Disease & Genomics

Holistic Approaches for Employees Coping with Cancer

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 said. "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 said. Supporting employees diagnosed with cancer involves much more than treating a disease. Cancer affects family, finances, faith and myriad of other facets of life as individuals struggle to cope with a new reality.

Creating a holistic plan to address psychological, spiritual and wellness needs can create a positive environment in which employees can fight their cancer, ultimately improving both their personal health outcome and their contribution at work. "Life threatening disease affects the productivity of workers, and cancer tops the list," said Brenna Shebel, vice president of the National Business Group on Health, a Washington, D.C.-based non-profit focused on the 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, alone, companies lost $33.6 billion in productivity from full-time empAs 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, said Shebel loyees who served as caregivers to cancer patients. Not surprisingly, then, cancer is considered the leading cause of long-term disability.

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 and heart rates and raise blood sugar levels.

Chronic stress can compromise immunity, trouble digestion, and increase fertility problems. Sleep disruption, headaches, depression and anxiety are additional concerns. Experimental studies have shown psychological stress can affect a tumor's ability to grow and spread in the body. In another study, breast cancer patients who received beta blockers to inhibit stress hormones had a better chance of surviving without relapse.

Generally speaking, those who suffer from a sense of helplessness or hopelessness experience higher death rates; although cancer is not necessarily the culprit. So what tools do employees with cancer need? Shebel suggested that companies take a holistic approach. She helped develop NGBH's Cancer Continuum of Care guide, a toolbox for employers provided 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 said.

Health and Wellness

Companies have long instituted health and wellness programs as a measure to prevent cancer and chronic disease, but supporting the physical fitness and nutrition needs of these patients is important as well. At Provision Health and Wellness, in Knoxville, Tenn., 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 said. "When they're mentally stronger, they're better able to fight." Studies show that starting or continuing an exercise regimen after a cancer diagnosis produces mentally and physically stronger patients.

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 and improved flexibility and function at the disease site, said Bullock. Similarly, 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. Additionally, 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 their 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, and improve 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 to create a wellness plan to complement traditional medical treatments."We see the health coaches as playing a huge role in this," said Shebel.

Social and Spiritual Support

Another resource for employees in the cancer battle is existing employee assistance programs. An EAP can help employees work out their need for time away or help to craft a flexible work schedule or serve as a liason with the disability department. "That has actually been shown to reduce leave duration and expedite the return back to work," said Shebel. "When things are better coordinated, you're really setting the employee up for success."

EAPs 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 said. "The EAP is really supposed to function in that support system."

Employers should be mindful of workers' 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 spiritual services to businesses and physicians' offices.

"It's good to have somebody to come in from the outside," she said. "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 arrives on-site, employees get that emotional, human connection."

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

Second Look at Healthcare

Employers should also examine their traditional healthcare plans with cancer patients in mind, Shebel suggested, especially considering the high deductibles now common with private plans. "It's no secret how expensive cancer treatment is," she said. One solution is for companies to adjust out-of-pocket thresholds to a monthly limit instead of annually, which can help cancer patients control expenses and alleviate the stress of enormous medical bills.

Alternatively 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, self-funded companies 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," said Shebel. "Many of the things we recommend for health and wellness employers are already in place. We are starting to see employers take the next step to support employees who have cancer.

About the Author

Larissa Brass is a social media and content coordinator with Provision Healthcare, an integrated, world-class outpatient cancer and wellness center featuring the Provision Center for Proton Therapy, which offers comprehensive diagnostic imaging services, traditional radiation therapy, a health and wellness center, a physical therapy center and clinical trials through the campus's biomedical research program.

The Provision Center for Proton Therapy is the first cancer treatment facility of its kind in Tennessee and only the second in the southeastern United States. Open to all credentialed physicians and health systems in the region, the center has three treatment rooms and is capable of treating up to 900 cancer patients annually. As one of 15 proton therapy centers in the nation and among 46 in world, the center has brought to Knoxville an advanced cancer treatment capability available in only a handful of cities.

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