Somewhere in the first week after a diagnosis, usually between appointments, the work question arrives. Do you tell anyone. Who. How much. What happens to your job if treatment goes on longer than you expect.
There is no single right answer, and the right answer for a person with a supportive manager at a large company is not the right answer for someone who is the only person doing their job at a company of nine.
A few things are worth knowing before you decide.
You control what you share
Under the Americans with Disabilities Act, you are generally not required to disclose a diagnosis to an employer. The Equal Employment Opportunity Commission is explicit that an applicant does not have to reveal a condition before accepting a job offer, and that an employee can request an accommodation later even if they said nothing during hiring.
There are narrow circumstances where an employer may ask about a medical condition — after a conditional job offer, if everyone in that role is asked the same questions; or during employment, when there are performance problems the employer reasonably believes are health-related, or when documentation is needed to support an accommodation request.
Outside of those, what you say is yours to decide. Many people tell their manager something general — that they are dealing with a health issue that will mean some appointments — and never name the diagnosis at all.
Two laws worth knowing by name
The Family and Medical Leave Act provides twelve workweeks of unpaid, job-protected leave in a twelve-month period, for your own serious health condition or to care for a spouse, child, or parent with one. Your group health coverage continues during the leave, and you return to your job or an equivalent one.
The eligibility rules are where people get caught. You must work at a location where your employer has fifty or more employees within seventy-five miles, you must have worked there at least twelve months, and you must have worked at least 1,250 hours in the previous twelve months. A great many people assume they are covered and are not. If you work part-time, recently changed jobs, or work for a small company, check before you plan around it.
The Americans with Disabilities Act applies to private employers with fifteen or more employees, and to state and local government. Under the ADA, cancer generally qualifies as a disability, including cancer in remission and a history of cancer. That matters because it means you can request a reasonable accommodation.
Some states extend these protections further, including to smaller employers. State law is where a lot of the real answers live.
What an accommodation can actually be
People hear "accommodation" and picture a ramp. The EEOC's own examples for someone with cancer are more ordinary than that:
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Leave for appointments or to recover from treatment
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Periodic breaks, or a private space to rest or take medication
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A modified schedule or a change of shift
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Working from home
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A change to the temperature where you work
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Using a work phone for calls to doctors, where personal calls are normally not allowed
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Moving a minor part of your job to someone else
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Reassignment to an open position if you can no longer do your current one
That list is worth reading twice, because most people do not ask for any of it. They assume the answer is no and then quietly struggle through.
How to ask
Put the request in writing, even if you also have the conversation in person. An email creates a record of what you asked for and when.
You do not need to lead with your diagnosis. You can describe what you need and why in functional terms: you need a later start two days a week, you need to work from home on infusion days, you need to be able to step out for twenty minutes in the afternoon. Your employer may ask for documentation from your doctor to support the request, but you control the level of detail that goes in it.
If the first answer is no, that is not always the end. The ADA contemplates a back-and-forth about what is workable, not a single yes or no.
Where to get real answers
This article is general information. It is not legal advice, and Salto Health is not a law firm. Employment law varies by state, by employer size, and by the specifics of your situation, and a short article cannot tell you what applies to you.
Triage Cancer, a national nonprofit, publishes a free Practical Guide to Cancer Rights covering employment, health insurance, disability insurance, finances, medical records, and appeals. It is available as a downloadable PDF in English and Spanish at triagecancer.org/guide, and they also run free educational events on these topics.
If you only do one thing after reading this, download that guide and look at the employment section before you have the conversation at work. Going in knowing what you are entitled to ask for changes the conversation.
Salto Health exists for the practical side of cancer — the things that help day to day, and a simple way for the people around you to send them.
Sources
U.S. Equal Employment Opportunity Commission. Cancer in the Workplace and the ADA.
U.S. Department of Labor. Family and Medical Leave Act.
Triage Cancer. Practical Guide to Cancer Rights.
