Can we reduce the financial burden of cancer?

Cancer is expensive. Cancer rehabilitation can reduce the financial burden by enabling patients return to work faster and in better condition.

Costs of cancer

The Irish Cancer Society recently published a report called ‘The Real Cost of Cancer’ which was based on survey research conducted by Millward Brown. The report details a significant rise in health-related expenditure after a cancer diagnosis, while income drops in many situations due to inability to continue in employment.

The research found that the average additional cost following a cancer diagnosis is €862 per month, with some people facing costs of up to €1,200 per month. These additional costs coincide with a loss of income in many cases. The average drop in income after a cancer diagnosis was €1,400 per month, or €16,750 per year. A quarter of working patients reduce their hours at work while a third give up work completely. Undoubtedly, this loss of income compounds the financial pressures associated with increasing costs after a cancer diagnosis.

Return to work rates after cancer

It is clear from the literature that cancer causes significant physical and psychological impairment and disability in many survivors. In many cases these issues prevent the person from returning to work, thus adding to the financial strain of a cancer diagnosis.

The National Cancer Registry of Ireland (NCRI) analysed work patterns in Irish survivors of head & neck cancer. They found that 77% reported taking time off work following their cancer diagnosis, with 59% of these reporting that they had since returned to work. The average amount of time taken off work was 9 months. While 59% of individuals returned to work within 6 months of diagnosis, 26% took 6 to 12 months, and 15% of individuals who returned to work did so after more than 12 months. Of those who participated in the workforce following head and neck cancer diagnosis, 52% reported reduced working hours – 33% reported reducing their hours due to cancer, with a further 14% reducing working hours because of treatment side effects.

A survey of 3,348 Irish prostate cancer survivors was performed by the NCRI and found that 75% of respondents reported at least one ‘current’ physical symptom, with 29% reporting at least three. Impotence, incontinence, hot flashes, breast changes and fatigue were the most frequently reported physical symptoms. The study clearly illustrates the high symptom burden among Irish prostate cancer survivors. Many of these symptoms impact directly or indirectly on return to full time employment. All of these symptoms are amenable to interdisciplinary rehabilitation.

What can be done to help reduce the financial burden of a cancer diagnosis?

Cancer rehabilitation plays a really important role in helping patients manage the consequences of cancer and the treatment of cancer and thereby can assist the patient to return to work. Cancer rehabilitation is defined as “medical care that should be integrated throughout the oncology care continuum and delivered by trained rehabilitation professionals who have it within their scope of practice to diagnose and treat patients’ physical, psychological and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population.”

It has been noted that cancer patients are 1.4 times more likely to be unemployed than the healthy population. It is known that multidisciplinary interventions can enhance return to work rates of people living with and beyond cancer.

There is an opportunity, however, to intervene sooner than at the time of therapy completion. This can ensure the best possible outcome for the patient, both physically and psychologically. Prehabilitation is “a process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment and includes physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.” Intervention with prehabilitation prior to cancer therapy can reduce longer term physical and psychological impairments that contribute to work absence in cancer survivors.

This optimisation of function will lead to the best chance of someone living with or beyond cancer returning to work – an outcome that has significant positive effects on the patient, their family and society. We know that having cancer is expensive – now it’s time to ensure comprehensive services are available to reduce costs associated with inability to return to work.

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