This document summarizes a webinar on cancer, culture, and careers. It provides 3 options for listening to the webinar - computer speakers, telephone dial-in, or teleconference. It also outlines the agenda which includes speakers from the National Comprehensive Cancer Network and National Business Group on Health discussing survivors in the workplace, the high cost of cancer, taboos and stereotypes, survivor stories, and employer challenges. Polling questions are included to gauge participant understanding.

1. You can listen to today’s webinar using your computer’s speakers
or you may dial into the teleconference.
If you would like to join the teleconference,
please dial 1.650.479.3208 and enter access code: 925 187 276 #.
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2. • Q&A
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3. Polling
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4. 1. Will I receive a copy of the slides after the webinar?
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Please allow up to 2 business days to receive these materials.

6. Cancer, Culture & Careers
Overview
Survivors in the Workplace
High cost of cancer
Taboos and stereotypes
Survivor Stories
Employer Challenges

7. Cancer, Culture & Careers
Speakers:
Rita Pyrillis, Senior Writer
Workforce Management
Liz Danielson, Director, Payer & Employer Initiatives, National
Comprehensive Cancer Network
Brenna Shebel, Director, Institute on Health Care Costs and
Solutions, National Business Group on Health

8. Survivors in the Workplace
There are more cancer survivors in the workplace than ever before.
Number of US Cancer survivors
American Cancer Society

9. High Cost of Cancer
An estimated $264 billion
a year in health care costs
and lost productivity.

10. Survivors in the Workplace
More than 1.7 million people will be diagnosed with
cancer this year.
More than half will be between 19 and 64 years old.
80% of survivors will return to work within the first
year.
American Cancer Society

11. The Big “C”
Cancer is no longer a death
sentence.

12. The Big “C”
Taboos and Stereotypes
During the 1950s and 1960s cancer was rarely
discussed publicly.
During 1970s First Lady
Betty Ford and President
Ronald Reagan broke
the silence.

13. The Big “C”
Cancer is no longer taboo

14. Cancer, Culture & Careers
Supporting Survivors in the Workplace

15. Survivor Stories

16. Survivor Challenges
FEAR
…that their careers will suffer.
…that they will be perceived as weak.
…fear of missing opportunities.

17. Survivor Challenges
Why Do Survivors Care About Their Jobs?
A sense of purpose
Financial support
Health care insurance
Social support

18. Employer Challenges
Controlling health care costs
Developing a comprehensive approach to managing
cancer in the workplace through benefit design,
vendor management, wellness programs and
supports for survivors and their families.

19. Meeting the Challenge
An Employer’s Guide to Cancer Treatment and
Prevention
A 3 year initiative of the National Business Group on
Health and the NCCN to help employers develop a
standardized approach to cancer care.

20. Cancer in the Workplace:
An Employer’s Toolkit on Cancer Treatment and Prevention
Cancer, Culture & Careers Workforce Webinar
April 1, 2013
Liz Danielson Brenna Shebel
Director of Payer and Employer Initiatives Director, Institute on Health Care
National Comprehensive Cancer Network Costs and Solutions
(NCCN) National Business Group on Health

21. Agenda
• About the National Business Group on Health
(NBGH) and the National Comprehensive Cancer
Network (NCCN) and their collaboration
• Project Overview – An Employer’s Guide to Cancer
Treatment and Prevention
• Snapshot of Recommendations
• Preview of Tools for Employees
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22. NBGH/NCCN Collaboration
• NCCN has widely accepted, evidence-based resources on
cancer: from risk reduction, through diagnosis and
treatment, to survivorship
• NBGH has extensive experience developing resources for
employers and evaluation tools, such as the WISCORESM,
the Wellness Impact Scorecard and EMPAQ® (Employer
Measures of Productivity, Absence and Quality™)
• NBGH and NCCN together have translated evidence into
recommendations, practices and tools for employers
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23. About the National Business Group on Health
• Representing approximately 363 mostly large employers
– 66 of the Fortune 100
• NBGH is the nation’s only non-profit organization devoted
exclusively to:
– Finding innovative and forward-thinking solutions to
large employers’ most important health care and
related benefits issues
– Speaking for large employers on national and state
health issues
• Members provide health care coverage to over 50 million
U.S. workers, retirees and their families.
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24. About National Comprehensive Cancer Network
• A not-for-profit alliance of 23 academic cancer centers
across the United States; offices in Philadelphia area
• NCCN Mission: As an alliance of leading cancer centers
devoted to patient care, research and education, is to
improve the quality, effectiveness and efficiency of cancer
care so that patients can live better lives.
• NCCN vision: To be the world’s leader in defining and
advancing high-quality, high-value cancer care
• NCCN Clinical Practice Guidelines in Oncology (NCCN
Guidelines®) and other resources are widely used by
physicians, nurses, pharmacists, billing staff, managed
care organizations and patients
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4

