Wholistic care for cancer patients


Note: This feature article will be published in an upcoming issue of the magazine Corporate Wellness.

When Sandy Tracy was diagnosed with kidney cancer last year, the last people she felt like talking to about it were her co-workers.

“I don’t like people feeling sorry for me,” she says. “I just wanted to go back to everything being ok. I just wanted to go on with life.”

And yet, managing the stress of a life-threatening disease in the place where she spent most of her waking hours was difficult.

“Sometimes I just needed somebody to talk to,” she says.

Supporting employees diagnosed with cancer involves much more than treating a disease. Cancer affects family, finances, faith and myriad other facets of life as individuals struggle to cope with a new reality. Creating a wholistic plan to address psychological, spiritual and wellness needs can create a positive environment in which people can fight their cancer, ultimately improving both their personal health outcome and their contribution once they return to normal life.

“Life threatening disease affects the productivity of workers, and cancer tops the list,” says Brenna Shebel, vice president of the National Business Group on Health. The NBGH is a Washington, D.C.-based non-profit group focused on health-related interests of large employers.

According to NBGH, although less than 1 percent of those covered by commercial health insurance are diagnosed with cancer, claims account for 10 percent of all medical costs, and overall spending on cancer care grew by $63 billion between 1990 and 2008. In 2009, and companies lost $33.6 billion in productivity for full-time employees serving as caregivers to cancer patients, and cancer is the leading cause in long-term disability.

As a result, it’s crucial for companies to create thoughtful, comprehensive benefit packages addressing the varied needs of cancer patients, both to a company’s culture and its bottom line, Shebel says.

 A physiological response

The results of stress related to a major life change such as cancer aren’t simply psychological. There are physical repercussions as well. Stress triggers the body’s fight or flight mechanism, releasing hormones such as epinephrine and norepinephrine into the blood that, in turn, increase blood pressure, heart rate and raise blood sugar levels. Chronic stress can compromise immunity, trouble digestion, and increase fertility problems. It can result in sleep disruption, headaches, depression and anxiety.

Experimental studies have shown that psychological stress can affect a tumor’s ability to grow and spread in the body, while in another study breast cancer patients who received beta blockers to inhibit stress hormones had a better chance of surviving without relapse. And generally speaking, those who suffer from a sense of helplessness or hopelessness experience higher death rates, although cancer is not necessarily the culprit cause.

So what tools do employees with cancer need?

It’s important companies take a wholistic approach, says Shebel. She helped develop the NGBH’s Cancer Continuum of Care guide, a toolbox for employers, which it provides as a free service on the organization’s website.

This includes benefits that provide an outlet and tools to manage stress, options for counseling or talk therapy, education, social support, medication management, exercise and nutrition.

“We look at a number of programs that can really support the employee,” she says.

Health and wellness

Companies have long instituted health and wellness programs as a measure for preventing cancer and chronic disease, but supporting physical fitness and nutrition needs for cancer patients is important as well.

At Provision Health and Performance, just across the street from the Provision Center for Proton Therapy, Kathleen Bullock guides her clients through stretches, strengthening exercises and cardio workouts, even as chemotherapy drugs and radiation therapy are waging war against the cancer inside them.

Bullock is a certified cancer exercise specialist who has seen first-hand the impact either starting or maintaining an exercise program during cancer treatment has on survivors.

“It gives them energy, motivation, a positive mental outlook,” she says. “When they’re mentally stronger, they’re better able to fight.”

Studies show that starting or continuing an exercise regimen after being diagnosed with cancer produces patients who are stronger mentally and physically. One small study of patients with solid tumors indicated a positive effect on the immune systems of those who exercised during their cancer treatment.

Additionally, exercise can help patients with certain types of cancer, such as those whose breast cancer requires reconstructive surgery, improve flexibility and function at the disease site, says Bullock.

Alongside physical activity, proper nutrition not only helps prevent cancer but supports the body during therapy.

Cancer’s effect on the body alters requirements for nutrients such as protein, carbohydrates, fats, vitamins and minerals. Cancer treatment itself can alter appetite, taste and digestion, affecting nutritional health.

The American Cancer Society recommends patients work with a registered dietitian to create a diet plan customized to a patient’s personal needs and disease type. Research shows that dietary counseling in conjunction with cancer treatment results in better outcomes, helping to alleviate side-effects during treatment, improving the quality of a patient’s diet as well as overall quality of life.

One way companies can assist employees is by providing a health coach to help employees maintain their best state of health during treatment. They can serve as a liaison between employees and physicians, helping creating a wellness plan to complement traditional medical treatments.

“We see the health coaches as playing a huge role in this,” Shebel says.

Social and spiritual support

Another resource for employees going through a battle with cancer is existing employee assistance programs, or EAPs. An EAP can help employees work out their need for time away or a flexible work schedule if employees facilitate a system of easy transition between the EAP and disability department.

“That has actually been shown to reduce leave duration and expedite the return back to work,” Shebel says. “When things are better coordinated you’re really setting the employee up for success.”

EAPs can also help guide employees through the stress of financial strain, family problems and depression or anxiety that can result from their diagnosis.

“They have those referrals and relationships for outside help,” she says. “The EAP is really supposed to function in that support system.”

Workers have spiritual needs as well, particularly during times of crisis. Sandy Tracy believes that EAPs alone don’t address all the needs of employees with cancer. That’s why Tracy, a certified chaplain, founded SoulWorks Chaplains, which offers chaplain services to businesses and physicians’ offices.

“It’s good to have somebody to come in from the outside,” she says. “Employees don’t feel like they can share with human resources, because they don’t feel like they can talk about things without it affecting their jobs. When a chaplain comes onsite, employees get that emotional, human connection.”

When employees learn they have cancer, they often turn to faith and spirituality for comfort and answers, Tracy says.

“Seventy percent of people don’t have a church or spiritual support,” she says. “I think being able to provide that for employees is an important part of helping support them. Ultimately, that kind of investment improves the culture of a company and results in happier employees.”

A second look at healthcare

Employers should also examine their traditional healthcare plans with cancer patients in mind, Shebel says.

“It’s no secret how expensive cancer treatment is,” she says, especially considering the high deductibles now common with private plans.

One solution is for companies to adjust out of pocket thresholds to a monthly instead of annual limit, which can help cancer patients control expenses and alleviate the stress of enormous medical bills. Or an employer could provide for specialty pharmacy counseling in order for employees to effectively utilize less expensive oral or self-injecting therapies.

Companies with self-funded insurance plans should also review their benefits to ensure they are customized to the needs of cancer patients. For example, companies can with self-funded coverage can pay for proton therapy and other established treatment modalities that may not be included under typical commercial plans.

Just as employers have come to embrace EAPs and wellness programs, they are beginning to recognize the importance of caring for their sickest workers.

“Cancer affects almost everyone,” Shebel says. “Many of the things we recommend for health and wellness employers already have in place. We are starting to see employers take the next step to support employees who have cancer.”