Employers have taken on a larger role in employees’ cancer care in the past few years, but the coronavirus pandemic changed the game even further, said Tim Clark, president of tc Health Consulting Inc., during Benefits Canada’s 2021 Chronic Disease at Work conference in late February.
Cancer is now the sixth most expensive disease by eligible drug cost for employers’ benefits plans, according to a 2020 Telus Health drug data trends report, which also outlined the increase was largely due to cutting-edge medications not yet covered by public plans and treatments moving from an inpatient hospital setting to outpatient clinics or patients’ homes.
Indeed, in the early stages of the pandemic, the health-care system was forced to delay appointments, tests and surgeries for patients with cancer and other chronic diseases, prompting doctors to shift their treatments from in-hospital to at-home and pushing the cost of care onto benefits plans.
While it’s important to be cognizant of the costs behind these medications and treatments, Clark noted benefits plan dollars aren’t endless. “It’s a balance. It is recognizing that coverage can’t strictly be a cost decision, but at the same time we have to be conscious of what the budgets are within benefits plans.”
According to an August 2020 survey by the Canadian Cancer Survivor Network, 23 per cent of cancer patients surveyed reported a doctor’s appointment had been delayed and nine per cent had their surgeries pushed back. Another 13 per cent said they were electing not to book appointments, while six in 10 (62 per cent) of the respondents said they were concerned about their ability to receive treatment in a timely fashion during the pandemic.
As well, six per cent of patients surveyed said their doctors had changed their treatment from an inpatient setting to at-home treatment, six per cent experienced a change in medication or dose and three per cent changed between intravenous and oral treatments. Additionally, 62 per cent of oncologists surveyed said they were seeing “moderate to severe” impact on treatment choices for patients, and 42 per cent said they were choosing more non-surgical treatment options for cancer patients, such as a prescription drug or a type of outpatient treatment — both of which would be employer-paid. One quarter (26 per cent) said they had chosen to send more patients to private infusion clinics.
Remote is now the default way to access health-care, whether you’re talking about a practitioner, a lab test, whatever needs to be done,” Clark said. “. . . Employers are going to have to be aware that this idea of remote being the default does mean some things are going to be put on the employer plate, more than they have been in the past.”
Beyond the physical location of treatment, he pointed out employers should keep in mind how health-care delays may affect employees’ well-being, whether they’re actively working or on disability. “Anybody dealing with a chronic disease is going through these same sets of issues, whether it’s delays, changes in treatment or mental-health impacts.”
And according to the CCSA survey, 30 per cent of patients expressed concern about the mental-health impacts of the pandemic, and 28 per cent of oncologists said patient mental health was one of their top three challenges going forward.
Cancer care will likely revert to something close to its pre-pandemic state, though Clark said he expected remote care will continue to be the default. Employers can best prepare for that reality by reviewing their human resources policies, benefits plan design and contract language to ensure patients have access to cancer care outside of a hospital setting if that’s what both they and their physician prefer.
The pandemic may be the perfect opportunity for employers to make changes to their benefits plans to accommodate the changing approaches to cancer care, Clark said, noting employees will understand the need to re-prioritize now if you explain the pandemic calls for a different approach, as limited dollars go toward cancer care, but it’s where people need the help right now, as opposed to in other parts of the plan that are more affordable.
“This is a time where people are expecting adaptation and change, so don’t be afraid of it. Lean into it [and] try to figure out how to do it in the best way possible.”