What is the private sector doing?
The two million people in the UK who have been diagnosed with, and survived, cancer need more support to cope with the after-effects of the disease, including negotiating the return to work, according to research published in the British Journal of Cancer.
The papers, published almost two years after the launch of a national strategy for cancer survivorship, have implications for both insurers and providers of care in the private sector, as the NHS forges ahead with plans to offer greater levels of support to cancer survivors.
"New models of care are needed to optimise health-related quality of life among cancer survivors," writes Professor Mike Richards, the national cancer director. "The development of these models depends critically on high-quality research."
Intermediaries have previously warned that the private sector is at risk of falling behind the NHS in offering packages of aftercare to people treated for cancer.
A chronic disease?
New research, published in the Journal, suggests that people who have been treated for cancer are in poorer health than those who have not been treated for cancer, as well as people with other serious chronic or long-term conditions. For example, 47% of cancer survivors report being in average or poor general health compared to 17% of those who have not been treated for cancer. Almost one in five (19%) of cancer survivors report that their health has prevented them from working in their preferred occupation, compared to 5% in the general population. Cancer survivors are also more likely to use health services.
"The good news of improving cancer survival statistics masks what is now a longer disease trajectory with increasingly unpredictable health outcomes for individuals and where little is known about the long-term implications for life following cancer," writes Professor Corner of the University of Southampton.
Over the last 40 years, long-term survival for individuals diagnosed with cancer has doubled and there is now a life expectancy of 10 years or more for the majority of individuals with some common cancers. This has posed challenges for insurers, as cancer is increasingly classed as a "chronic" rather than "acute" disease - a category of conditions traditionally excluded from cover.
Insurers have responded by promoting comprehensive cover while offering corporate clients the opportunity to put limits in place, or exclude cancer altogether. Aviva UK Health recently launched more extensive cancer cover, including "aftercare" benefits designed to recognise the long-term impact of cancer treatment, such as contributions towards the cost of a wig.
The growth in the number of cancer survivors also presents challenges for employers seeking to facilitate the return to work of employees who have survived cancer. About 100,000 people of working age are diagnosed with cancer each year and this number is set to increase as the default retirement age is phased out and employees remain in the workforce for longer. Research published last year by the Society of Occupational Medicine indicated that employers have "outdated" views about what such employees can achieve at work.
Research from Unum (which has seen cancer claims on its group income protection policies increase by 44% in the past ten years) shows that two-thirds of of cancer claimants referred for rehabilitation after more than six months return to work. Research conducted by charity Macmillan Cancer Support indicates that 79% of people would expect to go back to work after a diagnosis of cancer.
The involvement of organisations such as group risk providers, specialising in rehabilitation may be particularly important given the fact that other research published in the Journal found that patients reported little involvement by GPs in their care and perceived that GPs lack the necessary expertise in cancer management. In addition to this, researchers Foster and Fenlon of the University of Southampton highlight that a loss of self-confidence is an "under-recognised" problem experienced by a significant number of cancer survivors. They argue that regaining confidence can be facilitated by family, partners, friends, colleagues and employers – "such as through a gradual return to work following a long absence for treatment."
Implications for CI
Finally, the new research has implications for critical illness insurers. A study by Khan et al indicates that cancer patients are at greater risk of developing other serious conditions including heart failure, coronary heart disease, osteoporosis, diabetes and hypothyroidism. This may lend weight to arguments by PruProtect that policies enabling multiple claims and severity-based claims are the best form of cover, given the risk of claimants being diagnosed with another serious illness at varying levels of severity.