Hilda Haynes-Lewis, PhD, ANP-BC, AOCNP, and Rosaleen Bloom, PhD, APRN, ACNS-BC, AOCNS, discuss the financial stressors that face patients undergoing radiation.
Flexible workplace environments are necessary to allow patients with cancer to be able to prioritize their health, according to Hilda Haynes-Lewis, PhD, ANP-BC, AOCNP, and Rosaleen Bloom, PhD, APRN, ACNS-BC, AOCNS. However, for patients who do not have access to workplace adjustments, nurses can make a difference by screening them for financial stressors and connecting them to available resources.
“A nurse can put this into their practice by assessing [patients for financial stressors], talking to them about their distress, and talking to them about how they cope,” Haynes-Lewis, who is a nurse practitioner in Radiation Oncology at Montefiore Einstein Cancer Center and an assistant professor of radiation oncology at the Albert Einstein College of Medicine, said in an interview with Oncology Nursing News®.
During the 48th Annual Oncology Nursing Society (ONS) Congress, the nurse investigators presented research that showed that, at an Urban Cancer Center in New York, many patients undergoing radiation were struggling with paying their bills and losing income due to their treatment schedules and treatment-related toxicities.
The study assessed 20 participants who were receiving radiation therapy at Montefiore Einstein Cancer Center. The median patient age was 62.3 years and most participants were women (65%). The most common diagnoses in the study were breast cancer (25%), endometrium cancer (25%), and prostate cancer (25%). The remaining 25% had a variety of diagnoses.
Of note, 40% (n = 8) were privately insured, 40% (n = 8) had Medicare, and 20% had Medicaid (n = 4). The median household income per zip code was $72,884.45. Investigators conducted structured telephone interviews between January 2021 and June 2022. These interviews were then recorded, and transcribed. The distress thermometer was utilized to assess the patients stress levels.
In an interview following the presentation, Bloom, an assistant professor at Texas A&M University, joined Haynes-Lewis to discuss the key takeaways from their research and how nurses can best advocate for patients who are undergoing radiation therapy.
“What was surprising was all of the workplace adjustments [that patients] needed to make, but could not make because of their treatment, their fatigue, or other symptoms from the treatment,” Haynes-Lewis said.
Oncology Nursing News: Please describe the rationale behind this research.
Haynes-Lewis: This research takes place in urban centers, and we noticed there's a lot of distress [among patients receiving treatment]. We wanted to know what are people's coping mechanisms and what are the stressors for patients who are receiving radiation therapy? In this particular study, [we used] mixed methods—meaning we gave them surveys to get that information and then interviewed them. My colleague, Rosaleen Bloom, [and I] worked together on an interview guide.
Bloom: We both have a strong passion around how patients cope with their cancer when they are going through therapy. We wanted to focus on patients undergoing radiation therapy at Montefiore Medical Center and explore the coping and distress that they were experiencing, [as well as the] coping strategies they were using to [manage] their distress.
What were the study’s main findings?
Bloom: Patients had to make adjustments for work [due to] symptoms of their treatment and the physical adverse effects.
[Some patients experienced] deconditioning from physical activity, they had very physically active jobs and couldn't do those jobs anymore. Other patients talked about how the symptoms from their radiation were constant and [how] that was very disruptive to their work. Some patients lost their jobs during treatment because of their inability to do the work anymore.
Another element was being able to pay for their bills. How do you pay for rent now [that] you have lost your job? Some of the same patients were having all the same things [happen], but some patients already had come into the treatment having problems with being able to pay for food, rent, and their electric bill.
One of the other things that we found is in our patient population, (the mean age was 62), many patients were close to retirement, but a lot were still working and they couldn’t foresee not being able to work. Several patients talked about how they would not be able to stop working for treatment, they could not afford to do it, and they also did not have jobs that would flex in a way that they could take a paid leave. They either worked or they couldn't pay their bills. That was not surprising, but, at the same time, it is hard to hear as a nurse.
You want your patients to have that flexibility, [to] be able to take time off, heal and recover from their illness, and not feel that they have to go right back to work again.
Haynes- Lewis: We also found that some of the surveys that we gave patients about what kind of coping strategies they use [were different from] when we did the statistical analysis, [which] said, “people don't really use spiritual coping strategies and they don't use distraction.”
When we spoke to them, we found that they do use a lot of spiritual coping strategies and a lot of [people use] distractions—they use work as a distraction. Now, imagine if work makes you feel better, but you cannot really go to work, because they will not give you any adjustments. These are the [findings] that were new to us and kind of surprising.
With these findings, what would you say the implications are for oncology nurses?
Bloom: The day-to-day practice implications are around working with patients to understand what their specific financial stressors are and what they are concerned about, and then working within your cancer center and community to find out what resources we have available.
Some institutions have financial advisors or people who work with patients, but in addition to that there may be community resources and we have case managers and social workers we can work with and collaborate with [to] identify these patients so that we can get them the help that they need. Potentially even working with employers and talking to them advocating for the patient's flexibility with their work schedule, [can be considered] if possible.
On a policy level, we as nurses need to really advocate for paid leaves [and] for flexible workplaces. We saw this in the pandemic with people who had to continue to work despite the risk for their family members. Finding ways to not have one area of our society be impacted more if you're in a more precarious economic state that you have to continue to work [is important].
[Investigators] wonder why socio-economic status affects health outcomes, well, if you cannot rest, you cannot heal and you have extra anxieties, fears, and stressors. Our job is to push for legislation that can help alleviate that.
Duggan Bloom R, Haynes-Lewis H, Kalnicki, S, Garg M. Income loss and limited resources: financial stressors and work adjustments for individuals with cancer receiving radiation therapy at an urban academic cancer center. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, Texas. Accessed May 3, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/13484