Cancer, School, and Career as a Young Adult

The practical protections for a young adult's studies and job do not rest on goodwill. They rest on statute.

The EEOC has guidance on cancer in the workplace. It explains how the Americans with Disabilities Act applies. After the ADA Amendments Act of 2008, people who have cancer now, or whose cancer is in remission, should easily be found to have a disability. The reason EEOC gives is precise. They are substantially limited in the major life activity of normal cell growth. Or they would be, if a remission ended.

A history of cancer is covered too, under the "record of" part of the definition. The "regarded as" part covers people an employer treats as having a disability, including someone the employer believes has cancer.

Coverage has limits worth knowing. EEOC says the ADA covers private employers with 15 or more employees. Section 501 of the Rehabilitation Act gives similar protections for federal employment. EEOC also notes that most states have their own laws against disability discrimination.

This is where young adults applying for first jobs are most exposed, and the rules are sharp.

Before a conditional job offer, EEOC says an employer may not ask about an applicant's medical condition. It may not require a medical exam either. It cannot ask whether the applicant has or ever had cancer. It cannot ask about chemo, radiation, or a drug used to treat cancer, such as tamoxifen. And it cannot ask how much sick leave the applicant took in the past year.

It can ask about the job. EEOC's examples are whether the applicant can lift up to 50 pounds, travel out of town, or work rotating shifts.

Disclosure is not required. EEOC says the ADA does not oblige an applicant to reveal cancer. The exception is when an accommodation is needed for the application process itself. Its example is extra time on a pre-employment test, because of fatigue from radiation.

If an applicant brings up cancer, EEOC says the employer may ask whether an accommodation will be needed and what type. Ask what the guidance allows if you are unsure.

After a job offer, the rules change. EEOC says an employer may then ask health questions and require a medical exam, as long as every applicant for that type of job is treated the same way.

EEOC does not treat workplace bias against people with cancer as hypothetical. Its guidance states that even when the prognosis is excellent, some employers expect a person diagnosed with cancer to take long absences or be unable to focus.

It also lists what treatment actually does. That list is useful language for an accommodation talk:

• pain
• fatigue
• problems with nutrition and weight
• nausea and vomiting
• hair loss
• low blood counts
• memory and concentration loss
• depression
• breathing problems

One caveat belongs here. EEOC's own disclaimer says the document does not have the force and effect of law. It is meant to give clarity about existing requirements.

Federal medical leave is governed by 29 CFR Part 825. It lets an eligible employee of a covered employer take job-protected, unpaid leave. Earned paid leave can be substituted. The cap is 12 workweeks in any 12 months. Qualifying reasons include the employee's own serious health condition. They also include caring for a child, spouse, or parent with one.

Eligibility has three tests, all of which must be met.

• Employed by that employer for at least 12 months.
• At least 1,250 hours of service in the 12 months immediately before the leave starts.
• Employed at a worksite where the employer has 50 or more employees within 75 miles.

Early-career workers may fall outside FMLA. A first job of nine months, or a small workplace, would not meet the tests.

Two features soften it. The regulation says leave may sometimes be taken in pieces rather than all at once, or on a part-time schedule. And an employee on FMLA leave is entitled to have health benefits maintained.

The 12 months of employment need not be consecutive. The regulation says employment before a break in service of seven years or more generally need not be counted, with exceptions.

Section 504 is the federal disability rights law that schools use when they set up accommodations. Cancer-related fatigue, trouble concentrating, and lifting limits are the kinds of things to raise. Contact your school's disability services office early. Ask for any agreed accommodations in writing.

NCI's page for young people with cancer makes one point that is easy to miss. Depending on age and cancer type, treatment may follow a pediatric protocol or an adult one. This affects treatment decisions, so ask what your schedule will look like before you plan school or work.

NCI notes that more hospitals now run programs built for young people. That includes many NCI-Designated Cancer Centers. Its examples are young adult support groups, fertility preservation, art therapy, music therapy, and adventure-based programs. NCI also encourages young people to build self-advocacy skills, such as speaking up about side effects and life balance.

Job-side logistics during treatment are covered in working during cancer treatment. The return afterward is covered in returning to work after cancer. What is distinct about this age group is described in cancer in young adults.

• EEOC: cancer in the workplace and the ADA
• govinfo: 29 CFR 825.100
• govinfo: 29 CFR 825.110
• NCI: emotional support for young people with cancer