How Patient-First Care Helps Women With Cancer

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A growing number of women are navigating cancer care

Endless to-do lists and exhausting juggling acts: For many mothers, parenthood is emotionally and physically taxing, a 24/7 job made seemingly impossible by unrealistic expectations.¹ And when a cancer diagnosis means primary caregivers suddenly are in need of care themselves, the urgent necessity of centering one’s own needs can become another source of stress and shame.

As one study of how women manage these multiple roles put it, “mothers with cancer report guilt associated with failing to successfully balance their parental roles and cancer.”² Another study, focused on women with breast cancer, found many felt a sense of failure as mothers due to their physical and mental challenges.³

Navigating cancer challenges all patients, of course. But even putting parenting responsibilities aside, women face unique barriers to seeking and receiving cancer care. For one, they are significantly more likely to experience severe side effects of treatment compared with men.⁴ And female cancer patients are more likely to feel they have to prove their symptoms are real and less likely to be satisfied with the quality of their care, an American Cancer Society survey found.⁵

In effect, women may feel obligated to work harder to get the care they need—even as they grapple with stepping away from their normal caregiving responsibilities. (In the United States, women are far more likely to perform more work inside the home, even if they also work outside of the home.)⁶

The good news is that payers can act to improve the status quo. While there’s no quick solution to change the expectations placed on women, payers can take tangible action in one important area. They can address the often-fragmented nature of cancer care—which can lead to patient navigation challenges, delays in care, suboptimal outcomes and higher costs—by embracing a more integrated approach. Specialized, patient-first support closes gaps in care and helps women and mothers navigate treatment options and schedules, reducing stress and improving outcomes.

When it comes to improving cancer care for younger women in the U.S., the need for urgency is clear. More and more women under 50 are being diagnosed with cancer—the rate is 82% higher than for men under 50, up from 51% in 2002.⁷ The cancer burden faced by women aged 50–64 has also been ticking upward.⁸ In other words, more women in their prime care-giving years (including caring for aging parents) are suddenly finding themselves in a new role: cancer patient.

Here’s how an integrated, patient-first approach can help more women get the right cancer care at the right time and place.

Why integrated cancer care is more important than ever

The shift toward more integrated and patient-centric ways of delivering cancer care is being driven by two major trends that have challenged payers, providers, patients and employers for years.

First, a soaring number of diagnoses has led to a greater number of cancer treatments and higher total cost of care. Total cancer-related health care expenditures are projected to rise to $245 billion by 2030, a more than 30% increase compared with 2015.⁹ Cancer has become the top driver of large companies’ health care costs, surpassing musculoskeletal issues.¹⁰

At the same time, cancer care is becoming increasingly complex as research rapidly advances and new immunotherapy and targeted therapy options emerge. Life-saving breakthroughs offer new hope, but providers can struggle to keep pace in such a dynamic and ever-changing environment. Meanwhile, payers are trying to manage fast-rising costs, while helping members receive the most appropriate and effective care.

Given the growing complexity of cancer care, patients often struggle to make treatment decisions. For women juggling parenting responsibilities with new cancer patient-related needs, simply balancing a load of new appointments can be overwhelming. And the traditional treatment-focused approach to oncology care may overlook a patient’s priorities, values or concerns.

By centering women’s needs and circumstances, a patient-centric approach can make care more accessible, driving engagement and empowerment. This approach can also improve care by reducing the chances of unnecessary hospitalizations and inappropriate treatments.¹¹ Crucially, the patient-centric approach factors in a patient’s social context (health literacy, socioeconomic status) and psychological state (coping skills, personality), rather than only a patient’s biological qualities such as the characteristics of their tumor or their genetics.¹²

One key common feature of patient-centric care is health care navigators and oncology clinicians assigned to support individual patients. Case managers and clinical specialists destress the navigation process, helping patients understand diagnoses, symptom and pain management, treatment options and medication adherence. The entire idea of patient navigators, in fact, has its roots in cancer care. Cancer surgeon Harold P. Freeman created the country’s first patient navigation clinic in New York City in 1990, focused on helping breast cancer patients at Harlem Hospital. Five-year survival rates shot up from 39% to 70% after navigators, who helped patients address fears as well as insurance and transportation issues, were introduced.¹³

It’s no accident that integrated care and patient-centric care are becoming more prevalent at the same time. While distinct, both approaches are concerned with coordinating care in ways that improve the patient experience and outcomes. Taken together, they can make a huge difference in how female cancer patients—especially younger women struggling to balance parenting duties with their medical needs—experience health care systems.

