Managing Work and Metastatic Disease

Returning to work following cancer treatment is a topic that is extensively covered on cancer survivorship webpages. 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%) 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.¹

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.

These study findings remind us all to not assume that people diagnosed with metastatic disease will want to quit work, and instead are a call to action to reframe our initial assessment. We need to ask patients with newly diagnosed metastatic disease how they view and value their work, including work around the home. We also need to discuss the expected course of disease and how their jobs could be impacted. For those who choose or need to continue working, we need to identify ways to manage treatment- and disease-related symptoms. We also need to support our patients emotionally, especially those who closely identify themselves with their work. Helping people find meaning in their lives is critical during this time.

In addition, from a practical standpoint, we need to examine how our treatment facilities are supporting (or not supporting) people who continue to work during treatment. This not only includes the people with metastatic disease, but anyone undergoing cancer treatment who continues to work. Although many prefer to receive treatment on a Friday afternoon, far too many treatment facilities have policies that prohibit treatment after a set time, such as 2 PM. Very few have treatment appointments after work on Friday evening—a time that many working people prefer.

Our patients also may have questions about workplace rights and discrimination, which is a topic that few nurses or even physicians are able to accurately and comprehensively address. Referral to social services is helpful, but these services may not be available in some practice settings, such as small office practices. There is information available online through Cancer and Careers

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the American Cancer Society, LIVESTRONG, and Equal Employment Opportunity Commission websites. Providing patients with information about their legal rights empowers them to make informed decisions about work-related questions and concerns.

These new research findings that suggest at least one-third of our patients with metastatic disease continue to work merit changes in the way in which we assess our patients, when we administer treatment, and how we support these patients. We must not assume that the diagnosis of metastatic disease is reason enough to advise patients to stop working.

Tevaarwerk AJ, Lee J, Terhaar A, et al. Working after a metastatic cancer diagnosis: factors affecting employment in the metastatic setting from ECOG-ACRIN’s Symptoms Outcomes and Practice Patterns study. Cancer. 2015;122(3):438-446.

Lisa Schulmeister, MN, RN, ACNS-BC, FAAN is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.