Real World Health Care Blog

Behavioral Health

Cancer: Taking Care of the Mind and the Body

Krista Zodet

Krista Zodet, President, HealthWell Foundation

This post marks the final article in our series on cancer-related behavioral health. As the founding sponsor of Real World Health Care, the HealthWell Foundation has been honored to raise awareness of the behavioral health needs of cancer patients and to shine a spotlight on the organizations that participated in this important series:

The HealthWell team would like to recognize these amazing organizations for sharing their guidance and for the support we received in helping us promote our Cancer-Related Behavioral Health Fund to assist more patients in need.

Helping Cancer Patients Afford Concurrent Behavioral Health Treatments and Therapies

Providing financial assistance to people living with cancer has always been a priority at HealthWell. Through our 20+ oncology funds, we’ve assisted more than 120,000 individuals living with cancer with more than $380 million in assistance.

We recognize the unmet needs of oncology patients and the importance mental health has on treatment, recovery and overall well-being. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

Because HealthWell believes in operating programs that focus not just on the patient’s disease or condition, but on addressing the total needs of the patient, we are pleased to offer a Cancer-Related Behavioral Health (CRBH) Fund to assist individuals in need of cancer-related behavioral health treatments.  The Fund provides financial assistance to individuals with a diagnosis of cancer in covering their out-of-pocket treatment-related costs for prescription drugs, counseling services, psychotherapy, and transportation.  HealthWell provides up to $2,000 in financial assistance for a 12-month grant to eligible patients who have annual household incomes up to 500 percent of the federal poverty level.

Since launching the Fund in May, our grants have started to make a positive impact on people in need, including Robyn who is living with breast cancer:

“HealthWell has been a major help to me for a long time. I consider myself lucky to have benefited from a number of grants. I’d probably be dead without HealthWell.  HealthWell came to my aid with grants for my cancer treatments and now they are assisting me through the Cancer-Related Behavioral Health Fund so I can receive necessary medications and counseling to manage my condition.  The Foundation continues to come through where others have not.  It’s been a rough road and HealthWell’s assistance means a great deal to me.  Someday, I hope I can be on the other side and pay it back.” Robyn – CRBH grant recipient

Robyn is just one of countless Americans who struggle with cancer-related behavioral health problems. Unfortunately, the risk of psychological disability is six times higher for adults living with cancer than those not living with cancer. And more than half of cancer patients do not receive social or emotional support as part of their care. With so many barriers and unnecessary stigmas associated with behavioral health treatments, we believe that the cost of treatment should not be one of them.

To learn more about the fund and how you can support it or apply for financial assistance through the fund, visit HealthWell’s Cancer-Related Behavioral Health Fund page. We also invite you to join the ongoing conversation on Twitter @RWHCblog.

 

 

What Comes Next: How to Find the Right Therapist

For the past several months, Real World Health Care has focused on the behavioral health issues that can impact people living with cancer, their caregivers and their loved ones. We’ve brought you insights from therapists, social workers and mental health professionals, and we’ve highlighted the numerous resources available from a variety of patient support organizations.

We’ve also shared information from our sponsor, the HealthWell Foundation, about its Cancer-Related Behavioral Health Fund, which provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares for covered services rendered by behavioral health providers.

As our series comes to its conclusion, we are pleased to help our readers “connect the dots” by highlighting recommendations from Mental Health First Aid on how to find a good therapist. The following article was originally published by Franziska Ross on August 31, 2018 and is reposted here by permission of the National Council for Behavioral Health. Click here to view the original article.

Finding the right therapist can be a daunting task. This guide will walk you through the process, step-by-step.

Work with Your Insurance

One of the biggest barriers to therapy is cost, so most people want to find a therapist who is covered by their insurance. A good place to start looking for therapists who take your insurance is your health care provider’s website. Most provider websites have a “Find a Doctor” feature you can use to search for mental health clinicians near you, just like you would a physician. You can also select your health care provider on websites like PsychologyToday.com.

The Search – Things to Keep in Mind

Don’t get bogged down in the different professional degrees that a therapist can have – Ph.D., Psy.D., LCSW, LCMHC, etc. Any therapist who is licensed in your state has gone through rigorous background checks and training.

Some people have a strong demographic preference – men vs. women, for example. Unfortunately, finding someone who meets your exact criteria can be difficult. The good news is that you can still develop positive and productive relationships with a therapist who does not entirely align with your original criteria.

Most therapists list their treatment methods. They might say, for example, that they have a psychodynamic or behavioral approach. If you’re familiar with different approaches and you know what you’re looking for, great! If not, don’t worry. You can learn about the different general approaches online or wait to ask the therapist about their approach.

You might also want to take location into consideration. It’s helpful, for example, to pick a therapist who works near your home, work or school. Doing so eases the stress of transportation, scheduling and time.

Picking Up the Phone

Now comes the big (and often scary) step – making calls.

You have a list of possible therapists. It can be challenging to call a therapist without knowing them first. Some people find it helpful to make a list of talking points or a loose script to help guide the conversation. For example, you might start off with “Hi, my name is ___ and I’m looking for a therapist to help me work on ___.”

Asking Questions

In your initial phone conversations, therapists expect and appreciate questions about their education, licensure, experience and approaches to care. Asking questions can give you a sense of the person’s therapeutic style and if they could be a good fit. Here are some questions which you might want to ask: Where did you get your training? Do you have experience treating such-and-such issue or working with such-and-such population? Do you use evidence-based practices like cognitive behavioral therapy (CBT) or mindfulness? Do you take my insurance or have a sliding pay scale?

Availability – A Common Roadblock

Keep in mind that you might not be able to schedule an appointment with the first person you call. You might discover that your insurance provider’s records are outdated and some of the therapists listed no longer take your insurance, or maybe no one you initially reach is accepting new clients. It could take many calls before finding someone. Some people find it helpful to set up a schedule, a time to make and receive calls. When you leave messages, be sure to include your full name, call back number, times and dates that are best to reach you and your insurance information.

