A patient who has taken time off from working and is now ready to return is likely to find themselves in one of two circumstances:

• Planning to return to an existing job.
• Planning to look for a new job.

It is also common for patients in either circumstance to discover they no longer feel satisfied working in their previous job or professional field and wish to make a career change. All of these situations have their unique challenges and benefits.

This chapter discusses ways in which you can help your patients navigate this challenging transition.

PATIENTS RETURNING TO AN EXISTING JOB

Whether they’ve taken a long- or short-term leave, there are some additional points to help patient and survivors with re-entry to the workplace:

BREAKING OUT OF THE “CANCER PERSON” BOX. The upside for patients returning to their existing job and employer is that there are many known quantities. Being familiar with the responsibilities of their role — as well as with the people in the organization, the interpersonal dynamics of the place and what it takes to succeed — all have their benefits. However, one downside experienced by patients returning to their prior job is the feeling that they will forever be seen as the “cancer person” in the workplace, rather than being viewed as the employee they were prior to their diagnosis.

It is common for patients’ coworkers to make cancer-related comments during the re-entry process. For the most part, such comments are well-intended attempts to connect with the patient (e.g. “My uncle also had cancer,” “How are you feeling?”). However, regardless of good intentions, patients often find these comments off-putting. Therefore, a very important role you can play is to help patients prepare how they are going to respond to any cancer-related comments or questions. And to help them do this, we recommend a technique called “The Swivel.”

“THE SWIVEL.” We call it the Swivel because the goal is to acknowledge and address the cancer-related question or comment, then redirect — or swivel — the conversation toward a work-related topic. This allows the patient to re-cast themselves in a work context. Here are some examples of how a patient might swivel in the workplace:

Coworker: “My uncle also had cancer.”

Patient: “That must have been very difficult — thank you for sharing that. While you’re here, do you have a few minutes to review some of the notes from yesterday’s meeting?”

Coworker: “How are you feeling?”

Patient: “Really excited to be back! In fact, I have a few questions about the new timecard system. Do have a few minutes to answer them?”

The examples above give a sense of what a swivel might look like. However, the overall goal when working directly with patients is to help them find language that is succinct and feels authentic. Once they have crafted their own personal swivels, recommend that they practice saying them out loud so that the words feel natural coming out of their mouths.

GETTING YOUR PATIENT UP TO SPEED. After being away from work, it’s important for patients to regain confidence about their job-related abilities. Below are some points to address as you support them in that process:

• How is their psyche? Just as important as feeling physically capable of doing their job is for patients to feel psychologically up to the task. If your patient doubts their capacity to succeed, encourage them to consider one-on-one counseling or to join a support group comprised of other cancer patients returning to work.
• Formal return-to-work program or disability-management program. It may be beneficial to patients to look into whether their company has such a program in place. If not, they should explore whether there is an informal contact person for such transitions. Traditionally, Employee Assistance Programs, which help workers recover from drug and alcohol problems, involve a return-to-work meeting, in which employee and employer discuss expectations and capabilities. The same sort of meeting might be useful as your patient resumes their duties.
• Evaluate work-readiness. What should your patient expect in terms of residual side effects? Are they prepared to come back full-time or part-time? Can they telecommute from home a few days a week? Ease back into their usual routine with half days? Additionally, if your patient is choosing whether to work mornings or afternoons, it’s important for them to factor in the possible side effects of any medication they take.

REQUESTING TELECOMMUTING AS AN ACCOMMODATION FROM A CURRENT EMPLOYER. If your patient plans to broach the subject of telecommuting with their current employer, it’s a good idea for them to create a proposal or plan showing how they can continue to make their contribution to the work of the organization without putting in face time every day. You can help your patient think through the benefits for the employer, such as continuity of work and productivity gained by eliminating commute time. Being able to articulate the benefits for both parties, as well as a willingness to compromise — such as committing to attend onsite meetings or visit customer sites as needed — can help patients persuade their current employer to embrace the concept.

CONSIDERING A CAREER CHANGE

Many patients no longer find the same satisfaction in their job as they did before cancer — and that’s okay. This kind of shift may be temporary or permanent; either way, it’s important to validate patients’ feelings and support them as they explore and reflect.

However, even if your patient strongly feels that their work-related goals have changed so much that they wish to embark on a new career path, it still may be helpful for them to return to their old position for a while before searching for a different one. For many patients, regaining confidence as a full-time employee in a familiar environment can be invaluable.

