How to Mitigate the Emotional, Logistical, and Financial Burdens of Cancer Treatment?

Rachel Greenup, MD, MPH

During a site visit to Yale School of Medicine, CancerNetwork® spoke with Rachel Greenup, MD, MPH, a professor of surgery, the section chief of Breast Surgery, and the co-director of the Center for Breast Cancer at Smilow Cancer Hospital of Yale School of Medicine.

Greenup, who focuses on patient-centered approaches to cancer care and ways to mitigate the financial, emotional, and logistical burdens associated with breast cancer treatment, discussed topics ranging from shared decision making to leveraging social media during the conversation.

“The biggest challenge with being a [patient with] cancer is often the burden of care,” she said. Ultimately, Greenup spent the conversation emphasizing the importance of caring for patients in more ways than just administering treatment.

Read the full discussion here:

CancerNetwork: What should clinicians or institutions keep in mind to ensure that patients are adequately involved in the shared surgical decision-making process for patients with breast cancer?

Greenup: The term shared decision-making describes patients and families engaging in their treatment plan. It is by no means meant to burden patients with shouldering the responsibility of their treatment decisions on their own, but it’s to ensure that they have a voice in their treatment planning and that their values and goals are incorporated into the treatment planning. Patients and families should feel free to ask questions, ask how this will impact the other parts of their lives, and feel as though they’re being heard by their providers.

What demographic factors may correlate with barriers to effective care for breast cancer?

Patient demographics that serve as barriers to receiving high-quality breast cancer care include access to care, insurance coverage, distance to a tertiary cancer center, access to clinical trials, and baseline knowledge or health understanding of their diagnosis and their options. We are working as an oncology community to make sure that no matter where someone lives or what their background is, they have access to their diagnosis, that it is understandable to them, and that they have the ability to tap into support services if questions or additional needs arise. We, in a national setting, are working on improving clinical trial enrollment across more diverse patient populations but still have a ways to go.

What can be done to mitigate cancer-related financial toxicity?

Financial toxicity describes the distress of high cancer treatment costs for people going through oncology treatment, breast cancer or otherwise. It’s a multi-pronged approach needed to reduce or eliminate financial toxicity. The first thing patients and families need to know is that this is a big struggle for many people, and there should be no shame in asking for help with the affordability of care. Many case managers and social workers have access to either institutional- or hospital-level grants, or to regional nonprofit organizations that can also help defray the cost of care. Financial navigation is important, [like] helping patients think about coordinating their care so they’re not adding additional appointments or coming back and forth from the hospital many times, which can obviously cut into the ability to work and get paid for that work. I really encourage patients and families to ask, to first say, “Is there someone I can talk to about affording cancer treatment?” and to not feel shame. Unfortunately, many people don’t ask for help until they’re in crisis, at which point the bills are astronomically high, and the solution or the fix for those high costs is much more difficult to find.

How can national committees/organizations optimize breast cancer care?

We have several cancer cooperative groups across the country that focus on launching new and important clinical trials, as well as propagating the gold standard, or the highest level of care. When we think about coordinating multidisciplinary breast cancer care, our societies are working on guideline development, making sure that new data or evidence is incorporated into guidelines and disseminated broadly across the country, and making sure that we continue to get patient-reported outcomes as it relates to the new therapies we’re testing.

What are the next steps toward optimizing patient-centered care for patients with cancer?

We’re going to be working a lot on leveraging media and social media to help patients get the information they need in an accurate way. There’s a lot of promise with machine learning and [artificial intelligence], as well as with really connecting women to other women. There’s no more powerful support than women who have been through breast cancer treatment. As organizations grow nationwide, with the benefit of being able to do so much of this virtually, patients can have a real support system at their fingertips, without having to travel or be part of an urban or tertiary care setting.

What else would you like to highlight?

The biggest challenge with being a [patient with] cancer is often the burden of care. Everybody hears they have cancer, and their first goal is to get through their cancer treatment and to survive, but once the diagnosis has settled in and once treatment has been undergone or completed, patients realize they deserve to thrive after a cancer diagnosis. Making sure we’re reducing not only the [adverse] effects of the therapies we give, the surgeries we perform, but also making sure we keep patients whole, financially, psychologically, and emotionally, is critical to us. We’re studying how to make sure women know what they’re facing, that they’re making informed decisions, and that the collateral damage or [adverse] effects of those treatment decisions don’t leave them worse off than they were prior to their cancer diagnosis.