Changing Careers After a Cancer Experience

This page is for cancer survivors thinking about changing jobs, cutting hours, or leaving work. It covers why work often changes, the money and insurance checks to make first, and free job-retraining help.

Many survivors change jobs, hours or field after cancer treatment. Some leave paid work altogether. It can happen for several unrelated reasons at once.

Some reasons are physical:

• Fatigue after treatment can last for months or years, according to NCI.
• Treatment side effects such as nerve damage (peripheral neuropathy) or lymphedema (swelling caused by fluid buildup) can make some physical tasks harder.
• Chemotherapy and some other treatments can cause problems with thinking, concentrating, or remembering, according to NCI.
• Surgery can change what a body can do at work.

Some reasons are structural. People lose jobs during long treatment absences. Or they return to a role that has been reorganized around their absence. Or they find that a physically demanding job no longer fits.

And some reasons are chosen. Many survivors rebuild work around what they now want it to be worth. That is not a failure of resilience. It is not inevitable either.

If you are thinking about a big change, ask your care team how your recovery is expected to go first.

Before you resign, check these, in this order:

• Employer-sponsored health insurance. If your coverage comes through your job, leaving ends it. COBRA lets you continue the same plan, typically for 18 months. But you may have to pay the entire premium, up to 102 percent of the plan's cost, according to the U.S. Department of Labor. Losing job-based coverage also opens a Special Enrollment Period on the ACA marketplace. HealthCare.gov says Marketplace plans may cost less than COBRA, especially if you qualify for savings. HealthCare.gov says no Marketplace plan can reject you or charge you more because of a pre-existing condition.
• Disability insurance. Ask whether an employer short- or long-term disability policy requires you to be employed when the claim starts. Policies can define disability as being unable to do your own occupation. Others define it as being unable to do any occupation. Read the definition before you quit.
• Social Security. SSDI requires enough work credits. It also requires a condition that has lasted or is expected to last at least one year, according to the Social Security Administration. Medicare coverage for people on SSDI generally follows a 24-month waiting period. SSI is needs-based.
• Retirement and seniority. Resigning a few months early can cost you a lot. Vesting schedules, accrued pension time, and stock vesting cliffs are often forfeited.
• FMLA and the ADA. Eligible employees may take up to 12 workweeks of job-protected leave in a 12-month period for their own serious health condition. That may let you keep the job you have while you decide. The ADA may also give you a right to reasonable accommodations. The Department of Labor says FMLA leave can be taken intermittently or on a reduced schedule when medically necessary.

Every US state has a Vocational Rehabilitation (VR) agency, funded in part by the federal government. Federal rules do not require states to consider your finances, but a state may ask some people to share the cost of certain services. Ask your agency what you would pay.

Under federal rules, VR services can include:

• Counseling, guidance and assessment
• Help paying for college or vocational training, once other available grants and benefits are used first
• Assistive technology
• Job search, placement and job retention services

Here is how it works. Contact your state agency. The federal Rehabilitation Services Administration keeps a state directory. Federal rules say the agency should decide whether you are eligible within 60 days of your application, with limited exceptions.

If you are eligible, you and a counselor write an Individualized Plan for Employment. It sets one job goal, and the services that will get you there. People who have been found eligible for Social Security benefits (SSDI or SSI) are presumed eligible for VR services.

1. Do not resign during treatment unless you have to. Request accommodations or leave first, in writing.
2. Take time before you make any move you cannot undo. Fatigue can last for months or years after treatment.
3. Write down what has actually changed. Note the hours you can sustain, what you can lift, and the times of day you think clearly.
4. Contact your state VR agency and an oncology social worker in the same week.
5. Price health coverage under every scenario before you decide anything.
6. Talk to a financial counselor at your cancer center. Ask about the order your income sources arrive in, not just the total.

• Rehabilitation Services Administration - State Vocational Rehabilitation Agencies
• 34 CFR 361.41 - Processing referrals and applications
• 34 CFR 361.42 - Assessment for determining eligibility
• 34 CFR 361.54 - Participation in cost of services based on financial need
• HealthCare.gov - Special Enrollment Period after losing coverage
• U.S. Department of Labor - COBRA continuation coverage
• Social Security Administration - How you qualify for disability benefits
• U.S. Department of Labor - FMLA
• EEOC - Cancer in the Workplace and the ADA
• NCI - Fatigue
• NCI - Memory or Concentration Problems