This is often a challenging and frustrating part of the search for a therapist, so it can be a good time to lean on those you are close with for support.

The First Session

The first few sessions are a time to explore if the therapist is a good match. Therapy can be uncomfortable, especially in the beginning, so it’s not unusual for the first few sessions to feel scary and awkward. However, an important sign if the therapist is a good fit is if you feel they create a space of emotional safety and comfortable physical boundaries.

A sign that the therapist is not a good fit is if they cross your physical or emotional boundaries in any way. If there’s something that would compromise your ability to have a good relationship with a therapist, don’t ignore it. Instead, try to schedule an appointment with a different therapist. Seeing multiple people can feel like a lot of effort, but finding the right person is worth it.

Good therapy is based in a good relationship. A healthy part of therapy for many is having a conversation about the therapist-client relationship. If the relationship doesn’t feel right, it’s okay to tell your therapist how you feel about the dynamic and that you might need to see someone different. A good therapist will be open to that conversation and will support you through that decision.

Empower Yourself

As a client it’s important to empower yourself. Therapists have a code of ethics which they must follow. The code of ethics for social workers and the code of ethics for psychologists are both available online. These are good references to have in the case of any inappropriate behavior or if you think your therapist has crossed a boundary. You can also report any inappropriate behavior to your state licensing board.

When Therapy Isn’t an Option

For many reasons – family, location or money – therapy simply isn’t an option for some people.

Unfortunately, many people still do not have access to insurance. In these cases, integrated care facilities like Certified Community Behavioral Health Centers (CCBHCs) and Federally Qualified Health Centers (FQHCs) are good options because they provide care regardless of an individual’s ability to pay.

For those who do not have access to therapy but need help, hotlines are a great resource. There are many different regional and national hotlines available that provide support for different issues, including suicide, sexual assault and domestic violence. Trained advocates will support you through both critical and non-critical situations – you do not need to be in an immediate danger to call. While hotlines are not a substitute for counseling, they can be an important source of support.

 

Young Adult Cancer Survivors Need Special Support

Jean Rowe, Young Survival Coalition

Jean Rowe, Associate Director of Support Services, Young Survival Coalition

Young adults are at a certain stage of life development when diagnosed with cancer. They may be thinking about career decisions (i.e. do I stay in this job, go back to school or seek something new), where they want to live (e.g. hometown or move to another city), independently living on their own, and deciding what kind of mate they desire. They are not thinking about their lives being turned upside down by a cancer diagnosis.

All too often young adults are told “you’re too young” to have cancer when a concern is raised. This can result in late diagnoses and more advanced disease stage.

Young adults diagnosed with cancer experience interrupted lives. Their careers may be put on hold. They may have to take significant time away from work, which may or may not place their positions in jeopardy. They may have to move back home with their parents, which may involve having to move across the country. They often do not have financial resources (e.g. savings, 401(k)) to address the magnitude of cancer costs. While their peers are going through normal life steps (i.e. going to college, dating, or getting married and having children), young adults with cancer often isolate themselves and feel alone, thinking that their friends and family cannot understand what they are going through.

Anxiety and depression are not uncommon side effects of a cancer diagnosis. Chemotherapy can induce early menopause, a life and health change young women are not meant to experience for another 20 to 30 years. Early menopause impacts sexual libido and causes vaginal dryness. While in treatment and, potentially, for years to come, physical concerns like bone density and cardiac toxicity must be monitored. This could include taking preventative medication post-treatment (e.g. for osteoarthritis).

All of this impacts the young adult’s identity and life as he or she knew it. These side effects can last well past treatment when a young adult “looks fine” to the outside world while, “inside,” he or she is struggling emotionally, physically and existentially. They need and deserve support.

Celebrating its 20th year, the Young Survival Coalition (YSC) is the premier organization dedicated to the critical issues unique to young women diagnosed with breast cancer. YSC offers resources, connections and outreach so women feel supported, empowered and hopeful.

We offer a multitude of wonderful ways to connect and a wealth of resources. A young survivor can connect 1:1, in person and online (both in support group format and through social media). Our national Summit typically hosts 600 young survivors and their loved ones each year. Our educational materials are available for free to download or order in hard copy through our website. Our support and resources are there so that every young woman diagnosed with breast cancer knows that she is not alone at any stage and at any point in her journey. This includes resources for metastatic young survivors whose concerns and needs deserve attention and support.

YSC also supports Co-Survivors (e.g. spouse/partner, family member and friend). Co-Survivors may instinctively place their survivor’s needs before their own. That can come at a cost; their health could be impacted as well. YSC offers support and resources to our Co-Survivor population.

We want to make sure no young adult and their co-survivors face breast cancer alone. YSC is here to help. Please reach out!

About the Author

Jean Rowe is Associate Director of Support Services, Young Survival Coalition (YSC). She joined YSC in 2011 with a background in clinical oncology social work. She is a licensed clinical social worker, a certified oncology social worker and a certified journal therapist. Her focus includes the crafting, piloting and implementing of supportive and educational programming for young breast cancer survivors, co-survivors and health care providers. As a certified journal therapist, Jean crafted an original program addressing re-establishing intimacy after breast cancer as well as continuing education journal writing programs for mental health and nursing professionals regarding compassion, fatigue, and self-care. She holds a master of social work from the University of Georgia and a bachelor of arts from the University of South Carolina. 

Suggested Reading:

Acquati C., Zebrack B.J., Faul A.C., Embry, L, Aguilar, C., Block, R.,…Cole, S. (2017). Sexual functioning among young adult cancer patients: A 2-year longitudinal study. Cancer, 124(2), 398-405.

Adams, E., McCann, L., Armes, J., Richardson, A., Starck, D., Watson, E., & Hubbard, G., (2010). The experiences, needs and concerns of younger women with breast cancer: A meta-ethnography. Psycho-Oncology, 20, 851-861.

