What to Consider When Deciding Whether to Continue Working With MBC

There’s a lot to process after you’ve been diagnosed with metastatic breast cancer (MBC) — learning how to navigate your new normal, for one. And, figuring out the next practical steps, including whether to keep working as you go through treatment. Just remember, this isn’t always a black-and-white decision.

Depending on your circumstances, you may opt to work part-time or change to a more flexible schedule. Or, you may feel differently about your work situation as you continue treatment. “There is no one decision that can apply to everyone,” says Christina Annunziata, MD, PhD, a senior vice president of extramural discovery science for the American Cancer Society who’s based in McLean, Virginia. “Each person is living their own unique life, and decisions must be tailored to the individual’s situation.”

4 Factors to Consider When Deciding to Stay on the Job With MBC

While your first reaction may be to quit your job, you don’t necessarily have to act on it. “There’s no need to make that [work] decision in the moment of initial diagnosis,” says Sally Joy Wolf, a corporate well-being adviser and speaker based in New York City who has had MBC since 2018. “It’s impossible to know how you’ll feel on your treatment plan until you begin. So, I always advise others to focus on health first and let that inform how they approach work.”

Whether or not you’ll want to work depends on many factors, such as:

• Prognosis: Someone with a shorter prognosis may choose to stay out of work to spend time with family and friends. For others, targeted treatments allow them to continue to live and work with minimal disruptions, says Dr. Annunziata.
• Side effects: “This is perhaps the most influential on whether someone chooses to work,” says Annunziata. For instance, if you are going through chemo that lowers your white blood count, you may be susceptible to infection. If the chemo reduces red blood cells, you can have extreme fatigue. Some oral treatments can cause nausea and diarrhea. All of these side effects may affect your ability to work or prompt you to ask to work at home as you go through treatment.
• Financial stability: You may want to keep working to continue getting health insurance, pay medical bills, and support your family. “It is important to talk with social workers at the doctor’s office. Also, consult with your human resources at work. This will help determine what options exist for disability leave, if needed,” says Annunziata. Nurse navigators at local clinics can also help you identify resources for financial assistance.
• Physical and mental well-being: If you enjoy your job, staying at work can help you feel productive and give you purpose. In 2020, Wolf was laid off from her full-time job and decided to start her own business as a corporate well-being consultant. In addition to a flexible schedule, she appreciates working with companies who value well-being. However, “If the work is stressful and unenjoyable, this can cause worse fatigue, decrease a person’s quality of life, and also decrease the tolerability of the treatment itself,” says Annunziata.

“I would never tell someone to work or not, so as to honor what feels right to them. And, once they decide what that is, then they can figure out more of the practical details to set themselves up for success,” Wolf says.

What to Disclose to Whom

While you don’t have to disclose your MBC diagnosis and treatment plan to your employer, doing so can help you work together to find the best way for you to continue on the job. It’s also a good idea to get your oncologist to help. “The person with MBC should inform their employer that MBC is an illness that requires constant treatment to control it,” says Annunziata. “The treatments vary in what side effects may occur, and these should be written down by the treating doctor to facilitate communication.”

Talk to your human resources department to discuss accommodations recommended by your doctor, such as flexible work hours, working from home, or any short- or long-term disability benefits that might be available.

Be honest with your supervisor about how much time away you’ll need for your treatment, once you know. For the first three months of her treatment, Reena Wade, 48, who is an in-house attorney for a pharmaceutical company in Madison, New Jersey, and was diagnosed with MBC in 2018, decided to take Thursdays off for treatment and work from home on Fridays. That gave her the weekend to recover.

As for your coworkers, what you want to share with them is completely up to you. “I was pretty transparent with my boss, but not with the rest of my very small team or anyone else at the company,” says Wade.

Wolf took the opposite approach. “My personal opinion is that the more transparent we are about things that we need, the better off the teams or bosses or colleagues can be at supporting us,” says Wolf. “While it’s vulnerable to share something as personal as a cancer diagnosis, it also can be really helpful, because your [work] team can support you.”

Tips on Working During MBC Treatment

Once you’ve talked to the appropriate people at your job, it’s time to decide what working life looks like for you — and that’s different for everyone. “I personally wanted to continue working, because it represented normalcy to me, as well as a place to focus my mind on something other than the cancer,” says Wade.

If you do decide to keep working, consider these strategies to help stay productive and energized:

1. Make adjustments based on how you feel during treatment. Wolf finds that early mornings are tougher on her body, due to her medications, so she rarely schedules meetings before 10:00 a.m. “Listen to your body and how your body reacts to the treatment, and be open to changing your mind from whatever decision you’ve made,” adds Wade.
2. Schedule oncology appointments when they work for you. You might schedule doctor’s appointments at the very beginning of the day or go at the end of your workday, Wolf says.
3. Be your own advocate. Your boss and colleagues may want to help, but they won’t know what to do unless you tell them. For example, many MBC treatments leave people immunocompromised, so working in an open office setting may create anxiety. Wolf recommends requesting a private office or asking your coworkers around you to wear masks.
4. Do what you can to minimize side effects. Everything will be easier if you can prevent treatment side effects, both on the job and at home. During chemotherapy, Wade did scalp-cooling treatments to lessen hair thinning, ate ice chips to prevent mouth sores, and used ice packs on her hands and feet to prevent neuropathy.
5. Think about how you want to spend your time. MBC will make you more aware of time and how you want to spend it. While no job is perfect, working at some point during MBC, in some capacity, may help you feel grounded. Wolf suggests evaluating what excites you and taking the Sparketype assessment. If your current job doesn’t motivate you, perhaps you can look for a change. “The more we can feel purpose in this journey, the more we’re setting ourselves up to thrive as chronic patients,” she says.
6. Understand your rights and options at work. When working at a company with 15 or more people, you are protected under the Americans With Disabilities Act (ADA), which means you’re allowed to ask for reasonable accommodations, such as a modified work schedule, the ability to work from home (if possible), or rest breaks, as long as you are fulfilling your job duties. If you are not able to work due to MBC, you may qualify for Social Security Disability Insurance. Talk to your oncology social worker to understand these issues better. If you have no access to a social worker, call the American Cancer Society’s 24/7 cancer helpline at 1-800-227-2345 or talk to a cancer navigator. Then, learn more about legal protections for working people with cancer, how to take leave under the Federal Family and Medical Leave Act, and ADA protections from discrimination.
7. Seek support for yourself emotionally and mentally. It’s hard to work or do much when you’re struggling emotionally. Wade recommends seeking support from a social worker at your chemotherapy center or a therapist or psychiatrist. Some therapists even specialize in working with people living with cancer. Wade also meditates daily, which she learned in a mindfulness-based stress reduction program. “If it feels hopeless, you need more tools in your toolbox. You should feel empowered to go out and get that help, because you’re not alone,” she says.