Great strides have been made in cancer diagnosis and treatment. The death rate for cancer fell by 32% from 1991 (the peak year) to 2019. Still, cancer diagnoses are on the rise. The cost of cancer care is estimated to have increased by almost $19 billion from 2015 to 2020, to reach $209 billion. Cancer is in the top three categories of spend for most employers, and for some it is the top.
Today we can expect that employees with cancer most often will have a favorable response to treatment and that many will be able to continue working. Mercer’s latest National Survey of Employer-sponsored Health Plans found that the majority of large employers have taken steps to address the needs of employees dealing with cancer and provide specialized support. A comprehensive cancer strategy includes a broad range of elements along the cancer continuum, ranging from awareness campaigns on the importance of cancer prevention and early detection, to return to work support, to hospice options and end of life planning.
Elements of a cancer strategy
A comprehensive cancer strategy includes both support for employees as they cope with the physical and emotional stresses of a cancer diagnosis, and effective care management to help ensure the patient receives quality care quickly in the most appropriate setting -- which can lead to better outcomes and better use of healthcare dollars. Just over a third of large employers (34%) provide a specialized cancer care management program. These programs assist with care coordination, support compliance with treatment regimens, find applicable clinical trials, and connect families to local community resources and to other solutions the employer offers.
Centers of Excellence or site-of-care navigation programs, offered by 24% of large employers, help ensure that members are treated by quality providers with relevant experience and expertise. Hotlines, caregiver and family advocacy services, and financial planning services can help employees and their families deal with the day-to-day challenges of the cancer journey.
The role of genetic testing
Any discussion of cancer today needs to include consideration of genetic and genomic testing. Genetic testing has become an important part of cancer diagnosing and treatment planning, and in some cases, it is part of the diagnosis and treatment protocol. Pharmacogenomics, as it relates to personalized treatment plan options, has the potential to revolutionize cancer care, but it is important to follow the science in this area. Tests must be ordered by the attending physician for approved diagnoses and treatment protocols and the results delivered by the attending physician or someone on the care team, so the patient has an opportunity to process the information and ask questions.
Is there a role for genetic tests in broad population-based testing and early cancer screening? At this early stage, select populations might be good candidates for genetic testing; beyond that, the answer is less than clear. With the growth in new early detection, liquid biopsy products in this sector, some marketed directly to consumers, it is important to weigh the benefit and risks of broad-based testing that is not ordered by an individual’s physician. While the results have the potential to provide important insights, keep in mind that unexpected results can create significant stress and anxiety without necessarily being actionable.
Where to start with a cancer strategy
The success of a cancer strategy depends on a number of factors, the most important being adoption by members. A good place to start the journey is by taking the time to understand your membership – risk factors, health literacy, ethnic considerations, and financial barriers. These factors all play a role in health and can help you to choose the right focus areas and types of support. This “pre-work” can be leveraged when designing communication materials and methods, to genetic testing requirement and cancer treatment. Broad-brush strategies have shown to not lead to maximized outcomes. Consider the strategy for a demographic group with greater-than-expected breast cancer claims. Historically, the approach would be to publicize the importance of mammograms and early detection. However, if the population is low-income and rural, providing a mobile mamo van could be a more effective approach to facilitate early detection.
There are concrete steps employers can take to improve cancer screening rates in line with current USPSTF guidelines. Even as cancer treatment continues to advance, early diagnosis and identification of optimal treatment regimens will be key drivers in improving cancer survival rates – so a lot hinges on each individual. Knowing your population’s risk, barriers and typical access points are foundational in success with any cancer strategy.
This post is one in a series of Seven breakthrough benefit strategies to explore this year.