Cheung, C.K. & Zebrack, B. (2017). What do adolescents and young adults want from cancer resources? Insights from a Delphi panel of AYA patients. Support Care Cancer, 25(1), 119-126.

D’Agostino, N.M., & Edelstein, K. (2013). Psychosocial challenges and resource needs of young adult cancer survivors: Implications for program development. J Psychosoc Oncol, 31, 585-600.

Zebrack, B.J., Kent, E.E., Keegan, T.H., Kato, I., & Smith, A.W. (2014). Cancer sucks and other ponderings by adolescent and young adult cancer survivors. J Psychosoc Oncol, 32, 1-15.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are now accepting applications for our Cancer-Related Behavioral Health (CRBH) Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about our CBRH Fund and how you can support it by visiting www.HealthWellFoundation.org.

Effects of Parental Cancer on Children and Adolescents

Cancer is a chronic and sometimes terminal illness that impacts the person physically, emotionally and often financially. Time becomes a commodity, and the fragility of life becomes salient, often accompanied by an increase in humility and gratitude. Life often gets turned upside down; familial roles might change and a family may lose financial security. All family members may be affected by a loved one’s cancer, and children are among the most vulnerable and susceptible to familial impacts.  This article will briefly explore some of the psychosocial issues that children may experience when a parent or guardian is diagnosed with cancer.

Difficult Emotions

Maryrose Mongelli

Maryrose Mongelli, MSW, LMSW, Women’s Cancers Program Coordinator, CancerCare

Receiving a cancer diagnosis may elicit difficult emotions such as denial, anger, anxiety and/or depression, and these emotions may manifest in ways that psychologically affect children.  Family members experience turmoil when a parent is diagnosed with cancer. A newly diagnosed individual will begin to contemplate how they will tell their family, and if the individual is a parent with dependent children, they sometimes struggle with how to explain cancer to their children. Some may not tell children that they have cancer. In fact, parents may avoid using terms associated with cancer, such as chemotherapy, radiation, surgery and even the word cancer itself around their children as a means to protect their child(ren) from distress, disruption in their life, as well as avoiding questions about cancer and death. Avoidance is a coping mechanism that people use to protect themselves from experiencing difficult emotions when they are not ready to confront and accept the reality of why they are having these emotions.

Be Open and Honest

For a parent/caregiver with cancer, talking with their dependent children is one of the most difficult conversations a parent can have, but being open and honest with their child(ren) will help the child feel secure. Allowing the child(ren) to express their emotions and ask questions allows them to feel secure and grounded during an uncertain time. When a parent chooses not to disclose their cancer diagnosis to their child(ren), it is likely that their child will become confused and feel less secure when there are significant disruptions in their routine. Therefore, one can infer that parents often underestimate the level of their children’s intuition.

Children are Perceptive

Children are perceptive about the changes around them and will begin to question—whether internally or externally—any changes that occur, such as a significant change in the home environment, their own routine or their parent’s emotional and behavioral state. Like any partnership, rapport and trust need to develop. A child-parent bond does not automatically happen. A parent must earn their child’s trust even from birth. Children, especially young children, need to feel secure in their attachment to their parent/caregiver. When a parent is emotionally absent, insecure attachment occurs, e.g. a mother’s rejection of her child at birth. Moreover, when appropriate information is withheld from a child or adolescent their fundamental view of their parent becomes skewed. Young children may make assumptions that the cause of the changes/disruptions occurring is their fault, and this may result in the child becoming anxious or depressed.

Structure and Routine are Key for Children

A child thrives when their parents (guardians) provide structure and routine, and a cancer diagnosis can cause disruption to a child’s routine.  When first diagnosed, parents of dependent children are generally physically present, but psychologically less available to their children and their partners, due to their inability to be responsive to the child’s/adolescents needs (Earley & Cushman, 2002), resulting from a cancer diagnosis. This may result in a change in family dynamics, e.g. children might become parentified. Parentification is the role reversal between the child and the parent/caregiver, whereby the child becomes obligated to become the caregiver for their parent/caregiver, e.g. caring for younger siblings. If the child is an adolescent he/she may find employment to supplement the financial impact cancer has on the family.

As a result of parentification, adolescent truancy rates may increase and school attendance rates may decrease (Shah, Armaly, & Swieter, 2017). The parentification of children/adolescents prevents their personality, social, and emotional development. Poor social and emotional development may have significant impact on their future relationships. As a result, psychological issues that can occur in children when a parent is diagnosed with cancer or chronic illness are predominately adjustment disorders, anxiety, and depression. Based on a cohort study conducted by Wallin, et.al (2018), adjustment disorders were more common among children/adolescents aged 13 and older, keeping in mind that the psychiatric history of the parent with cancer did not modify the results.

Changes in Behavior

As parents are mentally and physically distressed, they may not have the ability to identify that their children’s behavior has changed. Changes in behavior in the home can often carry over into school or social environments. Children with a depressed or anxious mood may withdraw from activities, act out, and have diminished academic performance. Research shows that adolescents, especially adolescent girls, exhibit more psychosocial distress than pre-adolescent children. According to Welch, Wasdworth & Compas (1996), parents may be unaware of their child(ren)’s emotional distress, or have difficulty acknowledging it.

Children, not wishing to further burden their parents, may not express their emotions.  The internalization of emotions among family members, such as parents not discussing cancer to spare their child or children internalizing their feelings to avoid burdening their parents, leads to a lack of communication.

Communication is Key

In order to avoid misinterpretations or additional stress and anxiety within in the family when there is a cancer diagnosis, communication is key. Talking with children about their cancer diagnosis can be very distressing and is one of the most difficult conversations to have, and the first step is by using the word CANCER. As with any situation when talking with children it is best to talk in terms that their child(ren)/adolescents can understand e.g., “special medicine.” Parents can reassure their children that the cancer is not their fault, as well, giving them an opportunity to ask questions. Involving children in ways they can contribute to the parent’s treatment can be accomplished by assigning age appropriate tasks. Also, it is important to discuss the changes that may occur during treatment. Finally, reassure the child(ren) that they will always be cared for.

