National Comprehensive Cancer Network

About NCCN

An Update on NCCN/NBGH Initiative to Develop Evidence-Based Cancer Treatment Recommendations

Elizabeth Danielson, MHA, Director, Payor & Employer Initiatives

For the past 18 months, the National Comprehensive Cancer Network® (NCCN®) has worked with the National Business Group on Health (NBGH) to develop An Employer's Guide to Cancer Treatment & Prevention.  The Guide addresses issues related to cancer across the continuum of care, including prevention and wellness; medical, pharmacy and behavioral health benefits; employee assistance programs (EAPs); and disability and family medical leave. Recommendations are supported by evidence and knowledge from a wide range of experts so that employers using the Guide can be confident that benefit dollars are invested wisely and meet the needs of employees and their dependents.

In 2011, NCCN and NBGH focused on medical, pharmacy, and behavioral health issues. This year, the focus has moved to absence-related benefits such as short-term disability (STD), family medical leave (FML) and caregiver needs, and EAP capabilities.

Patient Decisions

For employed individuals, the role of work is likely to change following a cancer diagnosis. Work may become less important as their priorities shift to making treatment decisions, undergoing treatment, and dealing with the physical and emotional impact of having a life-threatening illness. Yet, for many, employment remains significant for several reasons, including its importance as the source of income, health insurance, and other benefits. Beyond these practical reasons, work can be an important source of meaning, sense of self, and social support. Remaining at work during treatment, or returning to work as soon as possible after treatment, can provide an important sense that a patient is still the same person, albeit one who happens to have cancer.

Some people want or need to take off a lengthy period of time to receive treatment and recover fully, while some need or choose to quit working or retire. Others will continue working as much as possible or take only a short disability leave. Fortunately, many employers are willing to offer reasonable workplace accommodations such as modifying hours, responsibilities or the workplace environment, or allowing employees to work from home. Of course, options vary by employer and the type of work the person does.

Physician Responsibilities

Treating physicians, nurses, and cancer center staff have an important role in relation to cancer treatment and work. It is important for the treating physician to understand the individual's job duties well enough so that the physician and patient can decide on a reasonable plan. By working together, the team is able to consider several treatment options, including establishing a flexible treatment schedule around a person's work schedule and recognizing the amount of time that a particular patient—with a specific profile—actually requires to take off from work following surgery. In addition to clinical considerations, the physician's recommendation should take into account the patient's preferences about taking disability leave and the employer's willingness to make workplace accommodations.

Physicians, nurses, and others should also be cognizant of the emotional impact of cancer and ensure that patients who are experiencing depression or anxiety are diagnosed and receive timely treatment. Comorbid depression is prevalent among those being treated for cancer. Failure to diagnosis and treat depression can result in unnecessary suffering, poorer compliance with treatment, slower recovery, and higher overall treatment costs. Many employers offer an EAP that can help individuals find a behavioral health provider and receive appropriate treatment.

STD, FML and EAP recommendations can be found in sections 4-6 of An Employer's Guide to Cancer Treatment and Prevention: Tool 2: Plan Design & Assessment Tool.

The collaboration between NCCN and the NBGH represents an opportunity to have a powerful impact. This project raises the bar on employer-sponsored benefits, makes a tangible difference for people with cancer and their families, and increases the value of benefit expenditures for employers.

About NBGH

The National Business Group on Health is the nation's only non-profit organization devoted exclusively to representing large employers' perspective on national health policy issues and providing practical solutions to its members' most important health care problems. The Business Group helps drive today's health agenda while promoting ideas for controlling health care costs, improving patient safety and quality of care and sharing best practices in health benefits management with senior benefits, HR professionals, and medical directors from leading corporations. Business Group members, which include 66 Fortune 100 companies, provide health coverage for more than 50 million U.S. workers, retirees and their families. For more information, visit www.businessgrouphealth.org.