Cancer and Careers’ Job Search Toolkit provides tips on how to find meaningful work as well as on looking for work after cancer. It’s a terrific resource for patients and can be ordered in hardcopy or downloaded free of charge.

JOB-HUNTING AFTER CANCER TREATMENT

Just as returning to an existing job has both pros and cons, so too does finding a new job after cancer. In the “pro” column, patients have an opportunity to enter an environment where their supervisors and colleagues don’t know about their cancer experience, leaving it up to the patient to decide if and when that information should be revealed.

Conversely, because he or she will be entering a new work environment, it will be necessary to invest more time and effort in figuring out their circumstances, including new job responsibilities, the personalities of and pre-existing relationships between coworkers (and where your patient fits in), and how to “succeed” within the organization overall. Additionally, it’s important to remind patients that all workplaces have their unique quirks and dysfunction, and it is worth taking some time to discover those as well.

However, before your patients can begin to acclimate to a new work environment, they’ll need to engage in the highly involved process of job-hunting.

NORMALIZING THE JOB-SEARCH EXPERIENCE. The fact is that looking for work is an inherently challenging and stressful experience regardless of the job-hunter’s cancer history. One area where you can be very effective with patients is helping them to accept this reality. Normalizing the highs and lows of job-hunting as being common to people of all backgrounds may prevent your patients from thinking their struggle is directly related to their cancer experience. It is also useful to help patients manage their overall expectations by exploring any thoughts and feelings they anticipate may be part of the process, and then work toward identifying various approaches to self-care that might be effective during the lows.

ADDRESSING CANCER DURING THE JOB-SEARCH PROCESS. For many survivors who are looking for work, a big question is whether and how to address their cancer during the job-hunting process. While patients are generally not legally obligated to disclose a cancer diagnosis at any point (during the application/interview process or once they are employed, for that matter), they should be encouraged to make a decision about disclosure that feels right for them. Some survivors can’t imagine a set of circumstances in which they wouldn’t share their story. Others may view their experience as something they coped with and survived, but not something that defines them or that they want to make part of their identity — professional or private.

It is also not unusual for cancer survivors to feel a certain obligation to disclose their cancer history so potential employers have a more complete understanding of the person they might decide to hire. If you’re working with a patient for whom this is the case, take some time to explore where these feelings might be coming from, and remind them that it is not essential for them to communicate every detail of their personal lives during the application and interview process. It may also be useful to point out that there are many people living with chronic life-long conditions, such as diabetes or Crohn’s disease, who don’t necessarily disclose their illness.

However, if your patient feels strongly about disclosing — or will need to request a reasonable accommodation once they are hired — the real consideration isn’t whether to tell, but when. We often get asked if someone should disclose in a cover letter or resume — or during the first interview. For these patients, it’s important to remind them that each stage of the job-search process — from the cover letter to the resume to interviewing — are all parts of a strategy to get hired. The cover letter and resume are designed to get them through the door, and the first interview is the very beginning of a potential relationship. The goal during each of these stages is to impress a prospective employer and advance to the next phase of the hiring process; so it is probably not the best time for patients to share their cancer history. Instead, encourage patients to be instinctual as they move through the interview rounds, and to choose a moment when they think the company is invested in them and likely to make an offer. Another, very viable option is to wait until the offer comes through, then share the information as part of their discussion of salary, benefits and other related factors.

JOB-SEARCH ESSENTIALS

When it comes to the actual job-search, there are a few essential “tools” that every survivor needs to have in their arsenal, and below are some key points to cover with patients. More detailed information on all of these topics — and others — can be found in Cancer and Careers’ 60-page Job Search Toolkit, which can be ordered in hard copy or downloaded for free.

NETWORKING. The vast majority of jobs today are found through networking rather than through job-board postings or newspaper listings. For patients who have taken time off, one of the biggest challenges can be reaching out to someone they haven’t spoken with in a long time. If your patient feels uncomfortable reaching out because time has passed and now they need something, encourage them to do the following:

• Acknowledge the lapse in time.
• Explain the “Why now?”
• Offer to do something in return.

It’s also a good idea for patients to keep track of their contacts and communications. Cancer and Careers’ networking tracker, which can help patients stay organized, can be downloaded here .