Although difficult during a time of great distress, communication allows the family to maintain stability within the unit by reducing misunderstandings, arguments, and fear. Within a family unit, stability or family homeostasis, is considered the family “NORM.” Considering that all families are different, ideally stability would be when all family members feel supported and nurtured. Stability within the home may combat a sense of insecurity. Insecurity may increase anxiety and depression among the family members and negatively impact the psychosocial functioning of children and adolescents. In order to mitigate feelings of insecurity and instability stemming from a cancer diagnosis, ideally a patient’s treatment plan would include psychoeducation about how cancer affects the family. In addition, the patient’s treatment plan could include family counseling and psychological intervention if necessary. Children and parents are equally affected by cancer, and employing all resources available can achieve stability in a potentially unstable situation.

About the Author

Maryrose Mongelli, MSW, LMSW, is Women’s Cancer Program Coordinator with CancerCare. She provides supportive counseling and resources to patients, caregivers, loved ones, and to those who have experienced the loss of a loved one. She is a part of the CancerCare for Kids program and is also is affiliated with the National Association of Social Workers (NASW).

About CancerCare

Founded in 1944, CancerCare is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Its comprehensive services include counseling and support groups over the phone, online and in-person; educational workshops; publications; and financial and co-payment assistance. All CancerCare services are provided by oncology social workers and world-leading cancer experts. To learn more, visit www.cancercare.org or call 800-813-HOPE (4673).

References

Earley, L., & Cushman, D. (2002). The Parentified Child. Clinical child psychology and psychiatry, 7(2), 163-178.

Ruoqing, C., Regodón Wallin, A., Norén Selinus, E., Sjölander, A., Fall, K., Valdimarsdóttir, U., Fang, F. (n.d.). Psychiatric disorders among children of parents with cancer : A Swedish register-based matched cohort study. Retrieved from http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-67312

Shah, B. K., Armaly, J., & Swieter, E. (2017). Impact of parental cancer on children. AntiCancer Research, 37(8), 4025-4028.

Welch, S. A., Wadsworth, E. M., & Compas, E. B. (1996, April 1). Adjustment of children and adolescents to parents cancer: Parents’ and children’s perspective. Cancer, 77(7), 1409-1418.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are now accepting applications for our recently launched Cancer-Related Behavioral Health (CRBH) Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about our CBRH Fund and how you can support it by visiting www.HealthWellFoundation.org.

 

 

“Triaging” Cancer and Behavioral Health Concerns

This week, Real World Health Care shines a spotlight on Triage Cancer, a national, non-profit organization that provides education on the practical and legal issues that may impact individuals diagnosed with cancer and their caregivers, through events, materials and resources.  We spoke with Joanna L. Morales, Esq., CEO of Triage Cancer, who offered insights on how the concept of “triaging” can be applied to behavioral health issues associated with cancer.

Collaborating to Help Cancer Patients

Real World Health Care: Can you tell us about the mission of Triage Cancer?

Joanna Morales, Triage Cancer

Joanna L. Morales, Esq, CEO, Triage Cancer

Joanna Morales: Triage Cancer believes that collaboration is the key to providing valuable information and practical tools on survivorship to the cancer community, particularly to its underserved members. To that end, Triage Cancer works with cancer community partners, healthcare professionals and other experts to connect people to relevant, practical and personal information on cancer survivorship issues, such as access to healthcare, treatment options, psychosocial care, survivorship planning, and the practical, legal and financial issues that arise as a result of a cancer diagnosis.

Navigating a Cancer Diagnosis

RWHC: How does the concept of triaging relate to being diagnosed, living with and surviving cancer, including related behavioral or mental health issues?

JM: Triaging is the process of determining the priority of patients’ treatment based on the severity of their condition. When someone is dealing with a cancer diagnosis, there is information to learn, things that need to be dealt with, and decisions to make. Trying to juggle it all can be incredibly overwhelming. Our goal is to provide access to quality information about all types of cancer survivorship issues that may arise after a diagnosis. Armed with that information, individuals not only get the big picture of how to reach their end goals, but they can better decide what needs to be handled first and what can wait until later – the very definition of triaging.

With behavioral health issues associated with cancer, it’s about deciding what you can do for yourself and in which order those actions will best serve you. With a cancer diagnosis comes side effects and difficult decisions regarding treatment, health insurance, financial issues and more. Dealing with these legal and practical issues can create stress and anxiety. There is also data that shows that individuals with a higher financial burden are more likely to experience depression. We offer education on how to effectively navigate these issues, to thereby decrease stress, anxiety and depression. We also provide tools on stress management and other psychosocial topics that impact mental health.

For example, we offer a Don’t Stress the Stress webinar as well as a webinar on Staying Healthy After Cancer: Behaviors You Can Adopt to Improve Your Health. We also offer Quick Guides and an educational blog on our Resources page.

We have a new webinar coming up on November 15 that does a great job explaining what stress is and how it affects everyone differently. It will also provide simple, common sense and practical techniques to get stress under control. I encourage your readers to register for the webinar.

Recognizing a Problem is Just the First Step

RWHC: What do you think are some of the biggest challenges facing the cancer patient community when it comes to behavioral health problems?

JM: At Triage Cancer, we believe one of the biggest challenges regarding behavioral health is not being sure where to start looking for help. Recognizing a problem is just the first step. Finding answers can be hard, and taking action toward a healthier you can be even harder.

While health insurance coverage includes coverage for behavioral and mental health care, there are still likely to be out of pocket costs that you may be responsible for. If your budget is tight, consider financial assistance programs that may be available to you, rather than just skipping getting the help you need. Triage Cancer offers a separate website at www.CancerFinances.org, which provides information on how to navigate finances after a cancer diagnosis and connects you to financial assistance resources.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are now accepting applications for our recently launched Cancer-Related Behavioral Health (CRBH) Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about our CBRH Fund and how you can support it by visiting www.HealthWellFoundation.org.

