No, not sexuality and intimacy. I am referring to financial distress and its impact on patient nonadherence to a treatment plan.
The high price of cancer treatment takes its toll on cancer patients. The corollary to this statement is that the current unemployment rate and the number of people without health insurance is unacceptable. While it is not a novel topic to address, I was struck by a recent survey of cancer patients, caregivers, and oncology social workers. The survey indicated that more than two-thirds of patients with major financial hardships suffer depression and anxiety, nearly one-third of patients delay filling prescriptions, and nearly one-quarter skip doses of their medication. The mounting financial pressures patients face have placed undue strain on patients' ability to follow recommended treatment plans and focus on recovery. Only a third of patients in this survey turned to an oncology social worker for assistance, yet most patients reported stress related to the financial burden of cancer care.
Are we in touch with the severity of this issue? Imagine choosing which essential expenses you cut back on—food or your cancer treatment. That is what nearly half of the patients reported in the survey. How does one focus on health when constantly worrying about paying bills and having enough left over to afford groceries? That is what 75% of the patients reported.
Are we in touch with the issue of nonadherence for oncology patients?
When one speaks with oncologists and oncology nurses, one finds a growing number of healthcare providers who have made a mind-set shift and recognize that cancer patients are not as adherent to treatment plans as previously thought. With this change in thinking comes a referral to oncology social workers and other staff who can help patients address the barriers they face. The number of oral oncolytics approved in the past 10 years has added another financial burden to the patient, especially the patient receiving Medicare. The need for financial resource assistance has grown, as has the need for emotional counseling related to the financial stress. However, only half of the patients surveyed are comfortable discussing financial matters with their healthcare provider. The patients may fear receiving substandard care, being offered different treatment options, or receiving less attention from their heathcare provider if they admit to financial hardships. Providers may hesitate to initiate a discussion based on a preconceived notion that a patient is facing financial hard times. And financial stress is only one barrier to nonadherence. The stress toll mounts for cancer patients, complicating their overall cancer care and recovery.
Making financial assessment a routine component of patients' visits may direct them to receive the counseling they need. The National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines regarding distress management. Within the guidelines is the Distress Management Screening Tool, a validated resource that can help patients identify their degree of distress and the source of that stressor. It is a visual, user-friendly tool administered to patients by their healthcare provider. This tool can help explore and uncover 5 areas of distress a cancer patient may be experiencing—practical, family, emotional, spiritual/religious, and physical. If a patient is not able to articulate the extent of distress or the root of the stress, this tool can facilitate both assessment and discussion of the patient’s worries. This is the first step in referring patients to the appropriate healthcare provider and finding effective resources.
Ide Mills, LCSW
SVP, Health Education
Encore, a HealthEd company