Can I work during chemotherapy?

Many people can work during chemotherapy, as long as they match their work schedule to how they feel.

Whether it works for you depends on three things. What drugs you are getting. How physical your job is. How much say you have over your hours. Two people on the same regimen can land in very different places. So can the same person in cycle 1 and cycle 5.

The rhythm to plan around

Chemotherapy is given in cycles, with treatment days followed by rest days. Side effects tend to follow that rhythm rather than sitting flat across the month.

Fatigue is the most common side effect. NCI suggests planning rest for the day of chemotherapy and the day after. For many regimens, that is the worst stretch, with function improving over the following week before the next cycle starts.

Track it for one full cycle. Each day, note whether you felt good, fair, or wiped out. After one cycle you have a pattern to build a schedule around, instead of a guess. That record also helps if you later ask your employer for a change.

The low point for infection risk is a different date than the low point for fatigue. Within each cycle, white blood cell counts fall to a low point and then climb back. The timing depends on the drugs. Does your job put you around crowds, young children, or sick people? Ask your team which days those are for your regimen.

What the law actually gives you

NCI notes that many employers are required by law to change your work schedule. Two federal laws do most of that work in the US.

The Americans with Disabilities Act. The EEOC says cancer counts as a disability under the ADA Amendments Act of 2008. The reason is that it limits normal cell growth. The ADA covers private employers with 15 or more workers. It also covers state and local government employers. It requires reasonable accommodation, unless that would be an undue hardship for the business.

The EEOC's own examples of accommodations for people with cancer include:

• Leave for appointments or to recover from treatment
• A modified or part-time schedule
• Periodic breaks, or a private place to rest or take medicine
• Permission to work from home
• Shifting minor duties to someone else
• Reassignment to a vacant position

You do not need special wording to ask. The EEOC says there are no magic words. A family member, friend, or health professional can make the request for you.

The Family and Medical Leave Act. FMLA gives up to 12 workweeks of leave in a 12-month period for your own serious health condition. It covers private employers with 50 or more workers, plus public agencies and school districts. To qualify, you must have worked there at least 12 months. You must have logged at least 1,250 hours in the past year. And your worksite must have 50 or more employees within 75 miles.

Here is the part people miss. FMLA leave can be taken in pieces, or as a shorter weekly schedule, when your doctor says it is needed. You do not have to take all 12 weeks in one block. Half-days on chemotherapy weeks can come out of the same bank.

Before you decide

Ask your cancer team which side effects your regimen tends to cause, and when they peak. Ask whether infusions can be booked late in the week. That way the worst days may land on a weekend.

FMLA leave is unpaid. Check whether your employer offers short-term disability, which replaces part of your pay.