Jean Sellers, RN, MSN, OCN®, says that the financial stress patients experience may be worse than the stress from their cancer diagnosis.

The headlines are ominous. The unemployment rate is climbing, standing at 10% in November 2009, up from 6.8% a year ago (Bureau of Labor Statistics, 2009). Companies, unsure of the economic recovery, are not hiring new workers. For every 1% increase in the unemployment rate, 1.1 million people lose their health insurance. Forty-six million adults younger than age 65 in the United States lack health insurance (Kaiser Family Foundation, 2008). In January 2009, the New York Times reported that states are seeing a 5%–10% increase in the Medicaid population (Sack & Zezima).

Helping Patients Cope Financially

The stressors are adding up for patients with cancer. How do nurses help patients and families cope? “Often times, the financial catastrophe families experience is worse than the cancer diagnosis,” says ONS member Jean Sellers, RN, MSN, OCN^®. She gives the example of a woman whose husband was in the operating room undergoing a craniotomy for removal of a brain tumor. The woman had put off her own treatment for a brain tumor, but what she really needed right then was $50 to have food at home for her family during her husband’s hospitalization.

Sellers is the administrative director of the University of North Carolina Cancer Outreach Program in Chapel Hill and is establishing nurse navigators throughout her state. The program is funded by the state legislature and is currently starting in Dare County, a rural area in eastern North Carolina.

“I am based in Chapel Hill, but our commitment is to all the people of North Carolina. We have a number of leaders at our institution and in the state legislature who are committed to the success of this program,” Sellers says. “We identify barriers to care and use local resources to ensure that patients get needed treatments and provide education to others about the importance of preventive care.”

Lynley Fow, ARNP, AOCNP®, says that some patients without insurance may delay needed treatments for fear they can

ONS member Lynley Fow, ARNP, AOCNP^®, is an advanced oncology certified nurse practitioner who works in private practice in Kirkland, WA. She finds that patients without insurance may delay treatment because they fear they can’t afford it. She says that an advantage of private practice is that it does give physicians the ability to write off copays or payment for a visit.

“10%–15% of our patients have no insurance or poor insurance,” Fow says. It is unusual, though, for them to see patients lose their insurance during treatment.

Fow identifies infusion nurses as being on the front line for financial crisis. Patients spend longer times in an infusion suite and will often first share their financial concerns with the nurses there. Patients may be hesitant to tell the medical team for fear of not receiving adequate treatment because of a lack of insurance. Infusion nurses can reassure patients that they will be provided with standard of care therapy and not denied because of lack of insurance.

“The only difference for patients without insurance is that their treatment takes place at the hospital rather than the office. We don’t turn anyone away,” Fow says.

She says that her practice works as a team to care for patients. Social workers help patients apply for charity care or Medicaid. A financial counselor reviews copays and informs patients what the maximum out-of-pocket expense will be. “We share with patients the cost of their chemotherapy so they are not shocked when they get the bill,” Fow says.

Her patients can also request a financial consult to look at their family’s budget to see if any expenses can be trimmed to help offset pharmacy copays, transportation for clinic visits, and over-the-counter medications. The pharmacy staff at Fow’s clinic help patients complete applications for patient assistance programs and advise them on using less expensive drugs to achieve the same results.

Sellers says that similar services are available in North Carolina. Patients expressing the need for financial support must show their tax return. Their budgets also are assessed to see if any items can be trimmed. In addition, social workers in Sellers’ program can give patients $25 gas cards. The employees hold bake sales to fund this service.

Programs That Offer Financial Aid

So, what can oncology nurses do to help their patients with financial concerns? “We look for local resources to help patients in crisis,” Sellers says. “We’ve partnered with the health department, Salvation Army, and local hospitals and churches. For example, we had a patient whose car needed new brakes for her to have transportation for treatment appointments. We were able to find an organization in the local community to pay for the brake repair.”

Fow’s workplace has a foundation that was established to provide patients with financial assistance. “The monies have come from fundraisers and patient bequests. We also use www.needymeds.org to find medication assistance for patients,” Fow says. She also advises patients about the $4 prescriptions offered at various local pharmacies.

Sellers recommends the Patient Advocate Foundation (www.patientadvocate.org), a nonprofit organization that provides a link for patients between their insurance company, employer, and/or creditors. The American Cancer Society offers a Road to Recovery program that can help with transportation.

She also finds that local communities have much to give. Establishing relationships and building trust with local groups are critical to helping patients find assistance close to home.

“We’ve developed a community care team called Hands of Hope,” Sellers says. “This is a volunteer program that helps community members learn about cancer and how they can support patients and families facing this diagnosis. The program collaborates with existing community programs so services are not duplicated. Most important, it’s about teaching volunteers the difference they can make in the life of a patient and family on the cancer journey by simply understanding what may be their needs.”

Program volunteers learn effective communication, the art of listening, and information about cancer, cancer prevention, and patient advocacy. Sellers says the goal is to have similar programs available throughout the state of North Carolina.

“Recently we were invited to develop a mini volunteer orientation program for local high school students,” Sellers adds. “This is exciting because we will have the opportunity to provide students with skills that will follow them throughout their lives.”

• Bureau of Labor Statistics. (2009). Labor force statistics from the current population survey. Retrieved December 14, 2009, from http://data.bls.gov/PDQ/servlet/Survey
  OutputServlet?data_tool=latest_numbers&series_id=LNS14000000
• Kaiser Family Foundation. (2008). Medicaid, SCHIP and economic downturn: Policy challenges and policy responses. Retrieved October 30, 2009, from http://www.kff.org/medic
  aid/upload/7770ES.pdf
• Sack, K., & Zezima, K. (2009, January 21). Growing need for Medicaid strains states. New York Times. Retrieved October 30, 2009, from http://www.nytimes.com/2009/01/22/us/22medicaid
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