Despite laws allowing portability of health insurance (see section on health insurance below), individuals with a history of cancer report in recent studies of being afraid to change jobs because of concerns about continuation of health insurance. More than 25 percent of cancer survivors in Short and colleagues’ recent study expressed such fears (Short et al., 2005a). Most individuals returning to work appear to inform their supervisors and colleagues of their cancer for both personal and work-related reasons. Relatively few (5 percent) cancer survivors faced on-the-job problems from an employer or supervisor directly related to their cancer, according to survey research conducted in the early 1990s. However, at this time, 4 percent of cancer survivors employed before their diagnosis said they were fired or laid off from their jobs because of their cancer.
Population-based, prospective cohort studies with adequate control groups are needed to better understand the effects of cancer on employment and in order to observe transitions in and out of the work force over time following diagnosis. Also needed are studies of work-related outcomes other than employment status alone (e.g., full-time versus part-time, job mobility, limitations in ability to work) and systematic assessments of employment differences among cancer survivors, as well as between cancer survivors and noncancer control groups. Efforts to identify remediable risk factors and interventions to ameliorate the deleterious effects of cancer on employment are also needed. Investigators have proposed a conceptual model of work after cancer and have defined important work outcomes that should be monitored to improve our understanding of the relationships among cancer, quality of life, and work outcomes (Steiner et al., 2004).
Although cancer survivors do not have an unqualified right to obtain and retain employment, they do have the right to freedom from discrimination and to be treated according to their individual abilities. Four federal laws—the ADA, the Family and Medical Leave Act (FMLA), the Employee Retirement and Income Security Act (ERISA), and the Federal Rehabilitation Act—provide cancer survivors with some protection against employment discrimination.
The Americans with Disabilities Act of 1990 prohibits certain employers from discriminating against individuals with disabilities (see Box 6-2). A qualified individual with a disability is protected by the ADA if he or she can perform the essential functions of the job. Under the ADA, a disability is a major health impairment that substantially limits the ability to do