Returning to Work
Most women who are treated for breast cancer take some time off from work. There is wide variability in how much time away from work is necessary or helpful. Someone who has "only" a wide excision may need just a few days to recover from the surgery and may be able to plan daily radiation treatments that don't interfere too much with a work schedule. Another woman who has a mastectomy and reconstruction, followed by chemotherapy, may need at least six months away from her office.
In addition to the time dictated by medical/physical necessity, there are many other factors that influence this decision. The kind of work and job site matter a lot. If you teach kindergarten, you likely will be worried by the constant physical demands and the exposure to every possible germ and virus known to five year olds. If you work in construction, you can't be on the job until you have completely regained full physical strength. If you work in an office, the attitudes of your supervisor and colleagues will influence your planning. A manager who is flexible, understands your need for doctors' appointments, and allows you to work shorter days when you are not feeling too well may make it feasible to work through much of treatment.
Additionally, there are the financial realities. It is helpful, during the early days of your diagnosis, to speak with someone in HR to explore the benefits available to you. Do you have short-term disability? What happens to your insurance during a leave? (Although company policies vary, usually your contribution towards insurance remains the same for the duration of short-term disability.) If you only are paid when you work (whether you work for someone else or for yourself), the pressure is even greater. If income and budget will be a problem for you during your treatment, do speak with an oncology social worker (ask your doctor for a referral) who can tell you about possible sources of assistance.
My best advice, if you have choices about work, is to not make a decision too quickly. Certainly, you will need some time to recover from surgery. Beyond that, it is impossible to generalize and hard to predict. If you can wait to see how you react to chemotherapy or when your radiation appointments will be scheduled, it will be easier then to make the decision that is right for you. As a general statement, women tend to feel the worst on days 3, 4, and 5 after chemo. That is, if you are treated on a Wednesday, your harder days will be Friday, Saturday, and Sunday. Think about this when you schedule your treatment. Would you rather be sickish during the week or on a week-end?
Very important advice: Do not listen to everyone else's opinion about your working. This is an area where there is a whole lot of projection, judgment, and values--often without consideration for your particular physical, emotional, and financial realities. Only you know what is possible and whether it would be better for your psychological health to be home, away from any professional stresses, or whether you would be better off with the normal distractions of the workday.
Returning to work is also tricky. If you have been away for a while, you will have to face others' questions, stories, and sidelong glances. You likely look different, in this case, than you did the last time they saw you. I have had many conversations with women who could not decide whether they should wear a wig to work or go without, sporting the new short hair that looks so different from their old self. It can be helpful to speak with one or two people and ask them to ease your return by telling others what you look like and what your wishes are re talking about your cancer. Think about this. Would you prefer to tell your story over and over or would you prefer that others say only: "Glad you are back." and leave it to you to say more--or note. We have different reactions to this issue, and it will help you to consider your wishes before your return. The more concrete you can be with your requests, the more likely it is to go smoothly. No matter what you say, however, you can count on being ambushed by at least one thoughtless remark. Be prepared, when someone tells you about her neighbor who died of breast cancer or asks if you lost a breast, with my best all purpose response: "Why would you ask me that?" Note carefully: to use this line most effectively, you have to pause for a moment, look thoughtful, and then ask in a puzzled, not an angry, way. Done correctly, it works every time.
My final advice about returning to work is to try to negotiate a gradual re-entry. If you can work part-time for the first week or two, it will be easier. You will be surprised by your physical and emotional fatigue as you return to your job. Going for less than full days is easier for many women than going fewer than five days/week. Again, you know best what is possible in your position and what seems right for you.