FCRP Policy Statement

Socioeconomically disadvantaged cancer patients face many barriers in trying to access and obtain care. Medicaid patients, the uninsured, those in rural areas, and other high-risk vulnerable populations bear the burden of this excess mortality and morbidity. Therefore, as part of a larger project, the Supportive Cancer Care Intervention Study at Michigan State University examined the problems these higher-risk groups faced in obtaining cancer care services. Three main themes were identified: 1) insensitivity of providers, 2) lack of knowledge and support, and 3) financial concerns.

Insensitivity of Providers. Participants voiced concerns over provider's insensitivity in informing patients about their cancer diagnosis. Many felt physicians were not supportive and did not give follow-up information or guidance on where to go or who to call for information about the patients' future needs. Comments made reflected a "coldness" of doctors who delivered a cancer diagnosis to the patient "over the phone." The critical point for patients that determines follow-up care and accountability is when patients learn of their cancer diagnosis and options for treatment.

Lack of Information and Support. Patients had to spend large amounts of their time to obtain their own information on cancer and treatment. Patients found it difficult to enlist support from some non-cancer health care providers in obtaining information on disease processes and treatment. Patients' concerns centered on employment issues. Those who continued to work felt abandoned by their co-workers, who treated them as if the cancer was contagious. Twenty-one percent of the patients remained employed during treatment and were surprised by how others treated them. Other patients reported resigning from their positions and taking lower-paying jobs or being forced to quit altogether because of issues arising in the workplace that may have been related to cancer-treatment demands.

Financial Concerns. Although the majority of participants (84 percent) currently had insurance, more than 40 percent of those had problems with costs of treatment. Only parts of the treatment costs were covered by their current insurance, leaving them to pay the remainder of their pockets. Choice of treatment was not decided by insurance but by the physician providing the treatment

Policy Implications

• Support the ability of cancer patients to receive informed care from providers best suited to meet their needs and not dictated by insurance mandates.
• Support and development of legislation that prevents employers from forcing employees to take pay cuts and job demotions during the course of treatment for their cancer and educate people in the work environment.
• Emphasize continuing medical education for surgeons and oncologists regarding how to explain diagnostic and treatment modalities to cancer patients.
• The development of information resources accessible to all cancer patients; regardless of socioeconomic status.

Source: "Supportive Cancer Care Intervention, Intervention Patients, Focus Groups, Patient Surveys," Report to Participating Agencies, October 1, 1996 through September 30, 1997. Project leaders: C.W. Given, Ph. D., Department of Family Practice, College of Human Medicine, Michigan State University and E.J. Siegl, RN, OCN, MA, College of Nursing, Michigan State University.