Supporting Patients Through Employment Disruptions During Cancer With Michael Halpern, MD, PhD, MPH

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here at the ASCO Annual Meeting, and I'm joined by Dr. Michael Halpern. Thanks so much for coming on today.

Michael Halpern, MD: Thank you for inviting me.

Oncology Data Advisor: Would you like to introduce yourself and share what your work and your research focus on?

Dr. Halpern: Sure, my name is Michael Halpern. I'm a Medical Officer at the National Cancer Institute (NCI) in the Healthcare Delivery Research Program, which is part of the Division of Cancer Control and Population Sciences. My work broadly is looking at cancer care delivery, specifically treatment patterns, access to care, quality of care, costs, and patient outcomes.

Oncology Data Advisor: You have a study here on the associations of employment disruptions and financial hardship among individuals diagnosed with cancer in the US. For background, what are some of the unique financial hardships experienced by people with cancer?

Dr. Halpern: It's well known that for individuals who are diagnosed with cancer, and in some cases their families, financial hardship can be really devastating. The financial hardship is generally classified in three different categories. There's material financial hardship, which is having to avoid or delay expenses, going on vacation, buying a new home, buying a car, or other material aspects, as the name suggests. There's behavioral financial hardship, which is where the cost associated with cancer and cancer care delays someone from getting needed care—not going to the doctor, not getting drugs refilled, or not getting tests needed because of the cost. Then there's psychological financial hardship, sometimes called financial distress, where people worry about the cost and are anxious about whether they're going to be able to pay bills.

Oncology Data Advisor: Why did you decide to investigate the effects of employment disruptions associated with this?

Dr. Halpern: There's been a lot of research on what financial hardship is and how frequently it occurs. Unfortunately, it occurs very frequently, but there's been much less on what we can do about it. It's really time to stop researching just whether financial hardship exists—we know it exists—and it's time to really think about what we can do and what interventions are possible to help individuals either prevent financial hardship or deal with it once it has occurred.

One of the things that my colleagues and I are particularly interested in is employment. We also know that many individuals who are diagnosed with cancer have disruptions to their employment. They might need to retire early. They might need to switch to a different job or a part-time job. They may have trouble working. We were interested in how that then relates to financial hardship and whether there are ways to potentially help individuals stay employed, which would then decrease financial hardship.

Oncology Data Advisor: How did you go about designing and conducting this study, and what were your goals for it?

Dr. Halpern: There's a national survey that's free and publicly available, and anyone can access it. It's called the MEPS, the Medical Expenditure Panel Survey. In the past, NCI had a supplement to the MEPS called the Cancer Self-Administered Questionnaire, or CSAQ, which collects information from individuals diagnosed with cancer, who were age 18 and older, who completed the main MEP survey. This cancer supplement collects very detailed information about how cancer affected their lives in terms of cost, in terms of financial hardship, in terms of abilities to work, and in terms of quality of life. We used the data from this survey to look at both employment disruptions and then different kinds of financial hardships and the number of financial hardships that individuals with cancer experienced.

Oncology Data Advisor: What were the results that you found in the study?

Dr. Halpern: We found that among individuals who were diagnosed with cancer, those who had some sort of employment disruption were much more likely to experience any financial hardship, more likely to experience multiple types of financial hardship, and more likely to experience some of the subsets of financial hardship. I talked about material, behavioral, and psychological financial hardship. It isn't all the same, as I said; there are different kinds of financial hardships, and some of them are more related to having employment disruptions than are others. But overall, those who had an employment disruption were more likely to experience any kind of financial hardship.

Oncology Data Advisor: Do you have any future directions for the study?

Dr. Halpern: We hope that it will serve as a guidepost, if you will, to help researchers look at more ways to interact with individuals diagnosed with cancer, help them prepare for how cancer might affect their job, and work with employers. There's a lot that employers can do to help individuals after they're diagnosed with cancer, to make sure that they can continue to do their jobs to the extent that they're able. What we'd like is for this study to serve as the basis for future research to develop interventions and programs that will help employment among individuals with cancer.

Oncology Data Advisor: What are some of the types of support or resources that employers can provide for their employees who have cancer?

Dr. Halpern: Yes, this is a great question. Once an individual discusses with an employer that they've been diagnosed with cancer, the first thing that is really important is that an employer shouldn't then be afraid of talking about it. Many employers seem to be worried about violating privacy. But once someone has said, "I have this diagnosis," it's kind of an invitation to help them, to say, "Well, I'm really sorry to hear that. As your employer, what can we do to help? Are there ways we can change your job to make you more able to do it? Are there accommodations? Are there things that we can do at the work site to help you more?" The big increase in teleworking and being able to work at home, I think, has been tremendously beneficial to individuals with cancer. I hope that employers are going to be willing to continue that, particularly for individuals who have been diagnosed with cancer. There's a lot that employers can do.

Oncology Data Advisor: Definitely. One last question I'll ask you is, since the theme of ASCO this year is "Partnering with Patients," how can clinicians partner with their patients to provide support for them when they're experiencing this financial hardship?

Dr. Halpern: That's another great question. As with the employers, one of the main barriers tends to be clinicians not talking with patients about these issues, about financial hardship or cost of care. Broadly, though that's certainly gotten better, there's a specific need to discuss being able to work and how cancer and cancer treatment might affect their ability to continue working, at least in the same way that they're working now.