Whole-person cancer care: 4 strategies for employers and payers

For the more than 18 million American cancer survivors — a designation that starts at diagnosis and lasts for life — the end of treatment marks the start of a different phase: follow-up appointments, ongoing monitoring, managing side effects and the challenge of learning to live with uncertainty.¹

The good news is that there are more people surviving cancer than ever before. Improvements in cancer screening, targeted therapies and immunotherapy are allowing people to live longer and better following a cancer diagnosis. The 5-year survival rate for all cancers has now reached 70% — up from 50% in the mid-1970s.²  

For employers and payers, that means members are spending more years on health plans and generating complex costs that go beyond the initial treatment episode. 

This is why instead of being seen as an acute event that concludes with treatment, cancer is increasingly being seen as a chronic condition — one that calls for the same wraparound, long-term care used for diseases like diabetes or heart disease to help keep survivors healthy, comfortable and ready for whatever lies ahead.   

Newer cancer treatments like cell and gene therapies, targeted therapies and personalized vaccines are improving survival and outcomes for patients with previously fatal cancers. The 5-year survival gains in many cases are dramatic: Myeloma survival has jumped from 32% to 62%, liver cancer from 7% to 22% and lung cancer from 15% to 28% over the past 30 years.³ 

But many cancer survivors may not return to their pre-cancer normal — at least not right away. Going through cancer treatment can have ongoing impacts such as:⁴  

• Bone loss 
• Cognitive changes 
• Fatigue 
• Fear of recurrence 
• Fertility issues  
• Financial stress 
• Neuropathy  

Returning to and remaining in the workplace can be challenging for cancer survivors. As a result, they are more likely to miss work, reduce their working hours or report more limitations.⁵

But keeping employees with cancer engaged in the workforce is highly beneficial. Sustained employment during and after cancer treatment is connected to better physical, financial and emotional outcomes for survivors.⁶ For employers, it also means preserving employee knowledge and helping to protect against short-term disability and lost productivity costs. 

The number of people diagnosed with cancer is climbing due to an older population and rising incidence rates in six of the 10 most common cancers — breast, prostate, endometrial, pancreatic, kidney and melanoma.⁷ By 2050, cancer costs are projected to surge by 67% per capita due to population aging alone.⁸ 

As a result, cancer remains the top cost driver for employers for the fourth year in a row,⁹ and 57% of payers say cancer is the most expensive and fastest-growing diagnosis.¹⁰    

Integrated cancer care — the kind that treats cancer as a chronic condition requiring coordinated physical, behavioral and lifestyle management — is not just better for cancer patients and survivors, it’s also a win for employers and payers. 

The following strategies can help employers and payers unlock the key benefits of this approach.  

1. Integrate behavioral health from day one 

Cancer touches every aspect of a patient’s life, from personal and work relationships to physical, mental and financial health. The impact on cancer survivors’ mental health alone is serious — between 30% and 35% of cancer patients experience anxiety, depression or another psychiatric disorder at some point following a cancer diagnosis.¹¹  

Many cancer patients and survivors also struggle with their finances due to lost income and the expense of treatment and follow-up care. A survey of cancer survivors found that the number who said they were unable to make ends meet increased from 2% before their cancer diagnosis to 13% more than 5 years after their diagnosis.¹²

The good news is that behavioral and social interventions work. When cancer survivors receive psychological support and treatment such as cognitive behavioral therapy or behavioral activation, they see significant improvements in depression and anxiety. This can lead to downstream improvements such as better adherence to treatment plans and lower costs of care.¹³  

Programs such as the Optum Cancer Support Program take this integrated cancer care approach. It pairs members with experts like oncology-trained nurse case managers and social workers to help them navigate care, address symptoms, pain, anxiety and financial concerns, through treatment and beyond.    

What employers and payers can do: 

• Address financial strain by providing financial counseling and connecting members and employees to assistance programs. 
• Consider removing cost barriers such as copays for behavioral health during the entire cancer care journey. 
• Leverage employee assistance programs (EAPs), which may provide access to mental health therapy, financial guidance, caregiver support and more for employees and their family members.  
• Offer digital tools alongside in-person care to increase access. That might include telehealth or virtual care options or tools to help members schedule and track their appointments. 

2. Select programs with longitudinal monitoring 

Late effects from cancer treatment can show up months or even years after treatment.¹⁴ Fatigue or neuropathy might be slow to recover or persist over time. That's why it’s important to offer programs or collaborate with partners who can provide regular outreach as members transition through their care. 

Proactive and automated monitoring can flag signals — missed or delayed pharmacy refills, missed appointments, spikes in emergency visits or inpatient claims — that might suggest nonadherence or worsening symptoms. 

What employers and payers can do: 

They can offer programs and work with partners that provide features such as predictive modeling. Predictive modeling stratifies cancer survivors by risk and alerts providers to potential member risks such as:

• Medication nonadherence
• Symptom escalation
• Mental health decline

3. Address lifestyle and wellness needs 

Recovering from cancer isn’t just about managing side effects; it’s about rebuilding health. Nutrition, physical activity, stress management and social connection all influence recovery and reduce recurrence risk.¹⁵ 

Employers can provide wellness programs that offer specific benefits for cancer survivors. Payers can fund or subsidize programs like fitness/rehabilitation, nutrition counseling and stress reduction to meet the unique needs of cancer survivors.  

What employers and payers can do: 

• Integrate social connection and peer support. Support groups (in-person or digital) reduce isolation and improve treatment adherence.¹⁶ The Optum EAP solution connects members to peer support groups to manage conditions such as cancer.  
• Use behavioral health tools such as digital coaching and habit-tracking apps to support lifestyle change.  

4. Improving access to care 

The outcomes and impacts of cancer are not the same for all populations. Native Americans, for one, have the highest cancer mortality rate of any group — 2 times higher than white cancer patients.¹⁷ And cancer survivors from lower-income households are more likely to have financial debt.¹⁸ 

Language barriers, transportation challenges and mistrust of healthcare systems can all prevent survivors from engaging with care. These disparities don’t disappear after treatment ends. 

What employers and payers can do: 

• Integrate social risk screening into all survivor pathways. Research shows that social risk factors such as financial strain and housing insecurity negatively impact medication adherence and other health outcomes.¹⁹ 
• Offer culturally responsive coaching and support. 
• Provide materials in multiple languages and at accessible reading levels.   

Cancer treatment ends, but life after cancer often isn’t the same. Cancer survivors face challenges in rebuilding their mental, physical and financial health.  

The upsides to treating cancer care collaboratively and as an ongoing condition are very real. Coordinated care that includes behavioral and mental health can improve a survivor’s anxiety, depression, function and quality of life.²⁰

The gap between what cancer survivors need and what systems provide is one that employers and payers can help close. It starts by recognizing that cancer care requires coordination, behavioral health integration, long-term monitoring and lifestyle support to manage it as the chronic condition it actually is. 

Optum oncology and behavioral health solutions for payers and employers are designed to help close the gap — coordinating care across treatment, recovery and long-term wellness.