CEU REQUIREMENTS

If you plan on requesting continuing education credits,

you MUST complete all of the following steps:

* An email with links to the evaluation and post test

will be sent 24 hours after the presentation.

** Certificates will be emailed within 4-Weeks.

1. You must have registered online for today’s session

2. Dial-in to the audio portion of the webinar

Please note that participants who “listen-in” on another

participant’s line will not be eligible for credit.

3. Within 2-Weeks of This Session:

• Complete the evaluation*

• Complete the post-test & earn a passing grade*

Rachel Becker, MSW

Senior Manager of Programs,

Cancer and Careers

Monica Fawzy Bryant, Esq.

Cancer Rights Attorney & COO,

Triage Cancer

This presentation is intended to provide general information on the topics presented. It is provided with

the understanding that the author(s) is not engaged in rendering any legal, medical, or professional

services by its publication or distribution. Although this content was reviewed by a professional, it

should not be used as a substitute for professional services.

SPEAKERS

Key Topics:

• Decisions about whether to work

• Americans with Disabilities Act (ADA)

• Disclosure and privacy issues

• Online brand and social media use

WHERE TO START

FROM CANCER PATIENT TO CANCER SURVIVOR:

LOST IN TRANSITION

• Identified key elements that should be included in a

Survivorship Care Plan:

– Specific tissue diagnosis and stage;

– Initial treatment plan and dates of treatment;

– Toxicities during treatment;

– Expected short- and long-term effects of therapy;

– Late toxicity monitoring needed;

– Surveillance for recurrence or second cancer;

– Who will take responsibility for survivorship care;

– Psychosocial and vocational needs; and

– Recommended preventive behaviors/interventions.

INSTITUTE OF MEDICINE REPORT - 2005

Psychological and social problems created or exacerbated

by cancer, including:

• depression and other emotional problems;

• lack of information or skills needed to manage the illness;

• lack of transportation or other resources; and

• disruptions in work, school, and family life

cause additional suffering, weaken adherence to

prescribed treatments, and threaten patients' return to

health.

INSTITUTE OF MEDICINE REPORT - 2007

CANCER CARE FOR THE WHOLE PATIENT:

MEETING PSYCHOSOCIAL HEALTH NEEDS

• 98% of cancer survivors experienced the

physical (i.e., pain), emotional (i.e.,

emotional distress) and practical (e.g.,

financial) concerns of post-treatment

survivorship

• Only 20 percent of survey respondents

received help with their practical concerns

• Alarmingly, the # of people NOT getting

care for physical, emotional or practical

concerns increased between 2006 and

2010

LIVESTRONG SURVEY - 2010

From the health care professional perspective:

• 77% of oncology social workers and nurses surveyed by Triage Cancer

(2013-2014) said it was important to include employment issues in

distress screening tools, but often these health care professionals are

not armed with the tools to effectively do so.

From the patient perspective:

• Patients don’t know what they don’t know

– So unlikely to ask about these topics

– Overwhelmed

– Don’t think that the healthcare team can help with these issues, so they don’t bring it up

– More likely to be offhand comments

• Personal nature of questions

– Privacy concerns, embarrassed by financial issues

WHY INCORPORATE CLINICAL

“LEGAL” ASSESSMENT?

Open-ended questions

• What type of insurance do you have?

• What type of work do you do?

• Do you have any concerns about working through treatment or taking time off?

• Do you have questions about your insurance coverage?

• Are you concerned about disclosing your diagnosis at work, at school, or to other people in your life?

• What is your family environment like?

• Do you have a strong support system?

INCORPORATING CLINICAL “LEGAL”

ASSESSMENT?

*Cancer and Careers checklist

RESEARCH: WORK & CANCER

• 41% of cancer survivors are diagnosed at “working

age”

(Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer

care in the United States: 2010-2020. J Natl Cancer Inst. 2011 Jan 19;103(2): 117-28. Epub

2011 Jan 12)

• Cancer survivors are more likely to be unemployed (JAMA 2009; 301(7):753-762)

• 20% of cancer survivors still report work limitations

affected by cancer-related problems 1-5 years after

diagnosis (Work & Cancer Survivors)

• In 2014, EEOC received 874 cancer discrimination

claims (www.eeoc.gov/eeoc/statistics/enforcement/ada-receipts.cfm)

• James was diagnosed with lung cancer. He has been

a truck driver for a large shipping company for 10

years.

• James is married with three kids and he knows that he

needs to work to pay his family’s bills and his family

has health insurance coverage through his employer.

• He isn’t sure about whether or not he has any

employee benefits, because he hasn’t taken a vacation

or sick day in five years.

• He is not sure of his treatment schedule yet, but his

doctor told him that he will need surgery and

mentioned something about chemotherapy and

radiation.

CASE STUDY: JAMES

• What should James be thinking about?

DIAGNOSIS/WORK DILEMMA

• How will treatment affect work and schedule?

• What are job demands, physical and mental?

• How flexible is the work environment?

• Can accommodations be made?

• What are the financial and health insurance concerns?

