WHAT'S NEXT: BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?

Once your cancer treatment is complete or nearing completion and you've been cleared to return to work, at least part-time, more challenges await. Here, what you need to know about how your cancer history may affect you on the job and how to take full advantage of the protections afforded you under the law. Our panel of experts: Page Tolbert, a social worker at the Memorial Sloan Kettering Cancer Center's Post-Treatment Resource Program, New York; Randye Retkin, an attorney and the director of LegalHealth, part of New York's Legal Assistance Group; Kimberly Calder, manager of Health Insurance Initiatives for the National Multiple Sclerosis Society; Barbara Hoffman, an attorney and the founding chair of the National Coalition for Cancer Survivorship.

Easing back into the routine
After you return to work, you will probably need to take time off for follow-up visits and checkups, or maybe for remaining chemotherapy sessions. Be aware that you're entitled to the benefits of the Family and Medical Leave Act (FMLA) if you work for a company with 50 or more employers. Under that law, you can take the leave in small increments, even as little as one-hour blocks of time. It's explained in more detail at http://www.dol.gov/esa/whd/fmla. If you work for a company with fewer than 50 employees, you might still be covered for medical leave under a state law. Check with your HR department, or your state labor department.

Your cancer history and your insurance
If you were employed and had health insurance before the diagnosis of cancer, took approved time off, and are back to work, there will be no effect on your group health insurance at all, experts say. If you are covered by a group plan, you can't be singled out for your cancer history. Your premiums can't go up higher than others' premiums, and you can't be dropped from the group plan due to the cancer. The federal law known as HIPAA (Health Insurance Portability and Accountability Act of 1996) protects the rights of people in group health plans. See the details at the government website, http://www.hhs.gov/ocr/hipaa/

Are you being treated fairly?
Legally, your cancer history can't be used against you in the workplace. But it can be difficult to determine if your cancer history is being used unfairly, because discrimination can be subtle. Some hints: If someone clearly less qualified is promoted, you should suspect the cancer history. If you hear disparaging comments, you are being treated unfairly. One woman (who filed a lawsuit) told of the day the office staff had to exit the building during a blackout and her boss said others should just follow her, since her radiation therapy made her glow. If tasks you used to do competently are being given to someone else, that might be a clue your supervisor thinks you're not as capable. If your assignments or projects are not as challenging or time consuming as they were before your cancer treatment, that might be a clue. But the evidence is very "fact-specific" for each workplace situation. Fortunately, most employers are savvy enough to know they have to watch their step when dealing with employees or potential employees with health problems. And as more employers experience cancer and other serious health problems in loved ones, many are growing more compassionate towards employees with a cancer history. Conditions may be improving, in a study published in 2004 in the Journal of the National Cancer Institute, researchers surveyed more than 1500 women, including 646 breast cancer survivors, and found "little evidence" that survivors faced discrimination at work due to their cancer history.

What to do if you suspect discrimination
First, discuss the situation with your boss, if you can. He or she might be trying to lighten your load and have the best of intentions. Decide first if that is the case. You might simply ask, in a cordial tone: "Are you trying to make it easier on me? I appreciate that, but I'd welcome the challenge of travel to meetings again." If your talk with your supervisor doesn't solve the problem, go next to your HR department and discuss the situation. If you can negotiate and solve the situation informally, that's better and cheaper than getting a lawyer. Your HR person may have a talk with your boss and resolve the situation quickly. If you do need to take legal action, first sit down and focus on what your goals are--Back pay? To get back your former assignments or clients? Promotion? To stay at the company or not? With those in mind, you can proceed with a clearer head. And your efforts will be more focused.

Moving to another company
Perhaps you're unhappy enough to look for another job, you've decided to go after your "dream job" or you just have an opportunity for an interview with another company. Going on a job interview is always challenging, but if you have a cancer history it might be more so. If you decide to look around for a new job, experts recommend squashing that natural urge some cancer survivors have to talk about it, at least right away, with a potential new employer. Also, you should know that your potential new employer does not have the right to ask about your medical history. The employer only has a right to know if you are qualified to do the job. Legally, potential employers are not supposed to ask about your health, but if they do, answer as of that day. And if you're well enough to be at a job interview, your health could definitely be described as good. Further into discussions, you may need to tell a potential new employer that you will need an accommodation, if that is the case. But that discussion can wait even until after you get the job offer Nail the job first, experts suggest. Then, if you will need, say, an afternoon off every three months for follow-up care, mention it then, before you accept the position.

Presenting yourself well
You can put a positive spin on things, as all job hunters try to do. One woman, after her cancer treatment, stayed off the job awhile but helped her church computerize their office. Her counselor asked if someone there might vouch for her work, and say that she had been a consultant for them. And that worked out fine. Keep the focus on your present ability to work. Legally, that is all a potential employer has a right to know. During the job interview, keep the focus on yourself as a job applicant, and the best one they will interview, not on yourself as a cancer survivor. Not telling may be hard for some cancer survivors, who often feel they have a "guilty secret." Experts advise you to get over that apologetic, confessional feeling. Of course, there are always exceptions to these guidelines. Some bold cancer survivors have gone to a job interview and said, "Hey, I made it through cancer." Their upbeat attitude is, If I can handle cancer, I can handle this job and all its challenges. Experts say it takes a certain type of person to pull this off but that you know who you are.

Handling the paperwork and ticklish questions
While you don't have to share your cancer history, you can't lie about a gap on your resume. While potential employers legally can't ask, "Did you have cancer?" they can ask "What about this gap in your resume?" Still, you can be discrete but truthful. Something like: "I had family issues that are now resolved" Or "I had medical issues that are now resolved" is truthful and provides enough information.

Insurance if you switch jobs
Even if you leave one group health insurance plan, you have protection in transitioning to another group plan. Another law called COBRA (Consolidated Omnibus Budget Reconciliation Act, passed in 1986) provides continuation of group health coverage that might otherwise be terminated. It offers the right to temporary continuation of health coverage under certain conditions. For questions and answers, visit the U.S. Department of Labor page that addresses COBRA at http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html. If you decide to switch jobs, plan for your health insurance transition. Inquire first about COBRA. Understand when it starts and ends, how much it will cost you (typically expensive since you will be paying both employee and employer portions), and if you have dependents whether they too are covered. Trying to get health insurance on an individual basis can be more difficult if you have a cancer history, especially if your treatment has occurred in the past five years. While it may be tempting to omit the cancer on an application for insurance, do not. That is fraud, not worth the risk, and dishonest. Ask your HR person or insurance representative about preexisting conditions under the group health plan and how they are handled. Under HIPAA, limits have been set for excluding pre-existing conditions, the period during which a specific medical problem may not be covered.

Setting the tone
If you can set the tone as a relaxed, confident cancer survivor, chances are those around you may be less uptight, too. If you can see your return to work as a major step forward in your recovery, that will affect your attitude in the most positive way, too.