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Colorectal Cancer Patient Support: Employment Rights

When you’re finally able to concentrate on something besides your cancer treatments, chances are you’ll look forward to getting back to your normal routine. This may mean going back to work. In fact, you may need to work — for psychological if not financial reasons. But you may also have concerns about your employment in light of your condition. Please don’t let those concerns discourage you. In many cases, the law is on your side.

The Americans with Disabilities Act (ADA)

This federal law makes it illegal for employers to discriminate against someone with a disability who is qualified for a position. Is cancer a disability? Not always, according to the Equal Employment Opportunities Commission (EEOC), but at times it can be. To be considered a disability, an employee’s physical or mental impairment must significantly limit one or more major life activities. For additional information, visit the ADA Web site.

If you have any concerns about your disability and your employment situation, you should contact your employer’s human resources manager or your local EEOC office.

In addition to federal protection, you may be eligible for employment protection under state laws. There are several organizations that can help you with your legal rights. You can find out how to contact them in the Useful Resources section of this Web site.

The Federal Rehabilitation Act (FRA)

The FRA bans public employers and private employers that receive public funds from discriminating against qualified individuals on the basis of disability. For additional information, visit the ADA Web site and the U.S. Department of Health and Human Services Web site.

Family and Medical Leave Act (FMLA)

This federal law generally requires employers with at least 50 employees to provide up to 12 weeks of unpaid leave for eligible employees to care for themselves, a newborn child, or an ill dependent, without loss of job or group health benefits. For additional information, visit the U.S. Department of Labor Web site.

There are no guarantees

You know that nothing is guaranteed. But these days, the employment climate for those with serious illnesses — including cancer — is much better than it used to be. And there are laws and organizations to help you make sure your rights are protected. Do not presume an employer will treat you differently because of your cancer. Instead, demonstrate to your employer how you can perform the essential functions of your job and know that the law will support you in your effort to return to work.

Find out about caregiver support.

INDICATIONS

Eloxatin® (oxaliplatin injection), used in combination with infusional 5-FU/LV, is indicated for

  • Adjuvant treatment of stage III colon cancer patients who have undergone complete resection of the primary tumor.
  • Treatment of advanced carcinoma of the colon or rectum.

Clinical Safety Considerations

Anaphylactic-like reactions to ELOXATIN have been reported and may occur within minutes of ELOXATIN administration. Epinephrine, corticosteroids, and antihistamines have been employed to alleviate symptoms.

  • ELOXATIN should not be administered to patients with a history of known allergy to ELOXATIN or other platinum compounds. Hypersensitivity and anaphylactic/anaphylactoid reactions to ELOXATIN have been reported and were similar in nature and severity to those reported with other platinum compounds (ie, rash, urticaria, erythema, pruritus, and, rarely, bronchospasm and hypotension). These reactions occur within minutes of administration and should be managed with appropriate supportive therapy. Drug-related deaths from this reaction have been reported.
  • ELOXATIN may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised not to become pregnant while receiving ELOXATIN. It is not known whether ELOXATIN or its derivatives are excreted in human milk.
  • ELOXATIN has been associated with pulmonary fibrosis (<1% of study patients), which may be fatal. The combined incidence of cough and dyspnea was 7.4% (<1% grade 3, no grade 4) in the ELOXATIN plus 5-FU/LV arm compared to 4.5% (no grade 3, 0.1% grade 4) in the 5-FU/LV alone arm in the adjuvant colon cancer study. In this study, one patient died from eosinophilic pneumonia in the ELOXATIN combination arm. The combined incidence of cough, dyspnea, and hypoxia was 43% (7% grade 3 and 4) in the ELOXATIN plus 5-FU/LV arm compared to 32% (5% grade 3 and 4) in the irinotecan plus 5-FU/LV arm in patients with previously untreated colorectal cancer. In case of unexplained respiratory symptoms, ELOXATIN should be discontinued until pulmonary investigation excludes interstitial lung disease or pulmonary fibrosis.
  • ELOXATIN is associated with two types of primarily peripheral sensory neuropathy: an acute, reversible type of early onset and a persistent type (>14 days). In patients with advanced colorectal cancer paresthesias occurred in 77% (all grades) and 18% (grade 3/4) of previously untreated patients. In previously treated patients, acute neuropathy occurred in 56% (all grades) and 2% (grade 3/4) of patients; persistent neuropathy occurred in 48% (all grades) and 6% (grade 3/4) of patients. In patients with stage II and III colon cancer, paresthesia was seen in 92% (all grades) and 13% (grade 3/4) of patients; 21% (all grades), 0.5% (grade 3/4) had residual paresthesia at 18-month follow-up.
  • Hepatotoxicity, as evidenced in the adjuvant study by increase in transaminases and alkaline phosphatase was observed more commonly in the ELOXATIN combination arm. The incidence of increased bilirubin was similar on both arms. Changes noted on liver biopsies include: peliosis, nodular regenerative hyperplasia or sinusoidal alterations, perisinusoidal fibrosis and veno-occlusive lesions. Hepatic vascular disorders should be considered and, if appropriate, investigated in case of abnormal liver function test results or portal hypertension not explained by liver metastases.
  • Monitoring of white blood cell count with differential, hemoglobin, platelet count and blood chemistries (including ALT, AST, bilirubin and creatinine) is recommended before each ELOXATIN cycle.
  • The safety and effectiveness of ELOXATIN plus 5-FU/LV in patients with renal impairment have not been evaluated. Since the primary route of platinum elimination is renal, this combination should be used with caution in patients with preexisting renal impairment. Clearance of these products may be decreased by coadministration of potentially nephrotoxic compounds, although this has not been specifically studied.
  • The incidence of diarrhea, dehydration, hypokalemia, leukopenia, fatigue and syncope were higher in patients ≥65 years old.
  • Extravasation may result in local pain and inflammation that may be severe and lead to complications, including necrosis. Injection site reaction, including redness, swelling and pain, has been reported.
  • There have been reports of prolonged prothrombin time and INR occasionally associated with hemorrhage in patients receiving ELOXATIN plus 5-FU/LV while on anticoagulants. Patients receiving ELOXATIN plus 5-FU/LV and requiring oral anticoagulants may require closer monitoring.
  • The most common adverse reactions in patients with stage II or III colon cancer receiving adjuvant therapy were peripheral sensory neuropathy, neutropenia, thrombocytopenia, anemia, nausea, increase in transaminases and alkaline phosphatase, diarrhea, emesis, fatigue, and stomatitis. The most common adverse reactions in patients with advanced colorectal cancer were peripheral sensory neuropathy, fatigue, neutropenia, nausea, emesis, and diarrhea.

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