 

 

Cognitive Behavior Therapy for Teens and Young Adults with Cancer

This week, Real World Health Care focuses on the special behavioral health issues that can impact teens and young adults with cancer. We are delighted to share information on this topic from the Association for Behavioral and Cognitive Therapies, and to feature insights from Tammy A. Schuler, PhD, a Licensed Clinical Psychologist and Director of Outreach and Partnerships for ABCT.

ABCT is a multidisciplinary organization committed to the enhancement of health and well-being by advancing the scientific understanding, assessment, prevention, and treatment of human problems through the global application of behavioral, cognitive and biological evidence-based principles. It seeks to decrease human suffering using science.

Supporting the Cancer Community

Real World Health Care: How does ABCT address the special needs of adolescents and young adults with cancer?

Tammy Schuler

Tammy Schuler, PhD, Director of Outreach and Partnerships, Association for Behavioral and Cognitive Therapies

Tammy Schuler: Adolescents and young adults (AYAs) and their families coping with cancer have a lot to deal with. The AYAs are dealing with a major, life-changing circumstance during a period of their life when they are also dealing with other huge changes and developmental milestones. ABCT provides a variety of information to this patient community on treatment for depression, anxiety, sleep, insomnia and other areas that AYAs may struggle with. We also offer a clinical directory in which people looking for cognitive behavioral treatment can find providers in their area. Some of these providers specialize in working with people and their families who are coping with cancer, and some of them specialize in working with young people coping with a range of concerns.

Reaching Out for Help

RWHC: What advice would you give an AYA or family member who may feel uncomfortable or unsure about reaching out to a cognitive behavior therapist for help?

TS: Normalizing it is important. Many AYAs dealing with cancer experience some sort of cancer-related behavioral health issue. Issues may not happen right away. They may come up at some point during treatment or when they’re recovering from cancer treatment and trying to get back to their lives, and even beyond. In fact, a lot of AYAs report that they experience struggles after cancer treatment is over.

It’s also normal for family members – especially caregivers – to experience a behavioral health concern, at any point after the AYA’s cancer diagnosis.

Behavioral health concerns can range from having more difficulty adjusting to or coping with the cancer than one might expect, to ongoing feelings of sadness, anxiety, worry, panic attacks, persistent insomnia, increased substance use, and other symptoms. If a distressing behavioral health symptom sets in and doesn’t let up, if a behavioral health symptom becomes really disruptive to day-to-day life, or if a person starts worrying that they might hurt or kill themselves, those are signs to reach out to a qualified therapist for help.

It’s perfectly okay to reach out to people who can help, including cognitive behavior therapists, no matter what. Cognitive behavioral therapists are used to working with people dealing with these kinds of concerns; and the sooner someone reaches out, the sooner a plan can be developed to help the person feel better. Be sure to carefully check the credentials of the therapist. They should be licensed to practice in the patient’s state and should be listed as members of professional organizations, such as ABCT or the American Psychological Association.

HealthWell’s Cancer-Related Behavioral Health Fund is a wonderful initiative for insured people who want to reach out to a cognitive behavioral therapist, but who are struggling with finances.

Fast Facts: Adolescents and Young Adults with Cancer

The following information has been excerpted from the full ABCT fact sheet, written by Glynnis McDonnell, Doctoral Candidate in Clinical Psychology at St. John’s University and a Psychology Intern with the University of Tennessee Health Sciences Center & St. Jude Children’s Research Hospital.

A cancer diagnosis can be upsetting for individuals of any age; however, the effects of a cancer diagnosis and treatment may be especially upsetting for people diagnosed as adolescents and young adults (AYAs). This period involves rapid physical and psychosocial development, and a cancer diagnosis can interrupt these developmental processes:

  • Treatment often leads AYAs to take a large amount of time off from school or work, affecting career and education plans.
  • Treatment can make the formation of romantic relationships difficult due to factors such as body image concerns, limitations placed on one’s activities, etc.
  • Treatment can lead to infertility, interfering with the ability to start biological families.
  • A potentially life-threatening illness can be especially startling for AYAs:
    • AYAs likely have a better understanding of the seriousness of their illness than child patients but are often unprepared to process the meaning of a serious disease as effectively as older patients.
    • AYAs are still in the process of developing a stable sense of self. Therefore, diagnosis and treatment of a serious illness during this period could have a different psychological impact than it does for older adults.

There is growing evidence that cognitive behavior therapy (CBT) is an effective treatment for many of the psychological difficulties faced by AYAs. CBT is a form of psychotherapy that draws upon the connections among one’s thoughts, behaviors and emotions. It cannot change the fact that this young person has had to cope with a difficult diagnosis, but it can help ease the related difficult feelings, including worry, sadness and guilt related to the cancer experience. It can also help the AYA process traumatic aspects of the cancer experience.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are now accepting applications for our recently launched Cancer-Related Behavioral Health (CRBH) Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about our CRBH Fund and how you can support it by visiting www.HealthWellFoundation.org.

 

 

Strength in numbers: how peer support empowers those coping with cancer

Online peer support groups are growing and it’s easy to see why. Peer support groups offer those dealing with a difficult diagnosis such as cancer, the chance to find empowerment, support and guidance from other members who are going through a similar situation.

Inspire, which is an online patient-driven community, has grown to nearly 1.5 million members since its inception in 2005. The company has more than doubled its amount of registered users over the past three years. Of the 200 groups that can be found on the site about a third have joined one or more of the online community’s cancer support groups.

“Inspire co-founder and CEO Brian Loew wanted to create a safe, supportive community for patients to gather, and if members wanted to participate in clinical trials, then Inspire could help connect them to researchers,” said John Novack, communications director at Inspire. “We deeply believed from the start that we can accelerate medical progress, and as we’ve grown to more than one million members, we are helping to do just that.”

Online Kidney Cancer Support Community

In 2014, the Kidney Cancer Association joined Inspire to create an online community for those who were diagnosed with kidney cancer. Currently, the community has over 2,000 active members.

