Background: Cancer-related job loss is associated with increased risk of financial hardship and its sequelae, including treatment nonadherence and cancer progression. Access to work accommodations (e.g., flexible scheduling) is a key predictor of job retention. Prior research has focused on patients treated in the curative setting. The increased life expectancy of patients undergoing noncurative treatment has created an unmet need: many patients need and/or prefer to continue working during treatment. 
 
Methods: We developed WE-ACT: Workplace/Employer Accommodations during Cancer Treatment, an English/Spanish mobile application (app) that combines vocational rehabilitation approaches, communication coaching, and resources to improve access to work accommodations for adults with cancer. WE-ACT was adapted from an existing app for breast cancer survivors undergoing adjuvant therapy. To ensure that app content was relevant across a wide variety of cancer types and disease trajectories, modifications were made with input from patients and other key informants. The finalized WE-ACT app was pilot tested among 59 patients with cancer who spoke English and/or Spanish, were 18-65 years old, had a smart phone or tablet, and had or were receiving systemic and/or radiation therapy with curative or noncurative intent. Purposive sampling was used to optimize the sample’s diversity in terms of race/ethnicity, job type, and treatment intent. Participants were surveyed one month after receiving WE-ACT.
 
Results: Of 59 participants (61% English, 29% Spanish, 10% both), 68% were female and 75% worked full time at diagnosis. Participants worked in various occupations: managerial/professional (25%), service providers (39%), sales/technical/administrative support (17%), operators/fabricators/laborers (12%), arts/media/athletics (2%), and other (5%). Cancer types included gastrointestinal (27%), breast (17%), head and neck (17%), and gynecologic (15%). 63% were undergoing treatment with noncurative intent (62% of these were receiving chemotherapy). One month after receiving WE-ACT, 98% reported that they found the app easy to navigate (72% “very easy”), user-friendly (75% “very user friendly”), helpful to patients (80% “very helpful”), and were satisfied with the app (71% “very satisfied”); 95% said they would recommend WE-ACT to other patients. Furthermore, 54% agreed WE-ACT made it easier to negotiate and/or ask for work accommodations, with 25 participants having requested one or more accommodation. These accommodations (number approved in full/number requested) were: time off to attend doctor’s appointments (21/23), time off (10/13), reduced hours/flexible work schedule (7/8), work from home (2/4), scheduled/additional breaks (3/3), change in job responsibilities/tasks (2/2), modified work environment (1/2), new/different equipment (1/1), and change in position (1/1). Of note, 3 additional participants were offered accommodations by their employer without having requested them: work from home (n=1), change in job responsibilities/tasks (n=1), and modified work environment (n=1).
 
Conclusions: Participants in this pilot study had positive perceptions of WE-ACT and successfully used the app to help them obtain work accommodations. This study highlights the need to address work-related concerns among cancer patients undergoing curative and non-curative treatment. Earlier intervention delivery may better position patients to understand what accommodations might be available to them as needs arise. Further research is needed to determine the optimal timing for intervention delivery and integration into clinical care.