Education and profession

Occupational performance may be impaired by various problems, such as reduction of physical performance [6]. In addition, fatigue, depression or cognitive (mental) deficits often burden affected individuals. This can manifest itself in the fact that affected persons have difficulties, for example, to concentrate for a longer period of time, to find the right word or to remember things. Learning new tasks, for example when retraining, can also become a challenge. You can find ways to improve mental abilities, for example, in the information brochure of the "Stiftung der Deutschen Leukämie- & Lymphom-Hilfe," https://www.leukaemie-hilfe.de/nc/broschuerenangebot.html?tx_drblob_pi1%5BdownloadUid%5D=299.

In Germany, continued payment of wages generally takes effect for 6 weeks from the start of incapacity for work if an employment relationship exists (except in the case of self-employment). After that, sickness benefit is paid by the statutory health insurance (around 25% less than the last net salary). Sickness benefit can be granted under certain conditions for a maximum of 78 weeks for the same illness within a period of 3 years. (The 3 years are the so-called block period. A block period begins with the first occurrence of incapacity for work for the illness on which it is based. A new block period begins with each incapacity for work due to a different illness. It is possible for several block periods to run side by side). The health insurance company, as the provider of benefits, can check at any time whether the requirements for continued receipt of sickness benefits are still met.

If necessary, the examination is carried out via a request for medical rehabilitation (§ 51, SGBV). In this case, independent counseling is recommended (e.g., cancer counseling center, independent patient counseling).

Self-employed persons may receive daily sickness benefits, depending on their insurance coverage. Employees in minor employment also receive continued payment of remuneration, but no sick pay. Students are not entitled to sickness benefits (§5 Abs.1 Nr. 9 SGB V).

• Cancer survivors can obtain advice on support services and statutory benefits from various agencies. This involves support to which you may be legally entitled. Social benefits can help you to devote yourself fully to your recovery and at the same time cover, at least in part, your living costs. Psychsocial aftercare for cancer patients differ from country to country. In Germany, you can find support in the following way:

• Hospital Social Service

• Already during your hospital stay, the social worker of your treating clinic can support you. Through the hospital social service, you will receive psychosocial counseling and you will be informed about the various social benefits. In addition, the hospital social service can work with you to prepare for discharge home, and you can clarify any questions that may arise in this context.

• Tip: Not every hospital routinely presents the social service - if necessary, take the initiative yourself by asking for one.

• Social worker in cancer counseling centers

After the inpatient stay or even later, there is the possibility of psychosocial counseling by, for example, the social workers in cancer counseling / psychosocial aftercare centers. People with cancer and their relatives may need information and advice on socio-legal issues, such as:

• Outpatient care and supply (e.g. home care, aid advice and aid mediation)

• Rehabilitation (e.g., medical and vocational rehabilitation services).

• Social and economic security (e.g. unemployment benefits and the German hardship fund of Deutsche Krebshilfe e. V.)

• Severely disabled persons law (e.g. severely disabled persons card, compensation for disadvantages)

• Assistance in accessing social services.

Counseling for students with special basic health needs is offered by the psychosocial counseling centers of the universities. An overview is provided by the German Student Union: https://www.studentenwerke.de/de/content/beratung

• During the rehabilitation measure

There are facilities for oncological rehabilitation with special offers for young adults with cancer. During oncological rehabilitation, various therapies offered - aiming to improve physical performance as well as coping with the disease. Furthermore, you can also take advantage of rehabilitation or pension counseling. In addition, consultations and information from the clinic social service offered among others:

• on training and career prospects, services for participation and occupational reintegration, on company integration (in Germany called “Berufliche Wiedereingliederung “ BEM)

• for the re-planning of the school and professional career

• job application and career search training

• support in orientation and decision making

• support in accessing social benefits and, if necessary, filing applications for e.g. financial security (unemployment benefit, housing benefit, compensation for disadvantages according to the law on severely handicapped persons, job-related benefits)

• restoration, adaptation and optimization of the individual ability profile through medical-occupationally oriented rehabilitation (in Germany called “Medizinisch-beruflich orientierte Rehabilitation” MBOR).