• How is identity connected to work?

• Have career priorities changed?

TO WORK OR NOT TO WORK

INFORMATION NEEDS

• Treatment Options

• Timeline

• Potential Side Effects

• Mitigation Strategies

Medical and Treatment

Info

• Insurance Support

• Company Policies

• Workplace Flexibilities

• Job Demands

Work Info

Legal Info

• Federal & State Laws

• Medical Leave

• Disability Insurance

• Health Insurance

• Open and forthcoming

• Discuss job, including schedule and

demands

• Discuss priorities for returning to

work

• Share concerns about treatment and

side effects that impact ability to

work

• Disclosure and medical certification

PATIENT / HEALTHCARE TEAM

COMMUNICATION

Federal Leave Laws

- Family & Medical Leave Act (FMLA)

Federal Fair Employment Laws

- Americans with Disabilities Act (ADA) • Discrimination protections for patients and

caregivers

• Reasonable Accommodations for patients

State Fair Employment Laws • Discrimination protections for patients and

caregivers

• Reasonable Accommodations for patients

Employment Contracts • Employment Contract

• Independent Contractor’s Contract

• Union Contract

EMPLOYMENT RIGHTS

Employer Policies • Employee Benefits

– Health/dental/vision insurance

– Short-term and/or long-term disability insurance

– Life and/or accidental death insurance

• Other Benefits

– Sick time

– Vacation time or paid time off (PTO)

– Pool of donated hours

– Flex time/job sharing

– Telecommuting

• Medical Leave Process

• Reasonable Accommodation Process

Eligibility

• Private employers with 15 or more

employees & State/Local Governments

- Note: Federal employees covered by

Rehabilitation Act of 1973 (similar to ADA)

- ADA does not apply to tribal employers

• Be a “qualified individual”

• Have a disability under the ADA’s

definition

AMERICANS WITH DISABILITIES ACT

(ADA) – TITLE I

Definitions

• Disability:

- “A physical or mental impairment that

substantially limits one or more major life

activities”

• Major life activity

• Eating, breathing, speaking, walking

• ADA Amendments: concentrating, thinking,

sleeping, operation of major bodily

functions

- Predictable assessments: cell growth

AMERICANS WITH DISABILITIES ACT

4 ways to use the ADA: • Currently

• History

• Regarded

• Association

Applies to all phases of the employment process

Benefits:

• Protection from Discrimination

– Employers can’t make employment-related decisions based on medical information

• Reasonable Accommodations

• Similar rights available in education arena: IDEA & Rehab Act

AMERICANS WITH DISABILITIES ACT

• Similar to ADA

• But, can be more protective in 3 ways

1. Broader definition of disability

• Ex: CA, IA, IL, NY, WA, WI

2. Specifically list cancer as a potential disability

• Ex: CA, ME, OH, VT

3. Cover employers with fewer than 15 employees

STATE FAIR EMPLOYMENT LAWS

1 2 3 4 5 6 8 9 12

AK

HI

IL

ME

MI

MN

MT

NJ

ND

SD

VT

VA

WI

CO

WY

CT IA

KS

NM

NY

OH

PA

RI

CA

ID

MA

MO

NH

OR

KY

TN

WA

AR (but

15 for

RA’s)

WV

STATE FAIR EMPLOYMENT LAWS

EMPLOYER SIZE

*If state is not listed, it requires 15 employees

ENFORCEMENT OPTIONS

If all you needed was a law . . .

1. File a complaint with federal (or state) agency

a. EEOC – ADA

b. DOL WHD – FMLA

2. Consult an employment attorney

3. File an employment lawsuit

a. ADA discrimination

b. ADA failure to provide reasonable accommodations

c. FMLA failure to provide time off

d. FMLA retaliation

CASE STUDY: CHRIS

• Chris is 25 years old and is a childhood cancer survivor. He

is very excited about graduating from college in a few

weeks.

• Chris has some trouble with mild depression and fatigue,

anxiety, and memory problems, so he was taking a lighter

load each semester, setting back his graduation date.

• He is ready to start looking for a job and is concerned about

how to enter the job market with a history of cancer and his

ongoing health issues.

• He is wondering if he has to disclose his medical history and

if people will still hire him if he does.

• What options does Chris have?

DISCLOSURE RIGHTS

Generally, not required, but may

need to disclose information to

use . . .

• ADA’s discrimination protections

• Reasonable accommodations

• Medical leave

Employers or prospective employers can ask:

Pre-offer

• Can you perform essential functions of the job?

• How will you perform essential functions of the job?

Post-offer

• Disability-related inquiries or medical exams,

regardless of whether related to job, but only if same

for all employees entering same job category

Employed

• Any disability-related inquiry or medical exam, ONLY

if job-related and consistent with business necessity

DISCLOSURE RIGHTS

CASE STUDY: ANN

• Ann is 38 years old. When she was 27, she was

diagnosed with cancer. She participated in a local

Relay for Life and was interviewed by the local

newspaper about her survivor experience.

