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Colorectal Cancer: In Treatment: At Work: Stage IV

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It may help get through treatment if you keep in mind that colorectal cancer does not have a negative long-term impact on the careers of most people. There may be problems in the work place in the short term, but they do not generally affect the long term.

If You Haven't Told About Your Condition At Work

  • Be cautious about telling now. 
    • There is no legal obligation to tell as long as your condition does not endanger other people. 
    • Cancer may cause co-workers to feel uncomfortable around you. On the other hand, there are many, many stories of co-workers who pitch in to help, including providing sick days for a co-worker’s use and taking food to co-workers at home.
    • If your work situation isn’t a good place to talk about your illness, perhaps your best option is to be discrete about your health condition. On  the other hand, it may be very difficult to keep a secret if you need time off to take your treatment or you may need an accommodation (a change) at work because of treatment side effects. For instance, if you have fatigue, you may need rest time. If you have diarrhea, you may need to work near a bathroom. If you are undergoing chemotherapy and get a fogginess or forgetfulness (commonly referred to as "Chemo Brain") you may need to have deadlines extended. If you have an ostomy it may need attention at work. 
    • Filing a claim with an insurance carrier does not automatically trigger disclosure of what is wrong with you. In most situations, the insurer and the company’s benefits department are specifically prohibited from such disclosure.Many companies  have a system under which you can send your claim directly to the insurer.
    • If you have not told your employer or co-workers about your condition yet, think about whether to continue to keep it a secret. The greater the secret and the longer you keep it, the greater the stress.
    • For help in determining whether to tell, and if so, who to tell, look for an advisor at work, someone who has an understanding of the culture of your workplace and will keep your discussions and information confidential. For information about advisors at work, including tips about how to choose one and how to start the conversation, click here.
  • If you do decide to tell, think about:
    • First consider who to tell. 
      • An employer must keep the information confidential. For more information, see Americans With Disabilities Act.
      • When thinking about who to tell in human relations please keep in mind that it is better to tell a supervisor in human resources rather than a lower level person. Supervisors are more likely to know about and honor the confidentiality requirement. Remind him or her that you expect this information to remain confidential -- at least until you have a chance to decide who you want to tell and when. For more information, click here.
      • There is no similar restriction on co-workers so what you tell co-workers is not confidential information. For information about telling co-workers, click here. 
    • You may need to tell your employer and likely your co-workers if:
      • You will need time off beyond what you are entitled to as vacation or personal time, or you need an accommodation at work to permit you to do your job while undergoing treatment.
      • You need an accommodation such as moving closer to the bathroom or shifting some of your work to co-workers for a while. 
    • It may help determine whether to tell if you read: How To Determine If An Employer Is Friendly To People With Cancer.. 

Protection Against Discrimination Because Of Your Diagnosis

  • The Americans With Disabilities Act (ADA) and similar state laws provide protection against discrimination and require reasonable accommodations to allow people with a disability to do their work.
  • Colon and rectal cancer are not always considered to be a protected disability. In order to be considered to be a disability under the ADA, the condition must be substantially limiting.
  • You have to disclose your condition to be protected by the ADA and even by a union. If your treatment interferes with your job and you have not disclosed your condition, you can be fired. NOTE: Even if the ADA does not apply to your employer, act as if it does. You have nothing to lose and everything to gain.
  • It is not advisable to get into a legal battle if you can possibly avoid one. As a practical matter,
    • If an employer says that the law doesn't apply to you, an alternative is to remind the employer of the effect on other employees and potential new employees if word gets out that the employer discriminates against people with cancer.
    • Whether you are protected by the law or not, you have to negotiate for an accommodation. Accommodations are not granted automatically. To learn how to request and negotiate for an accommodation, see: Work: How To Request  And Negotiate An Accommodation
  • "Just in case," start keeping track of facts that would be relevant to a discrimination claim.Include good things that happen such as when you receive a pat on the  back.Include anything that could be considered to be discrimination. Enough facts can create a pattern. A good place to keep track is in a work journal.
  • If you believe you have a discrimination claim, the EEOC offsite link is there to help for free (in addition to private alternatives). For more more information, see our article about the Americans With Disabilities Act. 
  • It is advisable to negotiate for what you need. If you do not ask for an accommodation, and your work suffers, you can be fired. 