• support in coping with the disease

• support with problems in the professional and social environment

• counseling of relatives

• consulting, organization and implementation of follow-up care after rehabilitation

At the end of a rehabilitation measure, you will receive a report summarizing the provided treatment during the rehabilitation measure, including a socio-medical expertise with regard to the patient's current performance capacity.

In Germany, you can receive support from various institutions and organizations, e.g. cancer counseling centers, German Cancer Aid, self-help groups, Sozialverband VdK as well as internet portals such as the Young Cancer Portal of the German Foundation for Young Adults with Cancer etc.

A compilation of offers of help in Germany is provided in chapter 3.2.

If the occupational activity can be performed for ≥6 hours per day, the person is able to work a full shift and there is no reduction in earning capacity. If the last activity subject to compulsory insurance and an activity on the general labor market can be performed for 3 to 6 hours per day, there is a partial reduction in earning capacity. If the last activity that was subject to compulsory insurance and an activity on the general labor market can be performed for <3 hours per day, there is a full reduction in earning capacity in relation to the last activity that was subject to compulsory insurance if the conditions listed below are met. This assessment is therefore decisive for further career prospects or for any necessary application for a reduced earning capacity pension.

Since the introduction of the "flexi pension," anyone who still feels physically and mentally fit despite a reduction in earning capacity can earn additional income (up to 34,500 € depending on the individual case) in addition to their reduced earning capacity pension and supplement their income.

Before you start working: please seek advice and have your individual supplementary earnings limit calculated by your pension insurance provider.

Various prerequisites are necessary to apply for a reduced earning capacity pension. Individual counseling is advisable on this complex topic. To decide whether you can apply for a reduced earning capacity pension, you should seek detailed advice from pension insurance companies, insurance offices, or cancer counseling centers. In addition to the medical requirements, insurance law requirements are also necessary to apply for a pension.

• Insurance law requirements: At least three years of compulsory contributions for an insured occupation or activity must have been paid in the last five years prior to the onset of the reduction in earning capacity. In addition, the so-called waiting period must be fulfilled (at least 5 years of insurance) (DRV).

• Medical requirements: The pension insurance agency first checks whether the claimant's ability to work can be fully or partially restored by medical or vocational rehabilitation measures. If this is not possible, the extent to which the applicant can still work is examined. Based on this, it is then determined whether a pension can be granted due to full or partial reduction in earning capacity.

Reduced earning capacity pensions are usually granted for a limited period of time. Important in the case of limited reduced earning capacity pensions: Apply to the pension insurance institution in good time for continued payment (about six months before the expiry of the time limit) if there is still a restriction of earning capacity.

Based on your personal and professional situation, it is important to clarify which contacts and institutions can help you with your reorientation. In the case of existing training relationships, possible steps for your re-entry can be coordinated in the company, e.g. within the framework of company reintegration management. Specialist integration services and specialist rehabilitation consultants offer advice, among other things.

If you have a recognized severe disability of at least degree of disability GdB 50, you can contact the rehabilitation department of the employment agency directly for questions about vocational training, depending on the situation. Contact the Employment Agency in good time, as it can take several weeks to months to determine whether you need assistance. Under certain circumstances, you may be eligible for special examination modifications such as time extensions, approval of special aids, or training in special rehabilitation facilities. You should apply for this at the examination board or the relevant vocational chamber, e.g. IHK, Chamber of Crafts, etc.

In any case, it is important to decide whether applying for a severe disability card will help your current life situation.

