Helping employees navigate cancer

It starts with those ominous words, “The test results are back…” and ends with the word that no one wants to hear: cancer.

Cancer requires care that extends beyond providing medical treatment, income replacement and financial protection. It changes lives, impacts families and hinders workplace productivity. Employers, in partnership with other stakeholders, can help cancer patients navigate through the process and potentially benefit from a quicker and more successful return to work.

The incidence and implications of cancer are growing. According to the Canadian Cancer Society, men now have a 45% lifetime probability (or one in 2.2 chance) of developing cancer; women have a 40% probability (or one in 2.5 chance). Furthermore, one in 3.5 men and one in 4.2 women—approximately one in four Canadians—are expected to die of cancer.

These scary numbers come with a high price—not only to patients, but also to the government. According to data from 2003’s Cancer Care in Canada, the overall cost of treatment to the government healthcare system—and the tax-paying public—is compounding at more than 7% a year. And based on data from the 2007 Report Card on Cancer in Canada, the cost of cancer-related drugs is rising at 35% per year.

Cancer also invades the workplace, affecting an employee’s productivity and the employer’s bottom line. Extended cancer-related absences and unnecessary delays in treatment and information for employees or their families can have serious effects on employees and employers. Data from Canadian Cancer Statistics find that 40% of cases occur between the ages of 18 and 65, and the incidence of cancer in the workplace is increasing as the workforce ages. Many of an employer’s most experienced and valuable employees are the most likely to succumb to the disease, resulting in increased absenteeism of middle and senior managers.

Gaps in patient care
While most employers provide some sort of protection—such as disability and other income protection—through group benefits coverage, from the cancer patient’s perspective, these benefits do not always address the most severe consequences. A cancer support benefit can serve as insurance for both the employee and the employer by clearing a potential path to recovery and return to work.

As the public healthcare system becomes more strained, cancer patients face an increasingly harrowing and difficult experience. Just getting the correct diagnosis can be a tortuous and lengthy process. Varied and overlapping tests may be needed, along with encounters with multiple medical specialists. Depending on where they live, patients can experience delays in getting access to often-overloaded cancer treatment centres, which may be short of equipment and personnel. The mental anguish that the patient experiences during this phase can be as devastating as the cancer itself.

Private providers, the public sector, employers and insurance carriers need to work together to ensure that cancer patients have as much support, compassion and guidance as possible.

Once within the cancer treatment system, the patient finds no one single person in charge of his or her case. While sub-specialists focus all of their knowledge on the immediate problem, they may not have the time or resources to treat the patient—who is still in shock from hearing and dealing with the cancer diagnosis—as a person. Solace, compassion and guidance can often be as important in the treatment of cancer as access to the latest drugs or therapies. While a patient’s family doctor may deliver these comforts, this familiar individual may not be available or may not be included in the overall treatment plan.

When the oncologist delivers news, options or recommendations to the patient, where can the patient turn? After the patient heads home, just trying to remember what was said or discussed in the oncologist’s office can be a challenge—never mind making an informed decision about often-costly treatment options.

Even if the news shared by the oncologist is good, there is a chance that the patient may not ask all of the right questions, such as, What should I do now? What lifestyle changes have been proven to reduce the risk of recurrence? or, How can I best deal with the residual unwanted side effects of the treatments?

While the public system has started to develop complementary services needed to address gaps in patient care, the approach to date has been piecemeal, and availability varies greatly by location. People are being deployed to provide emotional support during waiting times; guide patients to appropriate venues; guide family doctors; educate patients; assist in the acquisition of expensive treatments; and provide supportive care (e.g., exercise, nutrition). However, at present, there is no comprehensive approach that’s publicly available.

Filling the holes
To ease the diagnosis and treatment process—hopefully, leading to a full recovery—cancer patients need an advocate. All Canadians, in large and small urban and rural communities, need help to navigate themselves and their families through the public healthcare system; reduce the physical and emotional impact of cancer; ensure the use of medical best practices; reduce the risk of recurrence and of other chronic diseases with similar risk factors; and reduce the risk of late-appearing complications.

In order to complement and work with the public system, patient support services should be based on a one-on-one relationship between the patient and a highly trained oncology nurse; designed and directed by oncology physicians; accessible both by telephone and electronically; and available through group benefits plans. A comprehensive cancer assistance program enables employers to help employees through the process, encouraging the best possible results and, where possible, a timely and healthy return to work and productivity.

Finding a balance
Employers routinely face tough choices when determining how to allocate resources and balance their often-limited group benefits budgets. Of course, implementing a cancer support service comes at a cost—one that some employers may be unable or unwilling to bear.

That said, it’s not hard to understand the potential value to employees. Much in the same manner that disability helps employees and employers work toward a return to work and navigate rehabilitation and retraining options, cancer support helps employees and their families move toward a return to health, balance and recovery. This assistance is the first step toward a successful return to work from cancer that impacts employees, their families and their employers’ productivity and goals.

Private providers, the public sector, employers and insurance carriers need to work together to ensure that cancer patients have as much support, compassion and guidance as possible. The advantages are obvious: patients get access to the best in medical treatment and the best in emotional and other support. As cancer incidence continues to grow and have an impact on employees and employers, it is in everyone’s best interest to provide the best in cancer support.

Two case studies in cancer support

Mr. L: A 65-year-old male diagnosed with prostate cancer, Mr. L, was offered standard radiation treatment (intensity modulated radiation therapy) at the cancer centre in the town where his oncologist practised. At first, Mr. L was unaware of image guided radiotherapy (IGRT)—another prostate cancer treatment of equal efficacy but with fewer late-onset side effects. Mr. L’s oncologist had not mentioned IGRT because it was not available at this treatment centre. In order for Mr. L to undergo IGRT, he would have to travel at his own expense to another treatment centre.

Since Mr. L’s group benefits plan provided access to a cancer assistance program, the provider’s navigation nurse ensured that the patient was aware of the possibility of treating his prostate cancer with IGRT. Once the patient had been educated on the options, the provider’s nurse—with the patient’s permission—facilitated a treatment centre transfer via Mr. L’s oncologist and surgeon. Today, Mr. L reports very few treatment-related side effects.

Mrs. A: During the introductory call with Mrs. A, it became apparent that she was experiencing significant emotional distress and had difficulty articulating her thoughts and feelings about her cancer diagnosis. Further assessment revealed that she had experienced four to five panic attacks each day during the previous week. Mrs. A said she felt very alone, and she had retreated emotionally and socially from friends and family. The provider’s nurse performed an assessment of depressive symptoms, which showed very concerning results. Mrs. A admitted to having thoughts of harming herself to escape the emotional pain. The provider obtained permission to update Mrs. A’s family physician, which set acute crisis intervention strategies into motion.

The provider ensured that Mrs. A was educated regarding acute distress management, and she was advised to call a close family member during this acute anxiety phase. The family physician responded immediately and was appreciative of the intervention. He called Mrs. A personally, performed a risk assessment over the phone and scheduled an appointment for the following day for an in-depth discussion of intervention and treatment strategies. As a result, the physician prescribed antidepressant medication and expedited a psychiatry referral. Mrs. A was scheduled for ongoing visits with her family physician for continued assessment and monitoring, and the provider’s navigation nurse made regular, frequent calls, developing a strong and trusting relationship with Mrs. A.

Dr. William Hryniuk is medical director of CAREpath Inc., and Mike Waechter is director, group marketing, with Equitable Life of Canada.  whryniuk@carepath.ca; mwaechter@equitable.ca

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