LINKEDIN. Maintaining an effective profile on the professional networking website www.linkedin.com has become as crucial as crafting a good resume. LinkedIn multiplies your patient’s existing personal and professional networks by making their connections’ connections available to them as well. Additionally, in the past few years employers have increasingly turned to LinkedIn as an inexpensive alternative to headhunters when filling all but the most senior positions. Encourage your patients to devote time and effort to building their profile when they join, and it will likely yield benefits.

RESUMES, AND RESUME GAPS. Due in large part to the expansion of online communities and brands, the world of job-seeking has changed. What hasn’t changed is the fact that a resume must be carefully crafted and the information presented in a concise, targeted and visually appealing way. And remember, always communicate to your patients that the goal of a resume isn’t to get them the job — it’s to get them an interview.

For many cancer survivors, the most pressing question about resumes is how to deal with gaps. The assumption is that gaps on a resume mean being automatically relegated to the “no” pile. However, because of the downturn in the economy, it’s much more common for people to have gone for long periods of time without a steady, full-time job. Therefore, it’s important to communicate to patients that a gap on a resume is no longer a clear indicator of a health crisis — but it is something to be dealt with strategically. More information on designing a strategic resume can be found in Cancer and Careers’ Job Search Toolkit.

COVER LETTERS, AND ADDRESSING THE GAPS. A cover letter (or cover email) can help differentiate your patient from other candidates, and give them the opportunity to include more details about their interest in a specific job. It’s extremely important that patients do not simply regurgitate their resume when writing their cover letter. Rather, the cover letter is an opportunity to draw parallels or highlight an experience that makes your patient uniquely suited to the particular job for which they are applying. Additionally, cover letters should be no longer than three paragraphs, and they should be proofread very carefully.

If your patient has a significant gap on their resume and they feel strongly about addressing it in their cover letter, you can help them come up with an explanation for it that they’re comfortable with. Something such as:

"After a period of family responsibilities, I returned to school to refresh and update my accounting skills. Since accounting standards and regulations have changed substantially in the past five years, this training was timely and highly relevant.”

The point is for patients to briefly explain the gap and demonstrate that they have stayed current.

INTERVIEWS

Understandably, interviews make a lot of cancer survivors nervous — particularly when it comes to addressing any gaps in employment. However, one thing that you can do is to help your patients understand that interviews are a source of anxiety for many people — not just those with a cancer history — and that their best tool during any interview is good preparation. Communicate to your patients that while they don’t want to lie during any part of the hiring process, it is important to remember that no one shares every last detail about themselves either. The purpose of the interview is to figure out whether your patient and the company are a good match. Below are some additional points to keep in mind when talking to your patients about the interview process.

CAN A POTENTIAL EMPLOYER ASK ABOUT HEALTH HISTORY? The federal Americans with Disabilities Act (ADA) and State Fair Employment Laws prohibit most employers from asking a job applicant about a disability before offering the job. However, a potential employer may ask questions about whether your patient can perform the essential functions of a job and how he/she would perform those functions. For example, if your patient walks with a cane, they can’t ask why your patient uses a cane, but they can ask about their ability to carry heavy boxes or stand on their feet all day.

Of course, just because a prospective employer isn’t supposed to ask about health history doesn’t mean they won’t. Therefore, it is always a good idea to help your patients think through how they might field a question that shouldn’t be asked. Will they disclose? Will they tell a potential employer they shouldn’t ask that question? Will they acknowledge that they had a health issue in the past? Essentially it is up to your patient to decide. Your role is to support your patient in giving some thought to this ahead of time. This will help them feel in control and prepared for anything that might come up in the interview.

“SWIVELING” DURING AN INTERVIEW. Although it’s illegal for employers to ask specific questions about a patient’s health, it’s not out of the ordinary for them to inquire about a gap in employment. This is another area where The Swivel technique can be very useful. In this context, the goal is to acknowledge the question about the resume gap and then redirect — or swivel — the conversation in a way that addresses your patient’s professional goals and desire for the job. The ideal swivel does not leave an opening for the interviewer to dig further into the gap, but instead nudges them to pick up the conversation from the point it was swiveled to.

When helping patients plan their own personal swivel, work with them to develop a succinct, authentic answer to the “gap” question and then practice it over and over until they feel completely comfortable saying it out loud. Sample swivels:

“I was dealing with a family issue that is resolved now, and I am thrilled to discuss how my management skills can build the team and grow your business.”

“I realized that what I was doing didn’t fulfill me, so I took a step back to think about what would make me happy, and I think my tech background would be a great asset not just for this role but for the company as a whole.”