Balancing Work and Cancer Treatment

One of the challenges of living with cancer, especially during treatment, is finding the right balance between work and personal life. Suddenly, our personal lives don't only mean time with family and friends, but also necessary hours for appointments and naps.

Taking Time Off from Work

Most people find that they need to take some time away from work. There is wide variability in how much time away is necessary or helpful. Depending on your course of treatment, you may need anything from a couple of weeks to six or more months of leave.

Career Field and Job Role Factors

In addition to the time dictated by medical/physical necessity, there are other factors that influence this decision. Where you work and what you do 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.

Financial Considerations

Additionally, there are the financial realities. It is helpful 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?
• Will you only be paid for days you work? If so, the pressure is even greater.

If finances will be a problem for you, speak with an oncology social worker who can tell you about possible sources of assistance. There are some grants and assistance available, but it is not likely that anything will match your usual salary.

Deciding What's Best for You

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 are scheduled, it will be easier then to make the decision.

Remember that although everyone is different, most people react in a predictable way after each chemo cycle. We talk about the possibility of a 10-20% swing each time, meaning you might feel that much better or worse. It is not likely to be vastly different cycle to cycle. Remember, too, that the harder days may not be the day right after chemo, but the days a bit later. If you can go through it once, you will have a pretty good idea how your body is going to react.

Do not listen to anyone else's advice about your work decisions. This is an area where there is a 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 After Being Absent

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 differently 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 regarding talking about your cancer. Would you prefer to tell your story repeatedly or would you prefer that others say only: "Glad you are back." and leave it to you to say more or not? We have different reactions to this issue, and it will help to think about it before your return. The more concrete you can be with your requests, the more likely it is to go smoothly.

Unfortunately, you can count on being ambushed by at least one thoughtless remark. Be prepared, when someone tells you about her neighbor who died of cancer or asks a too personal question about your treatment 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.