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Working after a Diagnosis of Metastatic Disease

Posted 2/18/2016

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  First, and most importantly, this is an individual decision, and there is no single right answer. Whether or not it is wise and/or possible to work with metastatic cancer depends entirely on the individual medical situation, the treatment, and the work place. It also is a decision that must be fluid and open to reconsideration, probably time and time again.

  Sometimes the answer is very clear: if you are very ill, and the treatments are debilitating, and there are many medical appointments, it is pretty impossible to sustain a work life. In those circumstances, it is helpful if it is possible to take a medical leave or go out on Disability. If nothing else, this kicks the decision can down the road, enables you to take time to, hopefully, have physical things settle down a bit and to begin the difficult psychological adaptation. Sometimes the answer is clear in the other direction: the cancer, although the diagnosis is scary, is not an acute big problem, the treatment is not so bad, and the work is important for many reasons: feeling normal, maintaining a place in the world, finances.

  Probably about half of the people whom I know who are living with advanced/metastatic cancer are continuing to work. Sometimes schedules have needed to be changed, and it surely requires an understanding manager as there are certain to be some absences for appointments. There is also the very big question about what to tell people at work. In the beginning, there is no absolute necessity to say anything. Even if the diagnosis of metastatic disease comes with the need to be out for a short period of time, you don't have to share any details. When you return, there is a decision re how much to disclose.

  I have known people who were completely comfortable being very honest with their manager and a few close colleagues, and that is likely the best possible scenario. Others were afraid to share information about their diagnosis, fearing there would be discrimination and, perhaps, pressure to leave. I am thinking of one woman who continued to work although it was pretty obvious that she was too ill to successfully maintain her demanding full time job. Her manager was aware of the legal limits, but kept making small changes to her job responsibilities to make it less and less attractive. My patient was quite unhappy about this, felt mistreated, but wasn't dealing with the very difficult realities of advancing illness. Eventually she decided to retire, but it was an unhappy departure.

  This is an excellent article from Cure Today about some of these issues:

Getting Back to Work After a Diagnosis of Metastatic Cancer

Returning to work following cancer treatment is a topic that is extensively covered on survivorship blogs and websites. Working while undergoing cancer treatment has not received as much attention, and even less attention has been given to people who continue working after being diagnosed with metastatic cancer. In most cases, people with metastatic disease have a limited life expectancy
and often are advised to leave their jobs so that they can focus on treatment and activities other than work, such as travel and spending more time with friends and family.
A research team from the University of Wisconsin-Madison analyzed the Eastern Cooperative Oncology Group’s “Symptom Outcomes and Practice Patterns (SOAPP)” study data to identify factors associated with employment changes among people with metastatic cancer. A surprising finding was that among the 668 people in the analysis, 236 (35 percent) worked full- or part-time.
Better performance status and non-Hispanic white ethnicity/race were associated with continuing to work despite a metastatic cancer diagnosis. Interestingly, the type of cancer, type of cancer treatment, and time since diagnosis did not affect employment status.
The researchers noted that their data raise a number of unique survivorship issues that have previously been overlooked. Whether working by choice, necessity, or both, working provides social interaction and support, and may serve as a distraction from cancer symptom burden. A high burden of symptoms was the most likely factor that caused people to leave their jobs. Fatigue, drowsiness, memory and cognitive impairment, and numbness were the most common symptoms that prompted termination of employment.

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