• The path of vocational reintegration into the profession can also take place via a Berufsförderungswerk, https://www.bv-bfw.de/alltags-sprache/startseite.html. Berufsförderungswerke are specialized in vocational training and continuing education for adults who are generally unable to continue to their previous occupation due to health impairments. The measures provided as benefits for participation in working life in accordance with SGB IX. The cost units for this are the pension insurances, employers' liability insurance associations and the Federal Employment Agency. In contrast to regular vocational training, training in a Berufsförderungswerk lasts only two years. There is no separation between the company and the vocational school. In addition, the rehabilitants carry out job-related internships in companies close to their homes. In addition, rehabilitants supported by the integration specialist services in their timely reintegration.

In some cases, studies can no longer be pursued adequately due to the health impairments. If it is foreseeable that this phase will be prolonged, it is advisable, and sometimes even necessary, to take an official leave of absence from studies for one or more than one semester in order to concentrate entirely on therapy and rehabilitation. Make sure that a return to studies is guaranteed. It is important to ensure that certain deadlines must be met when applying for a leave of absence. These deadlines vary from university to university; at some universities, it is possible to apply for a leave of absence retroactively at others it is not. It is advisable to inform yourself as early as possible.

Important: Interruption of studies, leave of absence and exmatriculation affect the entitlement to BAföG, scholarships and other social benefits. You should clarify possible financial consequences before applying for a leave of absence. Ask your university how the change of status may affect you in terms of examination law and what rights and obligations are associated with it. As a rule, students who are on leave of absence due to illness are not allowed to take any courses or examinations. Deviating from this can have negative social-legal consequences. Students or their relatives should obtain information about financial consequences from the social counseling service of the responsible student union (Handbook of Studies and Disability: Chapter VII "Financing Living Costs," keyword: "ALG II in case of interruption of studies due to illness and leave of absence") and at https://www.studentenwerke.de/sites/default/files/Handbuch_Studium_und_Behinderung . If the interruption of studies due to illness lasts longer than three months but shorter than six months, unemployment benefit II (Hartz IV) can be applied for. If necessary, an application can be made for unemployment benefit II benefits. In case of doubt, it makes sense to contact the university's disability representative and the student counseling service for people with disabilities and chronic illnesses or the dean's office, as many universities have their own support programs.

• Have someone you trust accompany you to a doctor's appointment or to a counseling center, especially if you notice impaired concentration or memory.

• Talk to your treating physician early on about any physical or mental ailments that may be related to your occupation.

• Keep a record of your symptoms. When did they start? When do they get better or worse? Describe them briefly and precisely in the doctor's consultation using your bullet points.

• Make a note of the answers if necessary.

The above information is no substitute for personal counseling. Depending on the individual problem, the following institutions/contact persons, among others, may be considered for personal counseling:

• Federal Association of German Vocational Training Centers
  https://www.bv-bfw.de/alltags-sprache/startseite.html

• YOUNG CANCER PORTAL of the German Foundation for Young Adults with Cancer - Experts answer, among other things, socio-legal questions and questions about returning to work. Oncologists and social physicians in the vicinity are displayed, who answer questions via chat, telephone or in a personal conversation.
  https://www.junges-krebsportal.de/

• INFO-Net Cancer of the German Cancer Aid
  https://www.krebshilfe.de/helfen/rat-hilfe/ihre-persoenliche-beratung-dasinfonetzkrebs/

• Independent Patient Counseling Germany
  https://www.patientenberatung.de/de

• Cancer Information Service
  https://www.krebsinformationsdienst.de/

• Cancer Counseling Centers
  https://www.krebsinformationsdienst.de/service/adressen/krebsberatungsstellen.php

• Integration specialist service and/or company medical service https://www.integrationsaemter.de/Fachlexikon/Integrationsfachdienst/77c438i1p/

• Social Association VdK Germany
  https://www.vdk.de/deutschland/

• Sozialverband Deutschland e.V. Supports with applications or legal questions
  https://www.sovd.de/

• Centers for the Unemployed

• Employment agency
  https://www.arbeitsagentur.de/

• German pension insurance
  https://www.deutsche-rentenversicherung.de/DRV/DE/Home

• German Student Union
  https://www.studentenwerke.de/