If you Need To Take Hours, Days Or Weeks Off From Work

If you need to take time off work because of your treatment or side effects, you may be entitled to the time under any of the following concepts:

  • As an employer based benefit such as sick time, vacation time or personal time.
  • As a matter of right under such laws as the Family and Medical Leave Act (FMLA) which provides for unpaid time off and laws such as the Americans Disabilities Actunder which the time may be considered to be an accommodation to which you are legally entitled (possibly with pay). 

If you will need time off:

If You Need Changes At Work To Permit You To Do Your Job

Before you ask for changes at work to permit you to do your job, it is advisable to do the following:

  • Make note of everything you do on a daily basis, including deadlines. It can be as simple as keeping a written log of what you do each day as you go through the day so you don't forget anything.
  • Make a list of current projects and foreseeable next steps.
  • Think about what could be postponed or given to other people.
  • Note important dates when things have to be done.
  • If you haven’t disclosed your cancer to your employer, talk to your boss or a supervisor in human resources as soon as possible. Even if you are protected under the Americans With Disabilities Act and similar laws or even a union, there is no protection until your employer is informed of your situation.

Negotiate for what you need to permit you to work while going to treatment and medical appointments and dealing with side effects:

  • Think about specific accommodations that would work for your needs, including alternatives. In addition to thinking about what would work for you, balance your employer’s needs.
  • Examples of reasonable requests to permit you to work while undergoing colorectal cancer treatment:
    • Leaving work early on Fridays for chemo treatments.
    • Starting the work day later to accommodate radiation treatments.
    • Working from home all or part of the week. (See Work: At Home)
    • Sharing work with someone else.
    • Extending deadlines.
  • All accommodations involve a negotiation with your employer. Learn how to negotiate for what you need. (See: Work: How To Request And Negotiate An Accommodation)
  • Keep notes of what happens during every discussion with your employer about your condition and needs. Include name of person, date, what was discussed. Include your impressions and examples of facts which led to your impression. You may need this information in case you later need to file a discrimination claim under laws such as the Americans With Disabilities Act.

For additional information, see:

How To Review Employer Benefits In Light Of Your Diagnosis

Benefits may look different to you from the point of view of a person who has been diagnosed with Stage IV colon or rectal cancer. For instance:

  • If you have a tax advantaged savings account such as a Health Savings Account, now is the time to take full advantage of it. The Survivorship A to Z article about Health Savings Accounts shows you how.
  • Increase the amount of your life insurance if you can. 
    • You can purchase life insurance during open enrollment periods when no health questions are asked.
    • Even if your beneficiaries do not need the money, you can get money from a life insurance policy while alive if your life expectancy becomes shortened. A sale is through a process known as a Viatical Settlement or a Life Settlement. 
  • If you become eligible, it is worth considering purchasing disability income nsurance and/or long term care insurance. Your health condition makes it more likely that something else may happen in the future.. 
  • During open enrollment periods, look at health insurance alternatives from the point of view of a person with cancer. Survivorship A to Z's Health Insurance Evaluator helps you compare policies from such a point of view.

NOTE: If finances are a problem, look at the Survivorship A to Z information about dealing with a financial crunch. It provides information from the point of view of a person living after a diagnosis. 

How To Prepare At Work For The Future

Despite current medical knowledge and advances which are constantly being made, it is possible that at some point you will want to stop work or possibly have to.  “Just in case,” it is advisable to start being prepared. There are steps to take in the short term and steps to take for the longer term. Also see: Leaving Work Because Of Disability: The Steps To Take.

If you may need to stop work in the near future:

  • Learn about the disability income sources to which you may be entitled.
    • Check benefits at work. If you don't have an employee handbook, ask a supervisor in human resources about your benefits. 
    • Speak with your advisor  to find out if your employer has any informal policies about disability. Some employers provide disability income in some circumstances even though it is not in the handbook.
    • Look at the requirements for obtaining Social Security Disability Insurance (SSDI). While SSDI is a government program, you are entitled to the benefits because you paid premiums from withholding.
      • If you are going to apply for SSDI, keep in mind that only one third of applicants for SSDI are awarded an income.
      • Survivorship A to Z provides easy-to-use information for applying as an educated consumer that makes it more likely to get a "yes."
    • See if you qualify for Supplemental Security Income (SSI).
  • If you have health insurance through work, you will be entitled to continue it under laws generally known as COBRA.


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