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Are Cancer Patients Subject to Employment Discrimination?

Are Cancer Patients Subject to Employment Discrimination?

ABSTRACT: 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. [ONCOLOGY 9(12):1303-1315, 1995]

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.

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