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 cancerandcareers.org 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.