Survivorship Series: The Workplace

An individual is considered a cancer survivor from the time of diagnosis throughout treatment and the remaining years of life.

There are an increasing number of lymphoma survivors each year. Current data show 88 percent of patients with Hodgkin lymphoma (HL) and 73 percent of patients with non-Hodgkin lymphoma (NHL) are still alive five years following their diagnosis. Better diagnostic tools and more effective treatments are associated with improved survival rates; however, the challenge now facing many survivors is how to achieve long-term quality of life after treatment has ended.

While your history with lymphoma may make it challenging to re-enter or adjust to the job market, employment laws prevent employers from treating you differently based on your diagnosis. You can protect yourself from discrimination in the workplace by knowing your legal rights. Below are some of the top concerns lymphoma survivors may have about the return to their workplace and a summary of employment discrimination laws.

Work can help survivors fulfill financial and social needs and provide a sense of getting back to normal. However, your history with lymphoma may make it difficult to re-enter the job market. Survivors have reported dismissal, failure to be hired, demotion, denial of promotion or benefits, undesirable transfer, and hostility by co-workers. You can protect yourself from employment discrimination by learning about your rights in the workplace. In general, you are not required to disclose your lymphoma diagnosis to an employer or potential employer. While there are some instances where you may have to provide some medical information (see below), you choose when and how much you want to disclose. If you are qualified for the job, employment discrimination laws prevent an employer from treating you differently based on your history with lymphoma.

The Americans with Disabilities Act (ADA)

Eligible individuals with disabilities are protected under the ADA in all stages of employment (application and interview, job offer, and on the job). Title I of the ADA prohibits discrimination against individuals with disabilities and care partners in the workplace and applies to private employers with 15 or more employees and all state and local governments. Federal employees have similar protections under the Rehabilitation Act of 1973.

To be covered by the ADA, an employee must:

• Be qualified for the job: able to perform essential functions with or without reasonable accommodations.
• Have a disability: physical or mental condition that substantially limits one or more major life activities (activities that an average person can perform with little or no difficulty). These can be physical (breathing, hearing, seeing, talking, walking, other motor movements), mental (concentrating and learning) and social/professional functions (working or caring for oneself).

Under the ADA:

• An employer cannot ask you about existence, nature, or severity of cancer and you do not have to disclose that information prior to receiving a job offer.
• An employer may make medical inquiries, require exams and ask cancer-related questions after a job is offered as long as this applies to all persons in the same job category. At this stage and if asked, you must provide that information.
• Eligible employees can request reasonable accommodations like a flexible work schedule to attend medical appointments/ treatment or a change in job tasks. To request these adjustments under the ADA, you need to disclose some medical information to your supervisor or human resources department. Your employer can ask for medical documentation from a health care provider to confirm the need for an accommodation. However, your employer does not necessarily need to know about your cancer diagnosis if you are not willing to share that information.

Each state has laws to regulate employment discrimination, some of which clearly prohibit work discrimination based on a medical history of cancer. It is important to be familiar with your state laws on this matter. Check with your state’s employment agency for more information or visit triagecancer.org/employment-state-laws.

To learn more about the ADA, consult the Job Accommodation Network (call 800-526-7234 or visit askjan.org) and the Equal Employment Opportunity Commission (call 800-669-4000 or visit eeoc.gov).

Family and Medical Leave Act (FMLA)

The FMLA entitles eligible employees to take an unpaid, job-protected leave for a serious health condition and applies to private employers with 50 or more employees and all state, local, and federal government. This leave applies if you have a serious health condition and are unable to perform the essential functions of your job or have to be absent from work to receive medical treatment. While on FMLA leave, the employer continues to provide you with health insurance. To be protected under the FMLA, you must have:

• Worked for a covered employer for at least 12 months.
• Worked at least 1250 hours in the 12 months preceding the leave.
• Worked at a location where the employer has at least 50 employees within 75 miles.

