More and more cancer patients are increasingly likely to survive, thanks to earlier detection programs, better treatments and improved care. The latest Cancer Australia figures show 69 per cent of Australians diagnosed with cancer survived[i]. But sadly, many are not thriving in their post-cancer lives, and this is a common challenge for both patients and their insurers.
Up to 40 per cent of cancer survivors do not return to work because of fear of recurrence, depression, anxiety and cancer-related fatigue[ii]. The onset of COVID-19 is deepening this problem as patients deal with social isolation and the anxiety of knowing they are at higher risk than the general population.
CancerAid Coach Program is a powerful tool that is helping cancer patients do the things that are evidence based to help them return to an active and satisfying life after their ordeal.
Research has shown that patients who are engaged with their own healthcare – through activities like logging symptoms, doing exercise and undergoing appropriate rehabilitation – have better health outcomes.
CancerAid co-founder and radiation oncology specialist, Dr Raghav Murali-Ganesh, says health coaching has delivered positive impacts to patients living with chronic diseases, particularly for those with cardio-metabolic diseases like diabetes and obesity. The CancerAid Coaching Program is applying a similar approach to cancer patients.
“As cancer outcomes improve and increase survival rates, so too does the concept of cancer as a chronic disease and thus behavioural change becomes important,” Murali-Ganesh says. “Often patients may not know the evidence behind which particular activities may be meaningful, from a scientific literature perspective. The goal of the CancerAid program is to empower patients to be more active participants in their own health, in particular on clinically meaningful activities.”
CancerAid began purely as an app that directed patients towards activities that best help them recover. But behavioural change is difficult to bring about, and only a very small proportion maintained sustained use in the longer term.
In response, the team introduced a human touch, which proved to be the missing link to drive up engagement. Dedicated health coaches who are trained allied health professionals, nurses and doctors help patients through a digital curriculum that empowers them to return to healthier lives, including return to work, to regain a sense of normalcy.
Upon enrolment and receiving their first phone call from their health coach, there is a 93 per cent program engagement rate from patients.
“Cancer patients are in a particularly vulnerable situation and so we find that the addition of a human touch, rather than technology alone, is critical for providing an appropriate level of empathetic support for these patients,” Murali-Ganesh says.
“We have seen a significant increase in patient engagement since the introduction of the coaching component and we have also demonstrated improved clinical outcomes, including shortening the time to return to work.”
Doing what matters most
The program provides both structure and encouragement for cancer patients to do the things that are most likely to assist their recovery.
Maintaining an active involvement in daily life, minimising disruption to life roles, managing feelings of hopelessness and regulating the normal emotional reactions to illness are helpful strategies in reducing the risk of developing a mental illness, and the program educates customers about this.
An interactive app helps patients track their symptoms, exercise, diet, sleep and mental wellbeing. Crucially, the app also provides a community with articles and stories that motivate patients and help reduce their feeling of isolation. This is particularly relevant during the COVID-19 pandemic.
“The newly coined term, pandemic-related anxiety, is seen in patients who are vulnerable to the effects of COVID-19 but who also need additional support,” Murali-Ganesh says. “We have incorporated an additional module to alleviate these stressors and have delivered cancer-specific COVID-19 information to 10,000 individuals over the last few weeks.”
After feedback from users that they wished they had begun the program earlier, the program has become an integral part of insurer AIA’s focus on early intervention, where treatment for a condition begins at the beginning of a claims process, ultimately improving the rate of positive claims outcomes.
“The earlier we provide support to our customers, the better their health outcomes will be,” says Simonie Fox, AIA’s National Wellbeing Manager.
Early intervention, better recovery
AIA’s cancer recovery programs include its CaRe Movement program of exercise physiology during treatment, and RESTORE CaRe which is a wellness program for customers with cancer. AIA has health coaching programs for its three most commonly claimed conditions–cancer, mental health and chronic pain. These conditions account for 83 per cent of its total claims.
CancerAid Coach is introduced to customers as soon as AIA receives a claim for cancer-related conditions, typically over the phone in the first weeks after lodgment.
While some of AIA’s customers with cancer are terminal and will not have the opportunity to engage in occupational rehabilitation, 25 per cent of all CancerAid participants progressed to further occupational rehabilitation programs, leading to an 82 per cent return-to-work rate.
“More people are surviving cancer than ever before, and we wanted to provide early intervention support to our customers facing a cancer diagnosis,” says Fox, pointing to the fact approximately 40 per cent of working age Australians who recover from cancer won’t return to work.
“These people are surviving their cancer diagnosis, but they are not thriving. AIA is determined to make a difference in these customers’ lives by providing them with support as early as possible so that they are less likely to have ongoing psychological symptoms.”
As a result of COVID-19, AIA is also piloting a self-enrolment text service for customers so they have access to CancerAid Coach as soon as possible as it has additional benefits for them during the pandemic.
“The program is particularly helpful now with COVID-19,” Fox says. “Customers are more anxious than they would normally be as they are at higher risk for COVID-19. The CancerAid Coach calls are around 30 per cent longer as a result of the pandemic. AIA is so grateful to have a practical way to support these very vulnerable customers.”
Fox points out that the CancerAid Coach program is offered to customers before their claim is even assessed.
“We share with the customer that AIA does not have access to any of the data that they input into the app, such as the tracking of their symptoms, so that they can feel more confident to engage in the program,” Fox says.
Complementing the health system
Not all of AIA’s customers choose to take up the program; many receive comprehensive treatment and support at hospitals, above and beyond treating the disease alone.
But with the majority of cancer patients spending most of their time away from their clinical care team, CancerAid Coach complements the health care system by helping patients be more involved in their recovery.
Murali-Ganesh says the traditional healthcare model isn’t always effective at supporting health behaviour change–particularly in an era of chronic diseases–as well as the social and community needs of cancer patients and their intrinsic role in mental health and recovery.
“This is where we see the greatest unmet need for the CancerAid Coach Program,” Murali-Ganesh says. “It is our goal to improve the communication between the patient and their clinical care team by empowering patients to step into their own care and be more of a ‘partner’ in their care.”
[ii] Spelten ER, Sprangers MA, Verbeek JH. Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology. 2002;11(2):124‐131. doi:10.1002/pon.585