Despite cancer, many keep careers healthy

Times Staff Writers

Three weeks after a five-hour operation to remove cancer in her colon, Linda Scotto was back at work as a sales representative for a snack food company.

The Torrance resident continues to meet with buyers and travels to trade shows while undergoing regular chemotherapy treatments. Even a second surgery last year to remove cancerous nodules on her lungs hasn’t slowed her down.

“My work is one of the main things that gives me a sense of purpose,” said Scotto, 45. “You don’t want to focus on cancer 24/7. That will kill you.”


Medical advances, supportive laws and greater workplace acceptance are allowing many people like Scotto with advanced cancer or other serious diseases to continue working, in some cases almost immediately after major surgery.

Although some stay on the job to qualify for company-provided health insurance, many do it for the emotional support and mental respite from their diseases. And cancer’s stigma is fading for patients and co-workers.

The trend was spotlighted Wednesday, when possible Republican presidential candidate Fred Thompson revealed that he had been diagnosed with lymphoma more than two years ago. The actor and former Tennessee senator has a nonaggressive form of the immune system cancer that should not affect his life expectancy, his doctor said.

That followed the announcement last month that Elizabeth Edwards, wife of Democratic presidential hopeful John Edwards, would continue campaigning with her husband after learning her breast cancer had spread. White House Press Secretary Tony Snow said he also intended to return to his podium after surgery last month for a recurrence of colon cancer.

North Carolina State women’s basketball Coach Kay Yow guided her team to the final 16 of the NCAA tournament last month, after several cycles of chemotherapy to deal with breast cancer that had spread to her liver and spine.

About 40% of the more than 1 million Americans diagnosed with some form of cancer each year are working-age adults, according to the American Cancer Society. The vast majority return to work after treatment, often within a year, said Tenbroeck Smith, who directs research on survivorship at the Cancer Society’s Behavioral Research Center in Atlanta.


Millions of people with early-stage or localized tumors, such as some forms of breast or prostate cancer, have long been able to return to their jobs in the wake of their treatment. Now, said oncologist John Glaspy, a professor at the UCLA David Geffen School of Medicine, nearly three-quarters of his patients whose tumors have spread also head back to work. In the late 1980s, that was “very rare.”

Such “metastatic” cancers were once tantamount to an immediate death sentence. Now, it is becoming a chronic but treatable condition for many patients, akin to heart disease or AIDS. New drugs have blunted debilitating effects of chemotherapy that kept patients bed bound during treatment or left them with lasting disabilities. Targeted therapies have improved survival rates.

Every three weeks, sales rep Scottoreceives an infusion of Genentech Inc.’s Avastin, which was approved in 2004 to treat several types of metastatic tumors. As an independent contractor who works full-time for New York-based Robert’s American Gourmet, Scotto arranges her medical appointments around calls to brokers and customers.

New therapies such as Avastin, targeted at the genetic profile of individual tumors, have dramatically improved the quality of life for patients, UCLA’s Glaspy said.

“Now chemotherapy is highly toxic to the cancer and only a little bit to the person,” he said. In the past, the treatment was “highly toxic to both.”

Federal and state laws have also helped many workers by requiring employers to accommodate their physical limitations and treatment schedules.

The federal Family and Medical Leave Act allows most employees to take unpaid leave for surgery and treatment. The Americans With Disabilities Act requires employers to make accommodations for workers who, for example, can no longer lift heavy loads or become easily fatigued as a result of treatment.

California’s Fair Employment and Housing Act is even more protective of workers with cancer. It applies to companies with as few as five employees and defines disabilities requiring accommodation as any limitation on a life activity.

Some employers go beyond what the laws require to make employees feel comfortable during and after treatment.

Six years ago, the Cosmetic Executive Women Foundation, a New York-based industry group with more than 4,000 members, launched to disseminate “best practices” on the job. Among other suggestions, the site advises managers to provide a private room for employees to telephone their physicians and keep workers who are on leave informed about company happenings.

Health and wellness publisher Rodale Inc. was one of the project’s early promoters. The Pennsylvania-based firm creates a personalized website for each employee with cancer, similar to a MySpace page, linking them to resources and co-workers with the disease. Managers also receive special training on how to re-integrate cancer patients into the office and respond to colleagues’ questions.

“We wanted to make sure people understood that we were fully committed to help them,” said Amy Plasha, Rodale’s vice president of compensation and human resources. The program has also paid off in productivity and morale, she said.

Many disease sufferers want to continue working because it provides a big part of their social network, UCLA’s Glaspy said.

“Those social webs, they define ... they keep you alive,” he said. “You have to have a reason to roll out of bed in the morning and comb your hair.”

Peter Douglas wanted to prove “I wasn’t on my deathbed.” The California Coastal Commission’s executive director has been a frequent target of developers, homeowners and others who tangle with the agency.

“The sharks started circling the waters” the day he was diagnosed with Stage 4 tongue and throat cancer in 2004, he said, but he worked through his treatment.

Sales rep Scotto credits her colleagues for keeping her on an even keel. “Those people have been fantastic,” she said.

Her boss, company Vice President Elizabeth Fisher, offered to fly to Los Angeles to nurse Scotto after surgery. Scotto didn’t need the help, but Fisher did step in for her at a trade show she couldn’t attend and has at times helped her keep up with customer requests.

Going to work also creates a boundary around anxiety, making patients feel more normal, UCLA psychiatry professor David Wellisch said.

At their news conference last month, John Edwards revealed that although his wife’s cancer was no longer curable, her wish was to help him continue his quest for the presidency.

“Other than sitting around feeling sorry for ourselves,” the former North Carolina senator said, “there was no reason to stop.”

In a poll last year, three-quarters of those working with cancer said their bosses treated them very well, the survey by USA Today, the Kaiser Family Foundation and the Harvard School of Public Health showed.

But not everyone is so fortunate. Beverly Hills lawyer Gary Ross hears plenty from workers who’ve had trouble. Two of every 10 callers with cancer are employees who were fired.

“As the treatment improves and knowledge improves, that’s when legal wrangling results because you get into that gray area of what is a reasonable accommodation,” he said.

One of his current clients worked for 35 years as a valet at a Los Angeles luxury hotel, much of it as head valet. After surgery for prostate cancer diminished his bladder control, he asked for permission to use a bathroom at the front of the hotel. His bosses refused, saying they didn’t want the valet mixing with guests, and later fired him, Ross said.

“They could have put a port-a-potty in a remote spot, behind a tree or at one of the parking lots where he worked,” Ross noted.

On-the-job discrimination and firings are “more common than you would think,” said Joanna Morales, who runs the Cancer Legal Resource Center at Loyola Law School.

“People either don’t know about the laws or they’re choosing not to enforce them,” she said, adding, “It goes from professional to manufacturing to labor jobs.”