Cancer in the Workplace

As the number of cancer survivors grows, the disease has emerged as a greater concern for companies anxious to meet the needs of employees and their families while still operating their businesses in an efficient and cost-effective manner. Business leaders, though, say there is a paucity of resources for executives to tap when designing programs for the delivery of cancer-associated treatment, prevention, and support services in the workplace. As a result, the National Business Group on Health (NBGH), a nonprofit organization that represents Fortune 500 companies and large public-sector employers, is joining with the National Comprehensive Cancer Network (NCCN) to help companies craft solutions.

The stakes for companies and their employees are high, officials from the 2 groups said in announcing the initiative in December. Cancer is the second-leading cause of long-term disability and the sixth-leading cause of short-term disability in the United States. And, while cancer has an enormous physical and emotional impact on patients, family, and friends, the economic impact in the workplace also is quite significant. Although cancer patients represent only 1.6% of the commercially insured, they account for 10% of employers' medical claims costs, according to Helen Darling, president and chief executive officer of the NBGH. Employers' annual costs in lost productivity are estimated at $136 billion.

These realities, coupled with an aging workforce and a trend toward later retirement, underscore the need for benefits professionals, corporate medical directors, and human resource executives to gain a better understanding of cancer treatment and prevention programs available for employees. With the proper knowledge and training, Darling believes corporate benefits managers will start to implement their own company programs and policies aimed at supporting employees dealing with cancer whether as patients or as caregivers.

The NBGH-NCCN collaboration, a 3-year initiative, seeks to address these issues, as well as to reign in lost productivity dollars and to eliminate the fragmentation that exists in cancer care. The plan is to create a series of comprehensive resources and tools for large employers, including an Employer's Guide to Cancer Treatment and Prevention. The guide will be based on the NCCN Clinical Practice Guidelines in Oncology, and will place a strong emphasis on an integrated approach to care.

The alliance also will establish a 25-member National Advisory Committee on Employer Services for the Cancer Continuum of Care. According to NCCN's CEO William McGivney, PhD, the committee will include benefits managers and corporate medical directors from large employers, as well as human resources benefits managers, medical directors from managed care companies, and several leading oncologists. "We want to get the perspective of academic oncologists as well as that of community oncologists," says McGivney, adding that representation is also likely to include patient advocacy groups and pharmacy benefits management companies.

Corporate Concerns Evolving

Although the initiative marks a step by business leaders to tackle cancer in the workplace, concerns about the disease's impact in employment settings are not entirely new. In 2001, President George H.W. Bush challenged corporate leaders to "do something bold and venturesome about cancer within your own corporate families."

The result was the formation of the CEO Roundtable on Cancer. The group, based in Cary, North Carolina, has created a voluntary accreditation for companies that meet its cancer-care standards under what it calls the "Five Pillars." The pillars are lifestyle changes in tobacco use, diet and nutrition, and physical activity in order to reduce the risks of getting cancer; prevention, screening, and early detection programs; and access to quality treatment and clinical trials. As of 2009, approximately 45 companies achieved the group's Gold Standard designation, affecting more than 1 million people.

Dell, the computer and technology giant, is among the latest companies to achieve the Gold Standard. The company has had a comprehensive wellness program since 2004, with dramatic results, according to a company spokesman.

"Dell team members have become more physically active, improved their nutrition habits, reduced their cholesterol, and the number of team members using tobacco has decreased from 11% in 2005 to less than 6% in 2010," the spokesman said in an email. "Team members have attended on-site screening events (ie, skin cancer, on-site mammography screenings) and, if necessary, [were] referred to specialists for follow-up cancer treatment. Participants have attended Webinars on cancer prevention and early detection, and shared information on risks and symptoms with family members who sought out treatment. Access to Dell's online health portal has provided information on how participants can learn about clinical trials."

Leveling the Playing Field

In the NBGH-NCCN collaboration, closing gaps in employees' access to care also is an important goal. "There's a lot of waste and many inefficiencies in the system," says Darling.

For large, global employers that frequently experience growth in parts of the country that may not have nearly facilities offering high-quality care, the key issue is whether it makes more sense for an employee to travel out of the community to obtain the appropriate diagnosis and treatment, or to create the infrastructure and facilities within the community that provide these services.

"What we're trying to say is that there should be some aggregation of expertise and regionalization, the right kind of referral networks, and the right information so people know they really should be seeking care at [facilities] that specialize in their particular condition," Darling says, "and that, ideally, they have access to the right kind of diagnosticians early on so they will be channeled to the right places."

McGivney stresses the importance of enhancing the expertise of both academic as well as community physicians. While there will always be a need for what the NCCN refers to as "centers of excellence" programs, many centers are already working at capacity as the demand for care continues to grow due, in part, to an aging population and the evolution of some types of cancer to chronic, not fatal, conditions.

Physicians and Technology: Potential Roles

Although cancer patients often do make the decision to travel to centers of excellence to receive the best quality care, they eventually return to their communities. Follow-up care then falls to the community oncologist and local care teams. An open exchange of information, including the use of telehealth and telemedicine to monitor and transmit lab results, treatment plans, etc, is imperative.

"We want the right balance of information and access at every point in the care continuum," says Darling, referring to the development of a learning healthcare system. "We want a constant flow of information, not only to clinicians in practice around the country but also back from clinicians in practice for the purpose of conducting analysis and research." In this way, she says, "we can all be constantly learning."

A key issue, says McGivney, is that a growing number of community physicians view science as moving too fast. Physicians, who once treated 8 to 10 different types of tumors, are now having trouble keeping up. Biomarkers, says McGivney, are an indication of just how quickly science is progressing , but they're also a key to providing more effective care. They can be used to predict and identify patient subpopulations where specific therapies are most effective means that we can target treatment to patients who will benefit most and, at the same time, reduce poor outcomes in populations that won't respond to that specific treatment.

Darling notes that physicians play a key role in developing and sharing information on education and prevention programs. For example, corporations increasingly have their own on-site medical centers where physicians have been leaders in developing worksite programs. In addition, physicians continue to be directly involved on a national level, developing programs for organizations including Centers for Disease Control, the National Cancer Institute, and the Agency for Healthcare Research and Quality. "There's a lot going on in big companies, and it's usually a physician who has been the leader in making some of the more creative things happen," Darling says.

Looking Ahead

The urgency of improving cancer care will only grow, officials from both groups say. "People used to die of other things before developing cancer," Darling says. "Now, we're surviving those other diseases, meaning there's a greater probability that all of us will, in one way or another, be touched by cancer." Employers, she says, want to pay for care that makes a difference in people's lives. "But we're quite far from that in the United States, and not just in cancer care."

McGivney believes that the NBGH-NCCN effort, which brings together purchasers and providers, is a step in the right direction. "What we're going to try to do is bring the best to bear in terms of working together. I think a distinct advantage will be the very close, long-term collaboration between those who face issues every day in the clinic and those who face issues every day in their offices in terms of trying to provide the best available care and benefits to their employees." ____________________________________________

Ed Rabinowitz is a veteran healthcare journalist based in Upper Mount Bethel Township, Pennsylvania.

Published in Oncology & Biotech News; January 2011.