Esther Yarbrough had recently started a new job as the executive director of a membership organization when she got the news—breast cancer.
She was stunned. Just three months earlier in 2011 her predecessor had died of pancreatic cancer leaving the group's members and staff feeling adrift. She had stepped in to take charge. The last thing that Yarbrough wanted to do was panic her colleagues or raise doubts about her ability to do the job.
"It was very important to me to keep things going," says Yarbrough, 60, who was diagnosed in 2011. She heads an association of independent physicians in Georgia. "I wasn't sure how our association members would react."
She responded like the take-charge executive that she is, doing research on treatment options, getting a second opinion, scheduling a lumpectomy at a cancer center in Illinois, and, for the most part, keeping the news to herself. She had surgery to remove a small tumor on a Tuesday and was back on the job on Wednesday working from her hospital bed. She told her two staff members but never said a word to the association's board of directors or its members.
Thanks to cutting-edge medical technology and early detection, she didn't have to.
Yarbrough received a new treatment that allows breast cancer patients to receive radiation therapy in a single dose during surgery, sparing them weeks-long rounds of radiation and all of the side effects that come with it. And because her cancer was discovered early, she did not need chemotherapy. Few people knew that she was ill.
"No one had a clue," she says.
Yarbrough is one of a growing number of survivors who have had to balance cancer and career—returning to work after receiving what was once viewed as a death sentence. There are nearly 14 million cancer survivors today compared with just under 10 million in 2001, and those numbers are steadily rising, according to the National Cancer Institute.
Advancements in early detection and treatment mean that cancer survivors are being diagnosed younger and living longer. Nearly half are between 19 and 64 years old, which means there are more cancer survivors in the workplace than ever before. That poses new challenges to employers as they struggle to control health care costs and help their workers lead healthier lives.
"Cancer has grown in importance to employers as the frequency of diagnosis increased," says Helen Darling, president of the National Business Group on Health, an association of more than 300 large U.S. employers. In response, the Washington, D.C.-based business group has developed a series of online tool kits to help employers design medical and pharmacy benefit plans and other programs that support cancer patients and their families. The tool kits will be published in An Employer's Guide to Cancer Treatment and Prevention later this year.
"We have much better detection methods so people are diagnosed earlier and are under treatment for a longer period of time. It's important that employers help manage and support employees that have been diagnosed through a comprehensive benefit plan and other programs that support family members."
Cancer is no longer the taboo topic that it was in the 1950s and '60s when few talked about the disease, including doctors who frequently withheld the diagnosis from their patients. Given the low survival rates, many feared destroying their patients' hopes of recovery. It wasn't until well-known figures like first lady Betty Ford and President Ronald Reagan began talking publicly about their bouts with cancer in the 1970s and 1980s that the stigma began to fade.
Today, with celebrities like Good Morning America co-anchor Robin Roberts and TV actress Christina Applegate sharing their cancer stories with the world, the disease has emerged from the shadows. And the workplace is where many survivors share the news.
"A lot of people find out about their diagnosis at work, so a lot of people don't get to decide when or if to tell," says Kate Sweeney, executive director of Cancer and Careers, a program of the Cosmetic Executive Women Foundation that provides online resources for employees with cancer. "If they do share the news, more and more employees are telling people in the workforce. There is less of a stigma than there was even 10 years ago when we launched our organization. People realize that a cancer diagnosis isn't a death sentence."
Sweeney says that those who decide to keep the news a secret are driven by the fear that their careers will suffer. "They don't want to be labeled as someone who can't be productive. They worry that they'll be passed over for promotions." And sometimes well-meaning employers might withhold certain opportunities for fear of overwhelming an employee who is battling cancer, she says.
For Jonny Imerman, who was diagnosed with testicular cancer in his mid-20s, the thought of keeping his diagnosis from his co-workers never occurred to him.
"What is the fear? I realize that those who are executives or CEOs don't want to be perceived as weak or as losing a battle, but I don't agree personally," says Imerman, 38. "Cancer is part of life." He was working in commercial real estate in Detroit when he was diagnosed in 2001. A year later he quit his job, moved to Chicago and founded Imerman Angels, a one-on-one support group for cancer survivors.
"Today, younger people are more open about these things," he says. "They get a diagnosis and they go straight to Facebook and say, 'OMG, I have thyroid cancer.' "
Employers are realizing that they must focus on cancer care as they look for ways to manage health care costs. They can't afford not to.
Cancer costs employers an estimated $264 billion a year in medical care and lost productivity, according to 2012 figures from the American Cancer Society. While cancer patients represent just 1.6 percent of the privately insured population, they account for 10 percent of employers' medical claim costs and a large share of long-term and short-term disability claims, according to the National Business Group on Health.
And with 80 percent of working-age cancer patients returning to their jobs, employers must develop "a comprehensive approach to fighting cancer through general medical benefits, behavioral health programs and pharmacy recommendations," including employee assistance programs, says Ron Finch, vice president of the business group. "As employers, we need to learn about disability coverage, family leave, EAPs to help the patient, the family or co-workers as they experience cancer," he says.