Bill Bro

Bill Bro, Vice President, Kidney Cancer Association

“As a kidney cancer patient, I know how valuable emotional support can be,” said Kidney Cancer Association Vice President Bill Bro.

All in all, the Kidney Cancer Association has about 100,000 members on its social media pages in addition to its presence on Inspire.

“To my knowledge, the Kidney Cancer Association’s Inspire community and Facebook groups constitute the largest kidney cancer support network anywhere in the world. Thousands of people are ready to offer their perspectives on treatment decisions as well as offer help to caregivers,” Bro said.

According to Sara Ray, senior director of research at Inspire, peer support groups have a positive effect when it comes to patients making decisions and exploring all of their treatment options.

“The collective clinical and experiential knowledge of the peer support group helps patients not only learn which treatments are available, but what they can expect from those treatments, said Ray. “Patients often feel those who are on the cancer journey have a ‘real-world’ understanding of treatments and are eager to learn from them. In addition, patients can learn about upcoming treatments and clinical trials. This knowledge empowers them to speak to their physician, learn more, ask better questions, and become active in treatment decisions.”

Changing the Face of Cancer Care

Essentially, patient support groups are helping change the face of cancer care. Online support communities allow patients to make informed decisions with help from their peers.

“Patients are smarter and more empowered,” Ray said. “Peer groups have become a way to crowdsource information. As ‘asking the hive’ becomes more and more popular, patients are able to use the combined knowledge and experiences of their peers to learn about new options, manage expectations, and take part in decision making.”

When it comes to the psychosocial aspect, online peer support communities offer a myriad of resources for their members.

“Inspire provides a place for patients to feel less alone or isolated by providing a place for those dealing with cancer to share their worries and concerns and receive validation, love, and support,” said Ray. “Further, Inspire provides a place where patients can brainstorm and plan, feeling empowered to make decisions. In addition, many patients and caregivers on Inspire express the desire not to burden loved ones by seeking emotional support. Inspire provides a place where patients and caregivers can express their fears, discuss their worries, or just vent in a space apart from their loved one. Often, communities have discussion channels specifically for caregivers.”

Ray also noted that with communities like Inspire, patients gain what they lack in cancer support.

“They can seek clinical information or emotional support,” she said. “If they have a rare cancer, they can find others like them. Peer support groups are not a one size fits all solution. They are just as effective for a patient who wants to check in only at times of testing and for the patient who visits the board daily to share side effect struggles. Moreover, patients gain a place to give back. Many patients enjoy ‘paying it forward’ by sharing their experiences and providing support to others.”

From a personal perspective, the Kidney Cancer Association has seen a direct impact with its patients within Inspire’s community.

“I’ve witnessed patients moving from feeling hopeless to hopeful in just a few months as the result of positive interactions with others online,” Bro said.

For more information on Inspire, go to inspire.com. For further information on the Kidney Cancer Association, go to kidney cancer.org.

To join the Kidney Cancer Association’s Inspire community, go to kidneycancer.me.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are pleased to announce the introduction of a new Cancer-Related Behavioral Health Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about this new Fund and how you can support it by visiting www.HealthWellFoundation.org.

 

Childhood Cancer: Financial Distress Hits Families Hard

This week, Real World Health Care focuses on emotional stress associated with childhood cancer. We hear from Jessica Cook, MSW, Patient & Family Services Coordinator for the National Children’s Cancer Society (NCCS), about the services NCCS offers to help patients’ families cope with the disease’s devastating financial toll.

Supporting Families

Real World Health Care: Tell us about the mission and goals of the NCCS.

Jessica Cook

Jessica Cook, MSW, Patient & Family Services Coordinator, National Children’s Cancer Society

Jessica Cook: The National Children’s Cancer Society (NCCS) tirelessly and compassionately supports families making their way through the daunting world of childhood cancer. With over thirty years of experience serving nearly 42,000 children, the NCCS has become a master navigator of this world, helping families get where they need to be-physically, financially and emotionally. Distributing more than $65 million to families over its lifetime, the NCCS is able to take a “no matter what” approach, creating a clear path through the labyrinth of childhood cancer and survivorship to help families stay strong, stay positive and stay together. Because no family should go through childhood cancer alone.

The average cost to treat a child with cancer is over $800,000.  The financial and emotional impact a diagnosis has on the entire family is devastating. The NCCS seeks to help unburden some of the financial devastation.  By providing transportation assistance, whether a family is local or needing to fly across the country, the NCCS ensures that the child is able to get to the life-saving treatment facility no matter what.  For families having to remain in the hospital or relocated from home, we offer a one-time per year emergency stipend to help with expenses like meals while in the hospital, insurance premiums, household expenses, prescriptions, car expenses, and child care.

RWHC: What other types of support programs do you offer?

JC: In an effort to alleviate some of the behavioral issues children diagnosed with cancer face, we offer a mentorship program. Studies indicate that a mentoring program increases adjustment post treatment, reduces children’s anxiety and increases both self-care skills and self -confidence.  Our program connects young adult childhood cancer survivors with children who are currently in treatment.  The mentor acts as a knowledgeable and experienced guide, a trusted ally and caring role-model throughout the school year.

Behavioral Health Challenges

RWHC: Do children with cancer face unique behavioral health problems that aren’t as prevalent in adults with cancer?

JC: Children with cancer may face unique challenges such as missing school, isolation from extended family and peers due to compromised immune systems, survivor’s guilt, anxiety, depression, and difficulties in school.

RWHC: Do children with cancer have a difficult time accessing behavioral health treatments?

JC: The biggest challenges families face involve insurance coverage, geographic location and time.  Frequently, facilities offer group work to help address some of the behavioral issues children and their families face, however many simply live too far or don’t have the time to make another trip to the hospital and are unable to benefit from the resource.  The NCCS recognizes the value of counseling for children with cancer and provides transportation assistance to ensure the child receives the support they need.  It is important to note, that while initially children may experience anxiety and depression, decades of research on the impact of pediatric cancer and the psychological and emotional functioning of children indicate that a minority of youth demonstrate a long-term clinically relevant distress. In fact, the majority of cancer survivors show good psychological functioning.

