We sought to determine whether patients undergoing treatment for cancer had experienced discrimination in employment and, if so, how that discrimination was manifested. We also sought to determine what variables affected the rate of discrimination, including age, gender, occupation, and employer size. We surveyed 422 patients diagnosed with cancer who were being treated at an acute-care, comprehensive cancer center in Houston, Texas, or were being followed after therapy. Whereas 76% of respondents indicated that they were working at the time of diagnosis and 82% said that they wanted to work full- or part-time, only 56% were working at the time of the study. Type of occupation was the main determinant of whether individuals were employed after diagnosis. The study documents self-reported discrimination in employment on the basis of cancer. Additional research is needed to determine the measures, including legal recourse, necessary to enable cancer patients to obtain and continue work.
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 .
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 . 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 . Second, there is still much stigma associated with cancer . 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 . For example, treatment of breast cancer with high-dose chemotherapy and autologous bone marrow transplants may cost $100,000 to $150,000 .
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.
1. Hearings on S. 933, Americans with Disabilities Act of 1989, before Senate Committee on Labor and Human Resources and the Subcommittee on the Handicapped, 100th Cong, 1st sess (May 9, 10, 16, and June 22, 1989).
2. West J (ed): The social and policy context of the act. The Americans with Disabilities Act--From Policy to Practice, pp 3-24. New York, Milbank Memorial Fund, 1991.
3. American Cancer Society: Cancer Facts & Figures--1995. Atlanta, American Cancer Society, 1995.
4. Employment Discrimination Against Cancer Victims and the Handicapped: Hearings on H.R. 1294 and H.R. 370 before the Subcommittee on Employment Opportunities of the House Committee on Education and Labor, 99th Cong, 1st sess (1985).
5. Rothstein MA: Genetic testing: Employability, insurability, and health reform (Monog). J Natl Cancer Inst 17:87, 1995.
6. Harris v Mutual of Omaha Insurance Companies, 992 F2d 706 (7th Cir 1993).