, excluding basal and squamous cell skin cancer and carcinoma in situ, and there will be over 5 million Americans who are cancer survivors for more than 5 years [3]. Second, there is still much stigma associated with cancer [4]. Third, because of the high cost of cancer treatment, employers have a great financial incentive to get employees with cancer off their health insurance rolls [5]. For example, treatment of breast cancer with high-dose chemotherapy and autologous bone marrow transplants may cost $100,000 to $150,000 [6].
Study Population and Methods
We undertook a study to determine whether cancer patients currently being treated at the University of Texas M.D. Anderson Cancer Center (UTMDACC) or being followed after treatment had experienced discrimination in employment because of their diagnosis. We sought to determine, among other things, the extent, nature, and form of discrimination, as well as the characteristics of the employee and employer that made a self-report of discrimination more or less likely to occur.
The University of Texas M.D. Anderson Cancer Center is a 518-bed, acute-care, comprehensive cancer center in Houston, Texas. During a 4-month period (May 2, 1992, through September 23, 1992), we surveyed patients diagnosed with cancer about their employability. Study subjects completed a self-administered, 19-item questionnaire designed to assess their perceived employment discrimination associated with a diagnosis or history of cancer. The questionnaire also was designed to determine the demand for educational materials and programs to assist patients in finding jobs following diagnosis and treatment.
All study subjects took part voluntarily. All those agreeing to participate were receiving outpatient treatment or follow-up at one of the major outpatient clinics at UTMDACC. Two patient groups were specifically excluded, however: (1) patients less than 18 years of age and (2) patients with diagnosed brain tumors. These groups were excluded because their employment rates already were quite low. The cases who participated in the study were comparable to individuals who chose not to participate with regard to age, gender, and length of treatment in each clinic area.
Questionnaires also were distributed to Anderson Network members through the assistance of the UTMDACC Volunteer Services Department. Anderson Network is an organization of current patients as well as individuals who have already completed their treatment at UTMDACC.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
