Comorbidity: when cancer isn't the only health challenge
Bogda is particularly interested in cancer patients that have other health issues, where cancer is not necessarily their main health problem. In these cases, clinicians need to balance competing risks when thinking of their survivorship. If a breast cancer treatment causes cardiac problems and the patient already has heart issues, you might get rid of the cancer but damage the heart and shorten their life. You might be better off with a less toxic cancer treatment with less risk to the heart, but higher risk of cancer reoccurrence. We don’t yet have great tools that help us balance these competing priorities.
Bogda is currently developing a program to ensure that patients are fit to receive cardiotoxic breast cancer treatments before they are prescribed. She hopes this will prevent unnecessary deaths from heart disease.
When cancer comes with financial hardship
Another focus of hers is something most cancer clinicians don’t think about: their patients’ finances. One in five people diagnosed with cancer experience financial hardship. It’s not just about the costs of treatments and health care (which can be exorbitant). Cancer can prevent people from working, so they’re not earning income; this affects not only the person with cancer but often also a partner or parent. Perhaps they need more child care while they’re undergoing treatments, or they need to cover travel and accommodation to receive the treatments. Maybe they’re not able to return to the workforce after cancer thanks to the consequences of their treatment, disability, loss of confidence, or a swiftly changing job market. Perhaps their mental health has deteriorated. For those already in a financially vulnerable or unstable position, that situation can be exacerbated. The longer you’re away from work, the harder it is to return.
As we recognise more and more survivorship challenges after cancer, we need to rethink how cancer care is delivered. Oncology today is an acute discipline. Patients go to their oncologists with cancer and they want it gone quickly and completely. It can seem inappropriate for an oncologist to say, ‘Let’s forget about the cancer for a moment and focus on your financial position.’ They already have the complex task of treating cancer, dealing with side effects, encouraging changes of behaviour (e.g. healthy diet and exercise), and motivating the person to carry on with stressful treatment. If a patient is overburdened with all these tasks, we know that they may find it difficult to cope. You need to prioritise. But if some concerns—such as financial difficulty—are not addressed until later, the damage may already be done. Financial hardship can bring enormous stress to a patient who should be focused on their health.
Returning to work
It’s this thinking that drove Bogda and her team at Flinders to develop a website to help people maintain work or return to work early. Work After Cancer is a resource to provide advice to people diagnosed with cancer, their loved ones, clinicians and employers.
A team dedicated to the whole person
Bogda is thankful to be located at Flinders, which is home not only to oncologists but also psychologists, social workers, physiotherapists, and many others. Survivorship is something all health professionals need to think about. By drawing on a cross-disciplinary team, Flinders is tackling as many issues in survivorship as possible. Bogda says, ‘At the end of the day as long as we’re doing something useful every day, that’s all that matters.’ What they’re doing is more than useful—it’s important and appreciated work, caring for people throughout their time with cancer and into the future.