Let Your Child Be a Child

RWHC: What can parents do to help ensure that their financial distress does not add to the stress children are already under when they find out they have cancer?

JC: The most important thing that parents can do is allow their child to be a child. It is not the child’s role to be a part of financial discussions especially as it relates to their diagnosis.  When facing the financial challenges associated with their child’s diagnosis it’s important for parents to assess the personal impact the diagnosis will have on the family. Things to look at include loss of income, increased living expenses — such as child care and travel costs — and insurance coverage.  The increased expenses can seem overwhelming, but creating a monthly budget can help provide some understanding and control over their financial situation. Above all, it’s important that families understand that they are not alone.  There should be no fear or embarrassment when reaching out to resources, like the National Children’s Cancer Society, to help with the costs associated with treatment, and in discussing any financial or emotional concerns with members of their child’s treatment team.

Biopsychosocial Care Vital to Well-Being of Cancer Patients

This week, Real World Health Care brings you an interview with Jon Levenson, M.D., Associate Professor of Psychiatry at Columbia University Medical Center, and member of the American Psychiatric Association’s Council on Consultation-Liaison Psychiatry. Dr. Levenson spoke about some of the challenges facing psychiatrists and integrated health teams when caring for patients with chronic medical problems such as cancer.

Consultation-Liaison Psychiatry

Real World Health Care: What is the mission of the American Psychiatric Association’s Council on Consultation-Liaison Psychiatry?

Dr. Jon Levenson

Jon Levenson, MD, Associate Professor of Psychiatry, Columbia University Medical Center

Jon Levenson: The Council focuses on the psychiatric care of people who are medically ill. It recognizes that the integration of biopsychosocial care is vital to the well-being of patients and their families, and that full membership in the house of medicine is essential to the well-being of psychiatry. We achieve our goals through initiatives related to research, clinical care, education and health policy, working closely with other physicians, residents and medical students.

Medical Health Linked to Behavioral Health

RWHC: Behavioral health issues can strike just about anyone, but are there certain types of chronic medical illnesses that are particularly associated with a higher incidence of patients being at risk for developing behavioral health problems?

JL: Often, that link between medical and behavioral health problems depends on whether the medically ill patient has pre-morbid behavioral health problems. For example, if someone has a pre-existing complication such as an alcohol or opioid use disorder, they tend to be at higher risk of non-adherence to their medical treatment. Or, a long-time tobacco user diagnosed with throat cancer may need treatment for his or her nicotine addiction.

From the other perspective, there are certain medical illnesses, such as heart disease and cancer, that carry a heavy burden and come with various complications, which can lead to a higher risk of depression. When patients are first diagnosed with cancer, it can be very common to have acute emotional symptoms such as numbing, anxiety, sleep disturbance and depressed mood for about 7-10 days. If these symptoms endure — and often, they do not — the concern is that the patient may develop acute psychiatric disorders including major depression, generalized anxiety disorder and a group of disorders called adjustment disorders.

We also can’t discount the behavioral health problems associated with survivorship. The patient’s cancer may be in remission, but they may continue to suffer from psychosocial complications, including marked distress around the anniversary of their diagnosis, surgery or end of treatment. For some, the end of treatment can be particularly challenging because they are not being as monitored as closely, which can produce anxiety around living with an uncertain medical future.

Other concerns that our profession focuses on include sexuality, intimacy and fertility issues among survivors and problems relating to re-entry back into normal life such as difficulties finding a job or obtaining medical insurance due to their pre-existing condition.

Challenges for Care Teams

RWHC: What are some of the biggest challenges facing integrated health care teams in terms of making sure cancer patients receive the proper behavioral health screening and treatment?

JL: There are a number of issues, from ensuring that patients adhere to their oncological treatments to regularly screening patients for behavioral health problems using standardized programs such as the distress screening thermometer developed by the late Dr. Jimmie Holland or the PHQ-9 Patient Health Questionnaire. These tools give cancer treatment teams an easy-to-use method for routinely evaluating the behavioral health of their patients, not just during active cancer treatment, but also during ongoing outpatient monitoring.

Our Council works closely with other organizations such as the Academy of Consultation-Liaison Psychiatry and the American Psychosocial Oncology Society to collaborate, share knowledge and develop programs that will help patients and their families navigate the behavioral health challenges associated with chronic and life-altering illnesses. For example, we’re currently working on a position statement related to palliative care. We’re intent on improving the knowledge base around end-of-life care and the role that psychiatrists play.

RWHC: Do psychiatrists have a hard time finding a “seat at the table” in integrated cancer care teams?

JL: Today, cancer care is whole-person care. Virtually every comprehensive cancer center has a psychosocial oncology program with staff that works closely with the medical oncology teams and palliative care teams treating patients.

Consultation liaison psychiatry is well immersed in the medical setting, and from that point of view, we all have a seat at the table. While there can be challenges, we work to overcome them through training in acute and outpatient care settings with medical students, residents and fellows so they learn how to effectively develop and maintain that seat at the table. We work especially closely with medical students studying psychiatry to help them understand what consultation liaison psychiatry is and get them interested in the field, which enhances recruitment and long-term support for the field.

Consultation liaison psychiatrists are well-regarded advocates for patients and can help our medical colleagues understand how to screen for distress as well as get patients the support and therapy they need. Often, issues can be openly addressed and discussed with short-term psychiatric support that ameliorates the bulk of patients’ fears, anxiety and behavioral distress.

Encouraging Patients to be Open

RWHC: What advice would you give to a cancer patient who may be undergoing behavioral health problems associated with his or her cancer diagnosis, but who may feel uncomfortable or unsure about reaching out to a psychiatrist for help?

