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The Globe and Mail

Working with cancer: For many Canadians, it’s not always a choice

When New Democratic Party leader Jack Layton revealed last week that he had prostate cancer, many in the national press corps expressed surprise that he was not stepping down. Political allies and opponents alike lauded his courage and determination in austere terms that left the impression the NDP boss had one foot in the grave.

Mr. Layton was much more sanguine. He made himself the butt of a few jokes and was soon back to his regular work, staging a press conference to denounce unacceptable levels of poverty among women and children in Canada and internationally.

And so it should be.

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Virtually everyone diagnosed with cancer continues with their daily activities – including paid work, volunteering, recreational outings and care-giving duties – during their treatment and beyond.

Many keep working out of necessity because they do not have good insurance plans, job security or money tucked away for a rainy day.

Others, like Mr. Layton, do so to keep a sense of normalcy because they do not want a pesky tumour dictating how they live.

Cancer treatment has changed a lot over the years. There are still three basic forms – surgery, radiation and chemotherapy – but it is far less debilitating than in the past.

A man with prostate cancer can be in surgery on Thursday and be back to work on Monday. He can get radiation treatment in the morning and keep a lunch appointment. Or he can get chemotherapy then head out on a business trip and, in many cases now, not lose his hair either.

But let's not sugar-coat reality. Treatment can also be hard: physically, emotionally and financially.

What Mr. Layton will see during his treatment – he has not revealed the details, but it is likely six to eight weeks of almost daily radiation – is that many of his fellow patients have challenges that extend well beyond the disease.

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It will, without a doubt, get someone with his well-honed social conscience looking at the provision of health care differently. He will see that the links between health and social services are frayed and sometimes non-existent.

In Canada, we provide superb medical care, particularly in the cancer field. But the ancillary support services required to get care and live a normal life leave a lot to be desired.

Patients, particularly those with modest incomes, struggle with the cost of getting to appointments (taxis and hospital parking costs add up). Those with children or caring for elderly parents may not be able to afford daycare and respite care.

It is common for people diagnosed with cancer to suffer depression and anxiety, sometimes severe cases. Treatment, from prescription drugs to psychological therapy, can be expensive, especially for those without insurance.

While many employers are sympathetic to workers with a cancer diagnosis and give them time off for treatment and recovery (sick leave, short-term disability or otherwise), again, many Canadians live with precarious work conditions.

The cancer journey is rarely linear; it's full of ups and downs. Five-year survival rates for many major cancers now exceed 90 per cent, meaning that, in most cases, cancer is a chronic, manageable condition.

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Yet our employment insurance and disability rules lack the necessary flexibility, and the structures of our work are often too rigid to allow part-time work or physical and psychological adaptations that will help with recovery.

There are more than 700,000 long-term cancer survivors in Canada and their ranks are swelling each year. (In 2009, there were an estimated 171,000 women and men diagnosed with cancer and 75,300 who died of various forms.) All told, about 40 per cent of Canadian women and 45 per cent of men will develop cancer during their lifetimes; many of us will have recurrences and even new forms.

The survivors are all around us: The woman sitting beside you on the bus whose breast cancer was treated with a double mastectomy; the lawyer and colorectal cancer survivor pleading a case wearing a colostomy bag; the hockey player and testicular cancer survivor who has undergone orchiectomy.

While the challenges they face are largely invisible to outsiders, they are nonetheless real and need to be an integral part of treatment and rehabilitation.

This is true too for those living with chronic conditions other than cancer, such as heart disease, depression, diabetes, COPD and so on.

When will our public policies, big and small, reflect the reality of survivorship? When will we put strategies in place that manage chronic disease throughout the life cycle and involve prevention, treatment and recovery?

We should not wonder why Mr. Layton is at work. Rather, we should wonder how we can ensure every other Canadian has that choice and the support to fight cancer on their terms.

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