For most cancer survivors, as this LiveStrong magazine/online post makes clear, getting through treatment isn't the only major goal. They also have a job to return to—in order to truly heal.

"Don't even think about it," she thought that morning. And then she couldn't help but think about it: her breast cancer diagnosis, the surgery, the chemo, and the fears of a young mother with an infant son and five-year-old daughter. And the impact of that awful year, 2006, flooded back.

Yet on the same day this spring, when Adrienne Ambraziunas, 40, prepped for her callback job interview at There With Care (TWC), a Colorado-based, family service nonprofit agency, it finally hit her: Maybe this was one of the few job openings around in which survivor status might actually help her land the job. She also felt (but didn't see the need to share right away) that her experience fighting cancer would even help her perform her job. After all, the TWC mission is: "Helping children and families facing critical illness." And she was gunning to become a volunteer coordinator — one of the few administrative positions on staff — which helps direct the kinds of care and services that client families receive daily.

Chillingly, Ambraziunas later allows that she had been diagnosed at 36—the exact age as her maternal grandmother, who unfortunately didn't survive to age 40. Unlike her grandmother, Ambraziunas had been tested for the (BRCA) breast cancer genes and so far had been found to be clear of an ominous future. Would all this knowledge and worry crimp her confidence during her interview? It didn't seem to do so that day. The interview went well. Really well.

HOW MUCH DO YOU SHARE?

Of course, survivor interviews and human resources sessions on the job don't always match up well. Especially when you have an unenlightened employer who may view you or your situation as a drain on the company's resources. Fact is: Employees with checkered health histories have had a difficult time changing or obtaining high-quality health insurance. Legislation such as the Genetic Information Nondiscrimination Act, which went into law in 2008 and bars companies from using genetic information in hiring, firing, or promotion decisions, is new enough that even its initial impact is still being weighed. And the full effects of the Patient Protection and Affordable Care Act, the health care reform bill signed into law in March, won't be felt for at least a few years, as final pieces of the reform settle into place closer to 2013-14.

It's no wonder, then, that patients and survivors don't always share their diagnoses openly on the job. "I kept information from the company until I had all the facts about the cancer, had my medical team picked, and the treatment options," says Steve Nelson, 46, a Southern California colorectal cancer survivor and real-estate investment analyst. "I had a plan of attack to 'beat the beast' set in motion. This was done to eliminate the judgments and second-guessing of others, my coworkers' opinions, and the 'advice' of others."

While coworkers' intent may often be kindhearted or good-natured, Nelson felt protective of his job, career, and his long-term status as vice-president of a solid, mid-sized company. "It was ultimately up to me to do this," he adds of his delayed, strategic download of his case to his colleagues. When Nelson talks about the "judgments" of these same colleagues, he is referring to part of the social stigma of cancer diagnoses that remains, even in our technical, supposedly medically savvy society. Otherwise, why would a middle-aged husband, dad, and exec on the West Coast be so hesitant to talk to people he works with every day? Especially about fairly common aspects of his biology that ran amok and attacked his intestines, his colon. In 2010, certain diagnoses, such as lung cancer ("Did he smoke?"), skin cancer ("Didn't she do tanning salons?"), or colorectal cancer ("Was he a vegetarian?/Did he eat a lot of meat?"), are especially apt to act as targets for such stigmatized beliefs.

On a corporate level, the CEO Cancer Gold Standard is a national program that attacks stigma, outmoded beliefs about cancer, and laggard reimbursement or health insurance support for cancer prevention. (It was created and is run by the CEO Roundtable on Cancer, a nonprofit collection of top chief executive officers across the U.S. who join to help relieve the burdens of cancer on organizations and families. The Roundtable was formed in 2001.)

The CEO Roundtable on Cancer announced recently that its CEO Gold Standard) certification now covers more than 1.25 million employees (see "Corporate Cancer Pedigree", below). What's more, CEO Gold Standard hopes to have three million employees covered by firms accredited with the Gold Standard by 2011, according to Bill Weldon, the chairman of Johnson & Johnson, who chairs the CEO Roundtable on Cancer.