JL: First, they should know that help exists. If someone is suffering from acute distress such as debilitating anxiety, panic attacks or strong feelings of despondency, they should seek immediate help in the form of psychiatric support and pharmacotherapy. If they are hesitant to reach out directly to a psychiatrist, they can start by reporting their distress to their physician, nurse or someone else on their care team.

There are also a wide variety of patient support organizations — at least one for just about every disease in the book — that can provide information and support. Many of these organizations have “buddy programs” through which a newly diagnosed patient is partnered with someone who has been there before. These groups can help tremendously with feelings of isolation or differentness, and many offer both in-person and online support, so no matter where you live, help is only a click away.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are pleased to announce the introduction of a new Cancer-Related Behavioral Health Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about this new Fund and how you can support it by visiting www.HealthWellFoundation.org.

 

Community Cancer Practices Tackle Behavioral Health Concerns

This week, Real World Health Care brings you an interview with Robert “Bo” Gamble, director of strategic practice initiatives, Community Oncology Alliance (COA). COA is the only organization dedicated solely to community oncology, where the majority of Americans with cancer are treated. We discussed the importance of allowing cancer patients to receive quality, affordable and accessible care in their own communities and how the COA is addressing the needs of community cancer care through Oncology Medical Homes and its Advanced Practice Provider Network.

Behavioral Health & the Oncology Care Model

Real World Health Care: What are some of the biggest challenges community oncology practices face in treating the behavioral health needs of their patients?

Robert Gamble, Director of Strategic Practice Initiatives, Community Oncology Alliance

Bo Gamble: For cancer patients, having care that’s close to home is especially important. One of the biggest challenges and a key focus of COA is to keep local cancer care teams in community practice settings and minimize their migration to larger academic and teaching hospitals. COA provides an important support structure for integrated community cancer care teams, including physicians, advanced practitioners, nurses, pharmacists, and practice managers. With the right support, community cancer practices have more time to focus on patients’ emotional and behavioral needs in addition to their medical needs.

From a patient-centered perspective, it’s about getting them the right care in the right place and at the right time. That extends to care for behavioral health, which is a component of the Oncology Care Model (OCM). Highly-coordinated care is a cornerstone of OCM, and we have a support network that helps community oncology practices succeed and thrive in implementing the OCM while managing increasingly complex services — including behavioral health services — and health care delivery pressures.

Oncology Medical Home

RWHC: What role can the Oncology Medical Home (OMH) play in helping cancer patients get the behavioral health screenings and treatment they need?

BG: COA has pioneered policy on OMH, which is a patient-centered system focused on promoting, delivering, ensuring and measuring quality and value in cancer care. One of the support arms in this effort is the OMH implementation committee that identifies, reviews and recommends tools, technologies and templates to assist cancer care centers.

Patient engagement is an important domain within the OMH. Community cancer care teams must listen to patients and respond to all their needs, including medical, behavioral, spiritual and financial needs. The OMH concept also extends to detailed survivorship care planning, which is now starting to be addressed more directly in community cancer practices and involves a range of specialty care practitioners, including behavioral health professionals. Patients need to stay involved and connected with that survivorship care team.

Advanced Practice Providers Crucial in Community Settings

RWHC: What role do advanced practice providers such as nurse practitioners and physician assistants play in helping cancer patients get the behavioral health screenings and treatment they need?

BG: Advanced practice providers (APPs) serve as clinical quarterbacks and often handle the bulk of patient communications and coordination, especially through survivorship care as I referenced just a moment ago. The COA has an Advanced Practice Provider Network that consists of a private, peer-to-peer information sharing website and listserv; monthly conference calls to review practice issues and discuss solutions; and opportunities for in-person meetings. The goal of the Network is to keep oncology APPs up to date on the latest news and developments including patient support strategies, health reform initiatives, the newest drugs and therapies, and APP leadership roles.

Increasingly, APPs are called on to manage everything from care team coordination to screening patients for distress issues that range from behavioral health problems, to clinical navigation and support, to local employers for the cancer care needs of their employees.

COA conducted a patient survey a few years back and, in virtually every category, APPs outscored physicians. That’s because they’re often more hands-on and tend to have an extra level of sensitivity and empathy so patients are more willing to open up to them.

Cancer’s Financial Toll

RWHC: How can community cancer practices help patients address the problem of financial distress?

BG: One of the first steps is to determine where the stress is coming from: Did that financial distress exist before the cancer diagnosis? The CMMI Oncology Care Model specifies that patients receive guidance on the expected total cost of care. It can be difficult for community cancer physicians to accurately estimate the total cost of a patient’s cancer care journey due to the many variables that may happen in the care process. But what should be communicated is the patient’s out-of-pocket costs — not just for treatments, but also costs related to managing side effects, dealing with unexpected costs like emergency room visits, and costs associated with end-of-life care.

The cancer care support team assists in identifying these needs, investigating and then utilizing these resources to aid the patient and family with this burden.

This assistance and support is also demonstrated by being available to the patient 24 hours per day 7 days a week.  This minimizes unnecessary emergency room visits and hospitalizations.  The benefit to the patient includes reducing financial burden but oftentimes more effective and efficient cancer care.

From screening for distress and navigating resources to creating detailed survivorship plans, the community cancer care team can form real and lasting bonds with patients. Those bonds are sacred and cherished and they should be encouraged to grow.

A Message from Our Sponsor

As the founding sponsor of Real World Health Care, the HealthWell Foundation is committed to helping patients get the medical treatments they need, regardless of their ability to pay. We’ve seen first-hand how financial distress can impact the health and lives of individuals and families. Cancer patients with behavioral health conditions are particularly hard hit; according to the American Society of Clinical Oncology (ASCO), patients with some forms of cancer incur $8,000 more per year in health care costs than cancer patients without behavioral health conditions.

In keeping with our mission, we are pleased to announce the introduction of a new Cancer-Related Behavioral Health Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health providers (psychiatrists, psychologists, clinical counselors, and licensed social workers).

We invite readers of Real World Health Care to learn more about this new Fund and how you can support it by visiting www.HealthWellFoundation.org.