There are an estimated 3.8 million working-age adults (ages 20 to 64) with a history of cancer as of 2002, and consequently more cancer survivors are in the workplace now than ever before, (NCI, 2005). The proportion of individuals with a history of cancer rises with age, from 1 percent among individuals ages 40 to 44 to 8 percent among those age 60 to 64 (see Chapter 2). Consequently, many employers have had to address issues related to the reintegration of workers following their treatment and the alteration of work schedules and environment to accommodate any lingering cancer-related impairments.
Most cancer survivors who worked before their diagnosis return to work following their treatment (Spelten et al., 2002). In fact, with the advent of effective interventions to curb the side effects of cancer therapies and an increased reliance on outpatient care, some individuals are able to work throughout their cancer treatment (Messner and Patterson, 2001). Retaining one’s employment status has obvious financial benefits and is often also necessary for health insurance coverage, self-esteem, and social support (Voelker, 1999; Spelten et al., 2002). On the other hand, cancer may prompt retirement from an undesirable job or launch a search for a new career that is more satisfying personally, but less lucrative. Work after cancer must therefore be assessed in the context of an individual’s priorities and values, rather than exclusively using social or economic metrics (Steiner et al., 2004).
Employers, supervisors, and co-workers may assume that persons with cancer are not able to perform job responsibilities as well as they did before the diagnosis. They may also perceive them as a poor risk for promotion. These misconceptions can lead to subtle or blatant discrimination in the workplace (Messner and Patterson, 2001). Cancer survivors have reported problems in the workplace that include dismissal, failure to hire, demotion, denial of promotion, undesirable transfer, denial of benefits, and hostility (NCCS and Amgen, undated; Fesko, 2001; Hoffman, 2004b). Studies conducted prior to the passage of comprehensive employment discrimination laws suggest that survivors of cancer encountered substantial employment obstacles (Mellette, 1985; Hoffman, 1989, 1991; Bordieri et al., 1990; Brown and Ming, 1992).
Federal and state laws passed in the early 1990s have helped to ease problems related to job discrimination. The most important is the Americans with Disabilities Act (ADA), which protects disabled workers. In addition, the Health Insurance Portability and Accountability Act (HIPAA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA) have