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, Calif., 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 such as 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 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 that he also intended to return to his podium after surgery last month for a recurrence of colon cancer.
About 40 percent 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. Oncologist John Glaspy, a professor at the University of California, Los Angeles' David Geffen School of Medicine, said that 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 once were 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 had kept patients bed-bound during treatment or left them with lasting disabilities. Targeted therapies have improved survival rates.
Every three weeks, sales rep Scotto receives 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 work.
New therapies like Avastin, targeted at the genetic profile of individual tumors, dramatically have 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, whereas in past, the treatment was "highly toxic to both."
Federal and state laws also have 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, no longer can lift heavy loads or become easily fatigued.
Some employers go beyond what the laws require to make employees feel comfortable during and after treatment.
Scotto credits her colleagues for keeping her on an even keel. "Those people have been fantastic," she said.
Her boss, company vice president Elizabeth Fisher, offered to fly to Los Angeles to help Scotto following surgery. Scotto didn't need the nursing, but Fisher did step in at a trade show Scotto couldn't attend and has helped her keep up with customer requests.
In a poll last year, three-quarters of those working with cancer said their bosses treated them very well, according to a survey by USA Today/Kaiser Family Foundation/Harvard School of Public Health.