At Ameren Missouri, a public utility company based in St. Louis, cancer is becoming a topic of growing importance, according to Mark Lindgren, chief human resources officer.
"About two to three years ago we started to launch targeted programs around cancer and cancer prevention, and began looking at our benefit plans with a cancer lens," he says. That meant making sure that the company's health plans focused on cancer prevention and that wellness programs included cancer-specific initiatives like free screenings.
In addition to health and wellness benefits, Ameren also has generous short-term and long-term disability programs, Lindgren says, and allows employees to donate their vacation days to a sick co-worker if needed.
"We had a gentleman a year ago who had throat cancer, and I was amazed at how much workplace support he got," he says. "Employers today recognize that people want to be supported because that helps alleviate much of the stress when they are in that situation."
Helping employees navigate treatment and providing them with information and resources is critical in ensuring that they return to work as productive and engaged employees, says Tenbroeck Smith, a behavioral researcher at the American Cancer Society.
"Why does a survivor care if he or she has a job?" he asks. "Financial compensation, health insurance for sure, but also for social support and a sense of purpose and well-being."
Without supportive co-workers, Todd Lovern, 50, says he can't imagine how he would have made it through a devastating diagnosis. In 2010, the 50-year-old field-service engineer with GE Healthcare in Seattle was diagnosed with stage 4 colon cancer.
The father of four was training to run a marathon in the late summer of that year when he began noticing some strange symptoms like frequent urination and bowel movements and weight loss. At first he attributed the symptoms to his coffee habit and rigorous training regimen—he was running 40 to 50 miles a week.
His doctor suggested a colonoscopy. Lovern wasn't too worried at first. He was 48, and 90 percent of colon cancers are found in men over 50. But he was in the 10 percent, and the prognosis wasn't good. The cancer had spread to his liver.
"I was in shock for about three to four hours before it sunk in that I had quite a battle ahead of me," he says. "I called my manager and explained to him that I was diagnosed and that I'd probably need some time off. His reaction was amazing. He was obviously upset. He was shaken by the news, but he was very caring."
In fact, Lovern says that everyone from his general manager to the company's HR representatives to his co-workers "took a leadership role" in making sure that he and his family had all the support and information they needed.
"My boss and HR told me that I had six months of short-term disability but not to worry about it because, 'We've got your back,' " he says. "That was awesome to hear. It took some of the financial worry out of it. My wife works part time and makes a fourth of what I make. I thought we might have to move out of our house. But HR said you're good for a year at 100 percent of my pay if I needed it. They were very generous."
Lovern underwent aggressive chemotherapy and several grueling surgeries and procedures, but today he is cancer free. While he credits GE's comprehensive benefit plan with helping him get back on his feet, he says that the emotional support of his colleagues got him through some of his darkest times.
"Two days after I told my boss the news, I got a FedEx box from our general manager," says Lovern, his voice thick with emotion. "It was full of cards from my co-workers, people I don't even work directly with. She would travel around the country and every week for months she made sure that I had a FedEx box filled with cards. Some days I really needed those cards to get through the week."
But some survivors like Gail Nelson, a health care industry executive, find that old stereotypes can linger, especially when it comes to women in male-dominated industries.
Nelson, a senior vice president at MedSpeed, a medical courier and transportation company in Elmhurst, Illinois, was first diagnosed with breast cancer in 2003 when she worked for a different company. She says that her boss was very supportive, but Nelson chose not to share the news with her staff.
"When you're diagnosed with cancer, you worry about the perception people will have," she says. "I was afraid that I'd be pushed aside in terms of promotions and career opportunities. I had been climbing the ladder a long time without a hiccup and as a woman you have to climb twice as hard, twice as fast. You don't want cancer to derail your progress."
Her treatment was successful and her career flourished, but four years later the cancer returned. By then she was at a different firm. She decided to tell her colleagues, but she didn't get the response she had hoped for.
"The first time I went to a local team meeting, they were asking, 'How are you going to keep up with everything?' " she says. "I was so shocked that they were questioning me, saying, 'You must be sick.' They just didn't get it. They thought that this would derail me."
Nelson took time off while she underwent treatment. Three months after she returned, her position, along with another, was eliminated.
She found out later that some team members had expressed their concerns over her ability to do her job to company leaders. "I'll never know for sure if that's why my position was eliminated, but I'll always wonder about it."
While discrimination against cancer survivors has not disappeared completely, companies have come a long way since the days when sharing a cancer diagnosis sometimes meant the end of a career, says Barbara Hoffman, a law professor and founding chair of the National Coalition of Cancer Survivorship. "Back in the 1960s and '70s, cancer was still a private thing—there was a shame factor associated with it."
Before the Americans with Disabilities Act was passed in 1990, discrimination against cancer survivors was common.
"We've moved away from the taboo of having cancer toward almost a pride about being a survivor," Hoffman says. "I think we're getting to the place where employers look at cancer survivors and see an individual rather than a label."