Getting a cancer diagnosis can be devastating for patients, their families, and loved ones—triggering emotions such as anxiety, stress, and depression, which has an impact on people’s personal and professional lives.
Mental health treatment in tandem with oncology treatment can actually help improve cancer survival. One study looked at 50,000 veterans treated for lung cancer and found that those who received mental health treatment lived longer than those who didn’t participate in such programs. Treating mental health in oncology patients can also result in cost savings. According to data from the Evernorth Research Institute, oncology patients who do not get behavioral outpatient treatment are 2x more likely to have avoidable emergency room visits, averaging plan sponsors anywhere from $173 to $243 per member, per year higher than those who do seek outpatient behavioral care. Furthermore, coupling behavioral health treatment for cancer patients with antidepressant adherence could yield $5,273 per member per year inpatient-related savings for plan sponsors.
To better understand the impact that cancer can have on a patient’s mental health, we sat down with Dr. Rodgers Wilson, a national medical executive for behavioral health at Evernorth, who walked us through how behavioral health conditions in cancer patients differ from those without cancer, and why a specialized approach to both diagnosis and treatment is a must.
How prevalent are behavioral health conditions in cancer patients?
Numerous studies have examined the short- and long-term impact of a cancer diagnosis on mental health. The Journal of the American Medical Association for Oncology suggests that the risk of a psychiatric comorbidity can become heightened nearly a year before an official cancer diagnosis due to clinical work-ups, not knowing, and physical ailments.
Being diagnosed and actually living with cancer can also cause significant psychological stress. While stress is an expected part of getting a cancer diagnosis, if it is left untreated it could affect people’s ability to cope with their treatment and diagnosis, impact their health decisions and overall health and well-being. We also see stress in cancer patients that relates to the financial burden of their diagnosis. Research estimates that nearly one-third of cancer patients struggle with mental health-related issues such as depression, anxiety, and substance use disorder.
What are the risks if people with cancer don’t get help for their behavioral health?
Cancer patients may experience distress that can result in depression, anxiety, and substance use. Some may even experience post-traumatic stress disorder. The behavioral health impact can be acute or long-term along with physical symptoms such as fatigue, chronic pain, physical limitations and physical dysfunctions. Research also confirms a relationship between chronic stress and cancer progression. In patients who have cancer, stress has been linked to tumor growth, and a weakened immune system, which weakens even more during cancer treatment.
To help address the psychological impact of cancer, Evernorth has incorporated distress screening within its oncology case management program. We believe that actively addressing problems of distress will help in reducing physical and emotional suffering, improving the quality of life, treatment adherence, and, ultimately, health outcomes.
What does the mental health assessment of a cancer patient look like? Is it different from people without cancer?
A behavioral health assessment for a cancer patient must consider:
- Stress, trauma and distress
- Individual coping strengths
- Resources, social and family/caregiver support
- The patient’s life cycle phase
- Medical and psychosocial illness
- Resilience and posttraumatic growth
- Loss and grief
- Spiritual dimensions of the patient’s cancer care experience
It is also important to remember that the financial, vocational and social impacts of cancer and its treatment often profoundly affect patients and their family members. It’s believed that routine, early post-diagnosis patient distress screening and a multidisciplinary supportive oncology team’s clinical assessment are critical to high quality oncology care. Evernorth’s Oncology Nurse Case Management program is an integral component of our broader oncology solution. This program supports patients throughout their cancer experience to reduce avoidable hospitalizations and emergency room visits stemming from treatment complications and inadequate support.
Do behavioral specialists and providers need specialized training for working with patients with cancer?
There are programs that provide special expertise in the treatment of cancer patients in medicine and psychology. Therapists require expertise in treating an array of patients from cancer survivors, as well as those in palliative care and those facing end of life.
For our part, Evernorth is creating an oncology-specific behavioral health provider network powered by our collaborative relationship with the American Psychosocial Oncology Society (APOS), an organization dedicated to researching and treating the psychosocial aspects of cancer. Over 250,000 Evernorth behavioral health providers now have the opportunity to obtain our oncology specialty designation via APOS’s new Oncology Virtual Academy.
Providers who complete the on-demand, 30-hour course will receive an oncology specialty designation within the Evernorth behavioral health network. This designation for behavioral health providers will improve our ability to connect cancer patients to specialists who have the expertise and experience to help them achieve whole-person health and wellness.
What is the role of employers in supporting employees with a cancer diagnosis and mental health issues?
Employers need to understand the physical and the emotional impact of cancer and the possible impact on job functioning, and absenteeism. Having progressive sick leave, medical leave support, and strong benefits are important to reduce the social impact of cancer. Employers must also proactively educate their employees (or covered beneficiaries) on behavioral health benefits that are available to them and the role of EAP services.