Liz Sinclair, Contributing writer

Many women these days with breast cancer return to work while still undergoing treatment.

Legislation such as the Family and Medical Leave Act allows people who have a serious health condition up to 12 weeks of unpaid leave while keeping their positions and their benefits.

Dr. Ruth Oratz, a medical consultant with Cancer Care, says she encourages women to continue working if their energy levels are adequate and that it's unlikely working during treatment can cause harm.

"It's important to remain physically active," she says, "Psychologically and mentally, work helps us remain engaged and productive."

Women with breast cancer who return to work should inform their health care providers so that treatments can be scheduled outside of working hours. These women can get suggestions on how to best balance treatment with work, including dealing with any side effects.

They should consider asking their supervisors to have co-workers take some of their workload or have a colleague fill in for them while they are absent. If thinking and concentrating get difficult, or a patient has memory problems, it's a good idea to keep a journal to record meetings, deadlines, appointments and days off, as well as important conversations and to-do lists.

They also must set realistic goals at work. For example, they should not expect that they can achieve the same performance levels that they did before starting treatment.

It's also a good idea to take rests or breaks doing the workday, practice relaxation techniques such as guided imagery, or play calming music or meditation CDs to keep stress at bay, or simply put up inspirational pictures or quotes in the work area.

Dian, a radio journalist, returned to work six weeks after undergoing surgery for breast cancer while still receiving chemotherapy and radiation. She says that her employer has been very supportive, allowing her time off for medical visits and letting her start work later on days when she is tired or had a treatment. She also sometimes worked from home.

On days when Dian was unable to go to work, her employer arranged for temporary cover for her position. Dian said that there were days when she wondered if she had enough energy to go to work, particularly as treatment progressed, but she said that working motivatesdher and kept her distracted from thinking about the breast cancer, and that the support of her colleagues at work is crucial to her well-being.

For women who are self-employed, there may be some different strategies they will need to consider. These can include hiring temporary help, making sure that large tasks or projects are completed before starting treatment, and taking advantage of business ownership by keeping more flexible hours.

Some women do face discrimination from employers or colleagues when they return to work. Barbara Hoffman, a founding chair of the National Coalition for Cancer Survivorship, said, "Employment discrimination against cancer survivors has decreased. Most survivors are treated fairly at work, according to recent studies. Laws such as the (Americans with Disabilities Act) and the (Family and Medical Leave Act) are working. Also, attitudes about cancer exemplified by the use of terms such as cancer survivor and cancer survivorship have also helped to decrease workplace discrimination."

She says that "Ddiscrimination laws protect cancer survivors ... if they can perform their job with reasonable accommodation."

If anyone suspects she is being treated differently because of her health status, there are several strategies for dealing with it. Talking with a supervisor or the human resource department may be enough to address a problem, but in the event that a woman suspects discrimination she should document any relevant incidents with times, dates and detailed statements of what was said. She should also keep a written work history showing her job performance, including goals or targets met, hours worked, days off and shifts covered by other colleagues.