Member story: Advocates join forces throughout breast cancer journey

Throughout her life, Nancy Carruth’s medical history never included much more than the common cold. Twelve years ago, that all changed.

While on a trip to the Grand Canyon, Nancy, who was in her early 40s at the time, noticed a lump in her breast. “I’m too young to have breast cancer,” she thought. Unfortunately, that was the ultimate diagnosis after Nancy underwent tests upon her return home to Minnesota. So began Nancy’s long, winding journey, during which an underlying theme emerged: Someone in Nancy’s position can’t go through it alone.

Members stricken with cancer need holistic advocacy that usually starts with friends and family and extends to a team that includes specialized physicians, nurses and all the other caregivers that members connect with along the way. That support is not unique to Nancy’s journey; it is needed by each of the many thousands of patients who are newly diagnosed or are living with cancer.

The American Cancer Society estimates there will be more than 1.7 million new cancer cases in the United States in 2019.1 That’s nearly 150,000 new cases every month or — staggeringly — almost 5,000 new cases a day. Beyond the emotional impact that level of affectedness can have on an employee population, it also hits home for employers from a cost perspective. Cancer treatment accounts for 12% of employers’ total medical costs in the United States, with $125 billion spent on direct medical costs.2

While the data shows that having cancer is an unfortunate reality for many, Nancy’s story is one that rises above any set of statistics. It’s a story that demonstrates the power of holistic support and advocacy when a member needs it most. Most of all, it’s a story of survivorship.

A breast cancer journey begins

After receiving her breast cancer diagnosis, one of Nancy’s first calls was to UnitedHealthcare’s Cancer Support Program, which she had recently learned about through work. The program offers the support of experienced, specialized oncology nurses to cancer patients. As it turns out, that call — and the ongoing advocacy she received from that program and others — may have helped save Nancy’s life. 

“Typically we identify members early in their diagnosis and make outbound calls to let them know about the Cancer Support Program,” said Pam Schumacker, Sr. Director, Cancer Product at OptumHealth. “Nancy had already heard about us, so she called us.”

When Nancy first called the program, she wanted to develop a list of questions to ask her doctor about her diagnosis and its treatment. She talked to an oncology nurse named Patty Migler, a Cancer Support Case Manager, who helped her figure out what to ask. For example, Migler gave her a list of what she needed to find out: the size and grade of the tumor, whether it is estrogen or progesterone positive or negative, HER2 positive or negative status, and so on.

“I can’t tell you how important it was to have Patty coach me through this,” Nancy said. 

Migler was a source of knowledgeable, clear thinking that not only provided critical information at a tough time of Nancy’s life, but also supported her in other important ways, such as offering peace of mind, comfort and empathy. The Cancer Support Program has around 160 oncology nurses like Migler across the country, plus 4 social workers — all employees of UnitedHealth Group and all poised to help people navigate their cancer journey.

Advocacy and support guide Nancy through a challenging journey

The various advocacy and support resources Nancy engaged with are intended to guide patients through the key aspects of their journey, such as finding the right clinical expertise and treatment for their needs and helping them prepare for each step along the way. The end result is the right care at the right time that can result in a better member experience, better outcomes and lower costs.

“We are working to build an end-to-end, comprehensive platform to support our members with cancer from diagnosis, to treatment and right on through survivorship,” said Dr. Jennifer Malin, Sr. National Accounts Medical Director, Oncology and Genetics at UnitedHealthcare. 

For instance, the program helps members find child care, housekeeping and transportation, as well as address financial needs and billing issues.

“It’s a multi-faceted program that will also address mental health issues, screening patients for potential health needs throughout their cancer journey,” said Dr. Michael Rosen, Sr. National Medical Director at OptumHealth.

With the support of Migler and the program behind her, Nancy focused on the next steps in her care. Since there also was evidence of cancer in her lymph nodes, the doctors took steps to determine whether the cancer had spread to other areas of her body. They did a variety of imaging tests, including those focusing on her brain and spine. 

