Working your way through cancer

A generation ago, cancer was a whispered death sentence, carried out in cloistered withdrawal. But now more people are living with cancer -- juggling jobs and treatments, time for love and tough life decisions.

Elizabeth Edwards brought this balancing act into the headlines this spring when she and her husband, former Senator John Edwards, who have two young children, decided that the recurrence of her cancer would not stop his presidential campaign. Her cancer is treatable but incurable, yet she insisted that the campaign go on, a decision that has drawn both condemnation and praise.

I applaud her. What right do we have to tell others how to spend their time on earth? That's as misguided as saying a mother who works isn't a good parent. There's no single definition of a good life, and consider this: Chances are the 10.5 million Americans with a history of cancer have thought longer and harder about life's meaning than many of the rest of us.

The reality is that 60 to 80 percent of people diagnosed with cancer continue to work or return to work some time after their treatment , according to studies compiled by Barbara Hoffman, a Rutgers University law professor. Partly because treatments are gentler, only an estimated 17 percent of working age people diagnosed with cancer are unable to work.

"Twenty years ago, being treated for cancer was a full-time job," says Diane Blum, executive director of New York-based CancerCare, the nation's largest nonprofit support services organization for people battling cancer.

"Now symptoms are managed better, treatment is outpatient. People often are able to live their lives with some semblance of normality," she said.

And more people are living for years with metastatic cancers or beating back their disease. Largely because of earlier diagnosis and more effective treatments, 66 percent of people with cancer are alive five years after their diagnosis, compared with half of such patients in the mid-1970s, according to the American Cancer Society.

"The good news is that we have so many people surviving cancer now we have to help them recover as well as possible," says Dr. Julie K. Silver, a mother of three and medical director of Spaulding Rehabilitation Hospital's outpatient center in Framingham. She was diagnosed in 2003 with breast cancer at age 36.

After a six-month, partially paid leave of absence to undergo treatment, Silver returned to work, but struggled with pain, and she still battles fatigue. This experience inspired her to start the Restore program at Spaulding-Framingham to help patients and survivors cope physically with healing during and after treatments.

Douglas Corcoran, a 44-year-old Tyngsborough Highway Department worker diagnosed with bile duct cancer in November, yearns to go back to work, although his doctors have forbidden it for the moment. Not everyone can or will work through cancer, yet for many, work is not only a financial necessity but a place where they can be something other than a patient.

"When you work, you're keeping your mind busy," says Corcoran, who is on leave, partly covered by donated time from other town workers. He's grateful for the time at home, where he cheers on his 12-year-old daughter and 16-year-old son in sports and helps his working wife by cooking supper. But his goal is to return to the job.

"I want to keep going, and I want to try to do whatever I used to do," says Corcoran.

Working through cancer is more feasible, as well, because employers and colleagues alike are more accepting of survivors' rights and feelings. Few people nowadays think cancer is contagious. The Family and Medical Leave Act and the Americans with Disabilities Act offer job protection, unpaid leave, and accommodations such as flextime. Increasing management flexibility allows people to work and heal.

"You get your chemo on Thursday, and you start feeling awful at 3 o'clock on Friday, and you can go home," says Christine Fossaceca, the dependent care and flexibility manager at JP Morgan Chase, describing the company's "acute treatment policy." The policy allows ill employees up to two days off a week, in increments as small as an hour, for up to six months to recover from or undergo medical treatments, in addition to other time owed. "It's very flexible, it helps people through this," says Fossaceca.

Still, cancer is never easy. There are endless decisions to make, and friends and co-workers sometimes probe, or awkwardly back away. So what can we do? Offer a cooked meal, a chance to listen, but accept the need for privacy and space, says Stacy Chandler, a social worker at the Massachusetts General Hospital Cancer Center.

"People who are living with cancer appreciate kind words and gestures from people, but they also appreciate opportunities to feel normal," says Chandler. "Patients are trying to achieve a new normal. It's a really hard thing to achieve."

Balancing Acts appears every other week. Maggie Jackson can be reached at maggie.jackson@att.net.