In brief, the Gold Standard calls for firms to take actions in five key areas of health to fight cancer in the workplace:

Discourage smoking
Encourage fitness in or near the workplace
Promote healthful eating, nutrition
Detect cancer at its earliest stages
Provide access to quality care, including potential clinical trials

"I did not want the rest of my company to know," says one colon cancer survivor, after he told his CEO. "But as you know, COMPANY SECRETS LEAK OUT over time."

LIVESTRONG is among the organizations that have achieved the CEO Gold Standard rating. Other firms that have been cited for inclusion are Aetna, Dana Farber Cancer Institute, Li Destri Foods, State Farm, U.S. Oncology, and the Wistar Institute, to name just a few. Quest Diagnostics, considered the world leader in medical diagnostic testing and services, won the designation this spring. In response to a question from LIVESTRONG Quarterly, Surya Mohapatra, M.D., the CEO of Quest Diagnostics, explains how he and his firm see real value in reaching out to survivors and caregivers in the workplace, and more specifically to those on his payroll.

"In 2005, we made a formal commitment to the health and wellness of our more than 40,000 U.S. employees and their families through our HealthyQuest wellness program," he says. "At the heart of this program is our Blueprint for Wellness service, whichprovides employees and spouses or partners a comprehensive health risk assessment. It includes a panel of up to 30 tests, including screenings for prostate and colon cancer."

This last component is the missing link in so many corporate wellness programs today. What's more, Quest and other Gold Standard designated firms share the costs of the screenings, fitness programs, or both with their employees.

"The feedback we have received," Dr. Mohapatra says, "has been extremely positive and heartfelt, whether we helped find cancer early, or enabled [employees] to lose weight or stop smoking. Healthy, motivated employees are more productive today, and they strengthen a company's workforce for tomorrow, creating business power and advantage."

In Nelson's case, a small group of volunteer coworkers met with him every Wednesday (unsolicited) to see how things were going and what they might do to help him out at home an at the office.

Meantime, survivors and their families outside the CEO Gold Standard umbrella often quickly learn of a few key laws and acronyms that may help with transitions on the job. The first, commonly known in employment circles is the Americans with Disabilities Act (ADA), has been in place since the 1990s. In a few key areas, the ADA helps the outlook for cancer survivors improve when they apply for or return to a job. As the cancer survivor population continues to grow (12 million Americans are now living with cancer), employers will continue to recognize that millions of cancer survivors can and do return to productive careers after treatment.

SAFETY IN NUMBERS?

"The biggest role the Americans with Disabilities Act plays for cancer survivors going back to work is it discourages discrimination in the first place," says Barbara Hoffman, an attorney with the National Council on Cancer Survivorship and one of the leading authorities in the U.S. on the employment rights of cancer survivors.

When Lance Armstrong was diagnosed with testicular cancer in October, 1996, he didn't have health insurance in place. While he didn't suffer outright "discrimination in the workplace" due to his diagnosis, he found himself in an unusual place: casting about for a "team." An insurer. He was "lucky," he says, that one of his sponsors, Oakley eyewear, threatened to move its health insurance business elsewhere if the firm's health insurer didn't step up and insure Lance. "Without their help, I might not be alive today," Lance has said.

For Nelson, his feelings of being alone and fears of being shunned at work faded as his support at the office seemed to grow.. "My advice for others is: Do not change your daily routine. Try to remain independent. If you exercise, do not stop [though you'll obviously need to back off your personal best a bit]. Since your mind and body have been doing the 'work routine' thing for years, it is the simplest item you can maintain when you're feeling at your worst."

As for Ambraziunas, turns out she got the job. And perhaps more important, as a breast cancer survivor and therapist who formerly counseled domestic abuse victims, she gets the job, as a volunteer coordinator serving families hit suddenly by cancer or other lifethreatening conditions. Her survivorship status may not have won her the job. But in retrospect she can say it certainly enhanced her value to her employer, and even more importantly, to her survivor clients every day. Sometimes things work out.

Article first published Fall 2010 in LIVESTRONG Magazine