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 something else. It applies when an employer refuses to hire or fires someone because of cancer, or because the employer believes they have it.

Coverage has limits worth knowing. EEOC says Title I of the ADA covers private employers with 15 or more employees, plus state and local government employers. Section 501 of the Rehabilitation Act does the same job for federal employment. EEOC also notes that most states have their own laws, some reaching smaller employers.

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 someone does mention cancer on their own, EEOC says the employer generally may not ask follow-up questions. That covers the cancer, its treatment, and its outlook. There is one exception. If the employer reasonably believes an accommodation will be needed, it may ask whether one is needed and what type.

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. And 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.

Those thresholds are the reason early-career workers often fall outside FMLA. A first job of nine months, or a small workplace, fails the test.

Two features soften it. The regulation says leave may be taken bit by bit, rather than all at once, or as a reduced schedule. And health benefits must continue during leave, as if the employee had kept working. The employee keeps paying whatever share they paid before.

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.

The Department of Education has a resource guide on Section 504. It lists the major life activities that matter for eligibility. The list is long. Caring for oneself. Performing manual tasks. Seeing, hearing, and speaking. Eating and sleeping. Walking, standing, lifting, and bending. Breathing. Learning, reading, concentrating, and thinking. Communicating. And working. Major bodily functions count as major life activities too.

That list explains a lot. Concentration problems, fatigue, and lifting limits from chemo are eligible grounds, not favors.

The guide covers the after-treatment case directly. It gives cancer as an example. A person may have a record of a disability without still having the impairment. So protection from discrimination does not end when treatment does.

On paperwork, the Office for Civil Rights urges schools to put a student's Section 504 services in a written plan. The point is to prevent confusion about what was offered. The guide also notes that a student with an IEP under the IDEA does not need a separate Section 504 plan. The IEP is sufficient.

And on money: under Section 504, a free appropriate public education must be provided free of charge. Schools may charge a student with a disability a fee only if the same fee applies to students without disabilities.

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. That choice shapes how heavy the schedule is. It therefore shapes how much school or work is realistic.

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 frames speaking up as a skill to build, since many young adults are new to the health care system.

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
• ED: parent and educator resource guide to Section 504
• NCI: emotional support for young people with cancer