If eligible, you are entitled to 12 workweeks of leave in a 12-month period. You must request leave 30 days in advance if foreseeable, or notify your employer as soon as possible otherwise.

To learn more about the FMLA, contact the Wage and Hour Division office nearest you (visit dol.gov/agencies/whd) or visit the FMLA website (dol.gov/agencies/whd/fmla).

COBRA

COBRA gives workers who lose their health benefits the right to keep employer insurance for limited periods of time after voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. This law applies to private employers with 20 or more employees in the prior year, and state and local governments. Federal employees also have access to similar protections under another law.

Under COBRA, you and your dependents may keep insurance coverage for up to 18 months if:

• Your employer’s health insurance plan is covered by COBRA.
• Your employment ended for reasons other than for gross misconduct.
• Your working hours are reduced.

Many states have passed State Health Care Continuation Laws (“Mini-COBRA” laws) that give similar benefits. Depending on the state, these laws may extend COBRA insurance for longer than 18 months and apply to an employer with less than 20 employees. Visit triagecancer. org/health-insurance-state-laws#hioptions to find out if your state has a Mini-COBRA continuation law and if you are eligible.

To learn more about COBRA, visit the US Department of Labor website (dol.gov).

Disability Insurance

If you are unable to work due to your medical condition, disability insurance may be an option to maintain income. Disability insurance is available from the federal/state government or through private insurance companies.

Federal programs include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). These programs apply to people whose disability has lasted (or is expected to last) for at least one year or will result in death, are unable to do their jobs and cannot adjust to a new job. The SSDI program pays benefits to you and certain family members if you worked long enough (and recently enough) and paid Social Security taxes on your earnings. The SSI program applies to adults and children with disabilities who have limited income and resources. For more information on federal disability programs consult the Social Security Administration (call 800-772-1213 or ssa.gov).

Short-term state disability insurance (6-12 months) is offered in some states (California, Hawaii, New Jersey, New York and Rhode Island) and the territory of Puerto Rico. Depending on the state program, you may be able to benefit from state and federal insurance. More information is available below:

• California: call (800) 480-3287 or visit edd.ca.gov
• Hawaii: call (808) 586-9188 or visit labor.hawaii.gov/dcd/home/about-tdi
• New Jersey: call (609) 292-7060 or visit nj.gov/labor
• New York: call (800) 353-3092 or visit wcb.ny.gov
• Puerto Rico: call (787) 754-5353 or visit trabajo.pr.gov
• Rhode Island: call (401) 462-8420 or visit dlt.ri.gov/tdi

Keeping your information in one location can help you feel more organized and in control. This also makes it easier to find information pertaining to your care and saves valuable time. The Foundation’s Lymphoma Care Plan document organizes information on your health care team, treatment regimen, and follow-up care. You can also keep track of health screenings and any symptoms you experience to discuss with your health care provider during future appointments. The Lymphoma Care Plan document can be accessed by visiting lymphoma.org/publications.

The Foundation also offers a variety of educational activities, including live meetings and webinars for individuals looking to learn directly from lymphoma experts. These programs provide the lymphoma community with important information about the diagnosis and treatment of lymphoma, as well as information about clinical trials, research advances and how to manage/cope with the disease. These programs are designed to meet the needs of a lymphoma patient from the point of diagnosis through long-term survivorship. To view our schedule of upcoming programs, please visit lymphoma.org/programs.

The Foundation’s Lymphoma Resource Center staff are available to answer your general questions about lymphoma and treatment information, as well as provide individual support and referrals to you and your loved ones. Callers may request the services of a language interpreter. The Foundation also offers a one-to-one peer support program called the Lymphoma Support Network and clinical trials information through our Clinical Trials Information Service. For more information about any of these resources, visit our website at lymphoma.org, or contact the Lymphoma Resource Center at (800) 500-9976 or [email protected].

Para información en Español, por favor visite lymphoma.org/es. (For Information in Spanish please visit lymphoma.org/es).