When Nancy found out the results of her PET scan, her relationship with Migler took on critical importance. The oncologist said that it appeared the cancer had spread to her spine. If the cancer had spread, it would indicate Nancy had stage 4 breast cancer, which meant the approach to Nancy’s overall treatment would dramatically change.

When Nancy updated the nurse on the latest imaging results, Migler immediately sought more information, thinking it might be too early for the cancer to have spread outside the area of the breast. “She told me to take a step back,” Nancy said. One thing Migler was sure of — as Nancy’s diagnosis became more complex, she needed to get a second opinion at a cancer center that had specialists who deal with complex cases. It shows the value of having someone like Migler dedicated to a member’s case providing both proactive and reactive support. 

A second opinion made all the difference

Migler recommended that Nancy visit a UnitedHealthcare cancer Center of Excellence for her second opinion. UnitedHealthcare helps guide members with rare, complex cancer cases to treatment within cancer facilities certified by the National Cancer Institute. About 30% of newly diagnosed patients have a complex or hard-to-diagnose cancer.3 At the new hospital, the oncologist told Nancy that they could not conclude from the scan that the cancer had actually spread. So they decided to treat the cancer with a curative intent, starting with chemotherapy. 

Migler was able to coach Nancy through 8 rounds of chemotherapy, explaining important details about each drug she was receiving, the type of monitoring that may be needed and the side effects that might occur. 

UnitedHealthcare’s Cancer Guidance Program is the prior authorization platform in which providers enter treatment regimens and seek approvals. This program is designed to significantly cut the wait times for drug approvals, allowing members to begin chemotherapy rapidly rather than incurring the stress associated with waiting to begin treatment. The program is intended to improve the quality of cancer care, provide faster decisions on coverage, minimize post-service denials and offer physicians information on evidence-based treatments with decision support. The program uses National Comprehensive Cancer Network (NCCN) criteria to support the decision making process; 65% of requests are granted immediate approval.4

If a servicing provider does not choose to follow an NCCN-compliant regimen for a patient’s care, the Cancer Guidance Program works to demonstrate the value of following the NCCN treatment — which may improve patient outcomes and reduce patient out-of-pocket expense. In more than 25% of conversations with providers, the provider chooses to follow the NCCN regimen; for some members, this can avoid up to $10,000 per treatment in unnecessary costs.5

After completion of chemotherapy for Nancy, surgeons performed a bilateral mastectomy. Pathologists then followed the suspicious area on her spine for 6 years, finally determining it was a bone island and not a metastatic lesion. They are now certain that it’s not cancer. As of today, Nancy has been in remission for almost 12 years.

Looking back, she strongly recommends that members who have access to these breast cancer advocacy and support programs use them. She thinks employers can do a better job of socializing these programs among their employees.

 “A lot of people have cancer,” Nancy said. “This is a great service that more people need to be aware of.”

Please reach out to your UnitedHealthcare representative to discuss how these programs can support employees and their family members dealing with cancer.

Footnotes

1 American Cancer Society’s Cancer Statistics Center, 2019.

2 Johns Hopkins, 2017, https://www.johnshopkinssolutions.com/paying-attention-cancer-pays-off-employees/

3 This includes multi-modality, complex surgery, specialized radiation, specialized chemotherapy, rare cancers, cancers that are difficult to diagnose. From UHC 2019 brochure on Cancer Resource Services, https://consultant.uhc.com/assets/cancer-resource-services-employer.pdf (pdf)

4 Cancer Guidance Program, INTERNAL FAQ, Updated April 2019.

5 Optum book of business experience.

The Centers of Excellence (COE) program providers and medical centers are independent contractors who render care and treatment to health plan members. The COE program does not provide direct health care services or practice medicine, and the COE providers and medical centers are solely responsible for medical judgments and related treatments. The COE program is not liable for any act or omission, including negligence, committed by any independent contracted health care professional or medical center.