Job Accommodation Network

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Cancer

How prevalent is cancer?

The lifetime risk of developing cancer is 1 in 2 for men and 1 in 3 for women (Ries, et al., 2004).

What is cancer?

Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels of our body. When cells from a cancer like breast cancer spread to another organ like the liver, the cancer is still called breast cancer, not liver cancer (American Cancer Society, Inc., 2005).

What are the symptoms of cancer?

Some generalized symptoms and signs such as unexplained weight loss, fever, fatigue, or lumps may be seen in several types of cancer; however, other signs and symptoms are relatively specific to a particular type of cancer (American Cancer Society, Inc., 2005).

What causes cancer?

Cancer is caused by both external (chemicals, radiation, and viruses) and internal (hormones, immune conditions, and inherited mutations) factors. Different cancers have different risk factors. Causal factors may act together or in sequence to initiate or promote cancer. Risk factors may increase a person's risk but do not always "cause" the disease. Many people with one or more risk factors never develop cancer, while others with this disease have no known risk factors. Ten or more years can pass between exposures or mutations and detectable cancer (American Cancer Society, 2005).

How is cancer staged?

Staging is the process of finding out how much cancer there is in the body and where it is located. Doctors use this information to plan treatment and to help determine a person's outlook (prognosis). Cancers with the same stage usually have similar outlooks and are often treated the same way. Staging is also a way doctors can communicate with each other about a person's case. For most cancers, the stage is based on 3 main factors: the original (primary) tumor's size and whether the tumor has grown into other nearby areas, whether the cancer has spread to the nearby lymph nodes, and whether the cancer has spread to distant areas of the body (American Cancer Society, 2005).

How is cancer treated?

Treatment options may include surgery, radiation, chemotherapy, hormone therapy, and immunotherapy. Surgery is the oldest form of cancer treatment; sixty percent of people with cancer will have surgery. Radiation therapy uses high-energy waves, such as x-rays or gamma rays, to destroy cancer cells. Chemotherapy is the use of drugs to treat cancer. Systemic chemotherapy uses anticancer drugs that are usually given into a vein or by mouth to enter the bloodstream and reach all areas of the body. Hormone therapy is treatment with hormones, drugs that interfere with hormone production (American Cancer Society, 2005).

Cancer and the Americans with Disabilities Act

Is cancer a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with cancer will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Cancer

(Note: People with cancer may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with cancer will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with cancer experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with cancer been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with cancer to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding cancer?

Accommodation Ideas:

Fatigue/Weakness:

Reduce or eliminate physical exertion and workplace stress
Schedule periodic rest breaks away from the workstation
Allow a flexible work schedule and flexible use of leave time
Allow work from home
Implement ergonomic workstation design
Provide a scooter or other mobility aid if walking cannot be reduced
Provide parking close to the work-site
Install automatic door openers
Make sure materials and equipment are within reach range
Move workstation close to other work areas, office equipment, and break rooms
Reduce noise with sound absorbent baffles/partitions, environmental sound machines, and headsets
Provide alternate work space to reduce visual and auditory distractions

Medical Treatment Allowances:

Provide flexible schedules
Provide flexible leave
Allow a self-paced workload with flexible hours
Allow employee to work from home
Provide part-time work schedules

Respiratory Difficulties:

Provide adjustable ventilation
Keep work environment free from dust, smoke, odor, and fumes
Implement a "fragrance-free" workplace policy and a "smoke free" building policy
Avoid temperature extremes
Use fan/air-conditioner or heater at the workstation
Redirect air conditioning and heating vents

Skin Irritations:

Avoid infectious agents and chemicals
Avoid invasive procedures
Provide protective clothing

Stress:

Develop strategies to deal with work problems before they arise
Provide sensitivity training to coworkers
Allow telephone calls during work hours to doctors and others for support
Provide information on counseling and employee assistance programs

Temperature Sensitivity:

Modify work-site temperature
Modify dress code
Use fan/air-conditioner or heater at the workstation
Allow flexible scheduling and flexible use of leave time
Allow work from home during extremely hot or cold weather
Maintain the ventilation system
Redirect air conditioning and heating vents
Provide an office with separate temperature control

Situations and Solutions:

An engineer working for a large industrial company had to undergo radiation treatment for cancer during working hours. She was provided a flexible schedule in order to attend therapy and also continue to work full-time.

A machine operator who was undergoing radiation therapy for cancer was accommodated by having his workstation moved. The move transferred the individual to an area of the plant where no radiation exposure existed.

A warehouse worker whose job involved maintaining and delivering supplies was having difficulty with the physical demands of his job due to fatigue from chemotherapy treatment. The individual was accommodated with a three-wheeled scooter to reduce walking. The warehouse was also rearranged to reduce the individual's climbing and reaching.

A secretary with cancer was having difficulty working full-time due to fatigue from chemotherapy treatments. Her employer accommodated her by allowing her to work part-time and allowing her to take frequent rest breaks while working.

A psychiatric nurse with cancer was experiencing difficulty dealing with job-related stress. He was accommodated with a temporary transfer and was referred to the employer's employee assistance program for emotional support and stress management tools.

A lawyer with cancer was experiencing lapses in concentration due to the medication she was taking. Her employer accommodated her by giving her uninterrupted time to work. She was also allowed to work at home two days a week.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Cancer Society. (2005). Detailed guide: Cancer, general information. Retrieved July 1, 2005, from http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=72

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Ries, L. G., Eisner, M. P., Kosary, C. L., Hankey, B. F., Miller, B. A., Clegg, L., Mariotto, A., Feuer, E.J., Edwards, B.K. (eds) (2004). SEER cancer statistics review, 1975-2002, National Cancer Institute. Bethesda, MD, Retrieved July 1, 2005, from http://seer.cancer.gov/csr/1975_2002