What patient-centered oncology care looks like

Patient-centered oncology care looks different, depending on each patient’s needs. But a growing body of research has shown the value of 2 key things: providing patients with a special navigation support team and implementing managed care programs that offer oncology pathways to guide decision-making.

Here’s a look at how each of these components can support women in their fight against cancer:

Navigation supports

By helping women traverse an increasingly complex cancer landscape, navigation supports close gaps in care and improve patient experiences and outcomes.

Such offerings, which Optum provides through its Cancer Support Program, can also include coordinating with the patient’s treating oncologist, a specialized nurse case manager and a team of cancer experts. The high-touch, personalized experience provided by this support team has intrinsic value to patients, who can lean on the guidance of experts.

This support team can also help direct members to other specialized programs based on their needs, such as Fertility Solutions that can assist patients with fertility preservation as they undergo cancer treatment, or behavioral health support programs to help navigate stress, depression, social isolation and anxiety.

For women with work or parenting responsibilities, flexible scheduling, a focus on home care, and access to support groups can be invaluable. A support team can also directly bolster top-quality care—better pain management and treatment adherence, but also reduce unnecessary ER trips and hospitalizations.

Oncology pathways

These pathways offer unique value to providers trying to keep up with the latest clinical research. The basic idea is to support treatment decision-making by offering specific evidence-based pathways designed by oncologists and other experts.¹⁴

Grounded in clinical data, these tools help providers make optimal recommendations, given a patient’s specific cancer type, stage and clinical indication. The Optum Cancer Guidance Program also offers advanced pathways that consider not only treatment efficacy and toxicity, but also claims data detailing treatment duration, rate of hospitalization and total cost of care.¹⁵ And research points to promising outcomes.

A study of breast cancer patients in the Optum Cancer Guidance Program who adhered to treatment pathways, for example, had an 18% reduction in ER visits and hospitalization rates.

No one can battle cancer alone—and no one should feel alone as they progress from diagnosis to treatment. Thankfully, patient-centered oncology care can ensure that women reap the benefits of navigation specialists and evidence-based guidelines:

One-on-one meetings with oncology nurses
Help understanding why a certain treatment option makes sense
Support in making, and then adhering to, a treatment schedule
Direction toward specialized treatments such as fertility solutions and mental health support and counseling

Benefits of patient-first oncology care

The most obvious benefit to an integrated, patient-first approach to oncology care is happier, more satisfied patients. When providers develop personal relationships with patients, including by acknowledging and speaking to their emotions, trust in doctors and the perceived quality of care increases.¹⁶ Moreover, when patients feel that they are collaborating with providers to make decisions about their care, satisfaction goes up.¹⁷

Another benefit is improved health outcomes. Robust oncology managed care solutions provide access to second opinions at cancer Centers of Excellence (COEs) that have been clinically vetted for their ability to deliver top outcomes. COEs also can provide better coordinated care, an approach that can help keep patients healthier longer, better manage chronic conditions, and receive care that is more in line with their goals.¹⁸

Research also continues to find that fragmented cancer care is associated with higher medical expenditures.¹⁹ And although it may seem counterintuitive, a high-touch, patient-centric care model is almost always more cost-effective for payers and providers,²⁰ due to fewer ER visits and faster recovery periods, among other factors.

More time at home, faster routes back to normal life — all cancer patients want these things. But for women struggling to balance parenting, home life and careers as they move through treatment, an integrated patient-centric care model can mitigate the unique stresses, and even guilt, that can accompany cancer.