• She is now in the midst of changing jobs and she

Googled herself to see what was out there. The

local newspaper is now online and it comes up

when she searches for her name.

• She is worried about a potential employer finding

out about her cancer history because of this article.

• What options does Ann have?

RESEARCH: SOCIAL MEDIA & HEALTH

• 30% of consumers use social media as a natural

habitat for health discussions

• 80% of 18–24 year olds likely to share health

information through social media

• 90% of 18–24 year olds would engage in health

activities or trust information found via social

media

• 45% of 45–64 year olds would be likely to share

via social media, while 56% would be likely to

engage in health activities

PWC Health Research Institute Survey – April 2012

• Social media usage

• Employers Google candidates

• Privacy settings

ONLINE BRAND

43% of employers use social

networking sites to research

job candidates – Career

Builder 6/26/14

FACEBOOK

• Disclosure decisions

– Then communicate those decisions

– What are other people saying about you?

• MyLifeline or CaringBridge

• Long-term impact

• Relationships & dating

• “Friending” your health care professionals

ONLINE BRAND

• Volunteer gigs & jobs in the cancer community (and what they might say about you)

• Background & credit checks

• Employer access to voicemail, email, etc.

• Google searching at work

• Social media password laws

OTHER DIGITAL DIRT

STATE LAWS: SOCIAL MEDIA

*National Conference of State Legislatures,

Current as of February 6, 2014

• In 2012, state began to prevent employers from requesting

passwords to personal Internet accounts to get or keep a job

• In 2013, 11 states passed laws: Arkansas, Colorado, Illinois,

Nevada, New Jersey, New Mexico, Oregon, Utah, Vermont, and

Washington

• In 2014, legislation passed in Louisiana, Maine, New

Hampshire, Oklahoma, Rhode Island, Tennessee and Wisconsin

• Some states have also tried to protect students in public

colleges and universities from having to grant access to social

networking accounts

TOP TAKEAWAYS

1. Patients should communicate with their

health care team

2. Patients should gather information about

deciding to work through treatment or

take time off

3. Patients should think through disclosure

UPCOMING SESSIONS Thursday, April 30, 12 Noon

ET/ 9am PT

Working Through Treatment

• Disclosing in the workplace

• Accessing Reasonable Accommodations

• Managing side effects

Thursday, October 22, 12 Noon

ET/ 9am PT

Returning to Work

• Transitioning back to work

• Identifying job search distress

• Techniques to address resume gaps

More information & Registration:

http://www.cancerandcareers.org/en/community/eve

nts/healthcare-professionals

Thursday, May 14, 12 Noon ET/

9am PT

Taking Time Off

• Family and Medical Leave Act (FMLA)

• Disability Insurance

• Medical Certification

Thursday, November 6th, 12 Noon

ET/ 9am PT

Health Insurance Options

• Patient Protection and Affordable Care Act

(ACA)

• Eligibility for Medicaid

ADDITIONAL EVENTS

Conferences:

Midwest Conference on Work & Cancer Friday, April 10, 2015, Chicago

National Conference on Work & Cancer

Friday, June 12, 2015, New York City Travel Scholarships available.

Managing Long-Term Stress

Wednesday, April 1

1pm ET / 10am PT

Building an Effective LinkedIn Profile

Wednesday, May 6

1pm ET/10am PT

Managing Finances

Wednesday, June 24,

1pm ET/10am PT

More information & Registration:

http://www.cancerandcareers.org/en/community/events/webinar-stress

Webinars:

Legal Assistance: • National Cancer Legal Services Network

www.NCLSN.org

• LawHelp www.lawhelp.org

Employment Rights: • Equal Employment Opportunity Commission

www.EEOC.gov

• Job Accommodation Network www.AskJan.org

• U.S. Department of Labor (COBRA) www.dol.gov/EBSA

• U.S. Department of Labor (FMLA) www.DOL.gov/WHD

Disability Insurance Options: • Social Security Administration: www.SSA.gov

Health Insurance Options: • www.HealthCare.gov

• www.TriageCancer.org

ADDITIONAL RESOURCES

Rachel Becker, MSW

Rbecker@cew.org

www.CancerandCareers.org

Twitter

@CancerAndCareer

Facebook

www.Facebook.com/CancerandCareers

Newsletter

www.cancerandcareers.org/en/community/newsletter

Monica Fawzy Bryant, Esq.

MB@TriageCancer.org

www.TriageCancer.org

Twitter

@TriageCancer

Facebook

www.Facebook.com/TriageCancer

Blog

http://triagecancer.org/blog/

CONTACT INFORMATION

CEU REQUIREMENTS

If you plan on requesting continuing education credits,

you MUST complete all of the following steps:

* An email with links to the evaluation and post test

will be sent 24 hours after the presentation.

** Certificates will be emailed within 4-Weeks.

1. You must have registered online for today’s session

2. Dial-in to the audio portion of the webinar

Please note that participants who “listen-in” on another

participant’s line will not be eligible for credit.

3. Within 2-Weeks of This Session:

• Complete the evaluation*

• Complete the post-test & earn a passing grade*