A new study from the University of Michigan Comprehensive Care Center finds that breast cancer survivors have a high rate of long-term unemployment. The specific kind of treatment they get may lower their chances of keeping their job or finding a new job years later.

University of Michigan oncology professor Reshma Jagsi is lead author on the study, published in the journal “Cancer.” She says her team surveyed breast cancer survivors in Detroit and Los Angeles from 2005 to 2007, and narrowed their results to follow the women who were working at the time they were diagnosed.

Approximately 30 percent were unemployed four years later.

“I don’t think too many of us are surprised to hear patients are likely to miss work or even stop working altogether while getting chemotherapy treatment,” says Jagsi. What did surprise her? That women who received chemotherapy at the beginning of treatment had an even higher rate of unemployment four years on. Other studies have found lower levels of long-term unemployment among women who want to keep working after being treated for breast cancer.

Ragsi says knowing the possible long-term implications—on employment and personal finances—might help women and their doctors make decisions about whether to utilize chemotherapy early on in treatment.

The federal Family and Medical Leave Act (FMLA) passed in 1993 protects women who need time off for medical treatment, says Cathy Ruckelshaus at the National Employment Law Project. However: “It basically covers mostly full-time workers,” says Ruckelshaus. “She has to have been there for a year, and she’s entitled to 12 weeks of job-protected leave.” Ruckelshaus says the leave is unpaid, and can be taken intermittently over an extended period (i.e., not in a consecutive twelve-week period) to deal with chemotherapy treatment, side effects or long-term consequences such as fatigue.

If a woman still can’t keep up with a full-time schedule, or needs additional time off for follow-up treatment after her twelve weeks of FMLA are up, she can attempt to qualify for disability. If she can still work, then the Americans with Disability Act might require the employer to accommodate her with a flexible or part-time schedule, or provide the possibility of telecommuting, says Ruckelshaus.