25. © NCCN All rights reserved.
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26. NCCN Clinical Practice Guidelines in Oncology
• Cover the vast majority of cancers (about 98% by incidence)
• Address treatment, risk reduction and supportive care
• 46 multidisciplinary panels with 25-30 experts per panel
• 994 panel members volunteered more than 20,000 hours in 2012
to review evidence, develop and update content
• Transparent process and full disclosure of all panel members’
potential conflicts of interest
• Guideline development costs covered by NCCN Member
Institution dues
• Widely used as the basis for insurance coverage policy and
quality evaluation (CMS, United Healthcare, Aetna, Blues plans and
other organizations)
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6

27. Application of Guidelines to Patient Care
• Guidelines are applicable to
most but not all patients
• The individual clinical situation
determines if a
recommendation is appropriate:
– Co-morbidities (other health
issues)
– Genetic differences
– Side effect profile of drug
– Functional status
– Patient choice
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28. NCCN Clinical Resources
• NCCN Guidelines for Patients® – a subset of NCCN’s
professional Guidelines translated for non-clinicians –
available free at NCCN.org/patients and NCCN.com
– Currently, 12 Patient Guidelines are available
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29. Goals for the Employer’s Guide
• Evidence-driven benefits
• Evidence-based, personalized care for beneficiaries
• Integration and coordination across the benefit continuum
and cancer continuum
• Standardization of benefits across health plans
• Vendor accountability
Cancer continuum:
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30. Project Overview
Working group consists of staff from
• Health Care Benefits Plan (2011) NBGH and NCCN, supported by an
– General Medical, including behavioral Advisory Committee that includes
health
representatives from all stakeholder
– Pharmacy groups:
• Health and Productivity (2012) • Employers/benefit managers
– Short- & Long-Term Disability • Benefit consultants
• Patient advocates
– Family Medical Leave (FML) • Managed care plans
– Employee Assistance Programs (EAPs) • PBMs
• Health Promotion/Wellness (2013) • Cancer centers (physicians)
• Pharmaceutical industry
– Beneficiary Education
• American Cancer Society
– Prevention, Screening & Surveillance • Disability & EAP vendors
– Survivorship
Advisory Committee approves all
All resources developed through this deliverables.
collaboration are available in the
public domain.
30

31. The Toolkit
• Tool 1 – Quick Reference Guide: A brief summary of benefit and
program recommendations across the benefit continuum.
• Tool 2 – Employer Benefit Design and Assessment: Provides
practice recommendations and suggestions for comprehensive
benefits, along with a methodology employers can use to assess
their current benefits.
Tools currently include recommendations related to medical and
pharmacy benefits, short-term disability, family medical leave and
employee assistance programs.
• Tools 1 and 2: Use to assess current benefits against the
recommendations, considering guidance provided in the tools
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32. The Toolkit
• Tool 3 – RFP and Proposal Scoring Tools: Resources to
support implementation of recommendations from Tool 2.
• Tool 4 – SPD Guidance: Offers guidance to help employers
translate the recommended benefit or practice into summary
plan description language for beneficiaries.
• Tool 5 – Vendor Contracting and Administration: Includes
reporting requirements and timing.
• Tool 6 – Vendor and Program Evaluation: Supports
assessment of vendor performance and overall effectiveness of
the entire set of employee benefits.
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33. Sample of Medical Benefit Recommendations
An actuarial analysis of most of the medical and pharmacy benefit
recommendations is underway. The goal is to provide information on
the net incremental cost or savings associated with adding each of the
recommended benefits.
• Medical plan network should include access to a wide range of
cancer care specialists, both in the community setting and in
academic and NCI-designated cancer centers.
• Benefit plan should include access to “centers of excellence”
programs for transplants, including bone marrow/stem cell
transplants, and for complex and rare cancers.
Definitions and additional detail included in Tool 2.
33

34. Sample of Medical Benefit Recommendations
• Benefit plan should reimburse physicians for consultation with
patients and family members about all options for care, both during
active treatment and at end of life.
– Discussion topics may include evidence-based treatment options, palliative
care (both during treatment and at end of life), discontinuation of treatment with
curative intent and hospice.
• Benefit plan should provide coverage for routine costs of care
when a patient is enrolled in an approved cancer clinical trial.
• Benefit plan should include hospice coverage for individuals with
an estimated life expectancy of 12 months or less to live if their
disease runs its usual course.
– Beneficiaries should have access to clinicians with training in palliative care
and end-of-life issues who can address hospice and other options.
Definitions and additional details included in Tool 2.
34

35. Sample of Medical Benefit Recommendations
• Benefit plan should cover nutrition counseling and medical
nutritional therapy for individuals with cancer.
• Benefit plan should cover genetic testing and counseling for risk
assessment of individuals with significant personal or family
history, based on NCCN Guideline recommendations.
• Benefit plan should cover standard fertility preservation treatments
when a medically necessary cancer treatment may directly or
indirectly cause infertility.
• Benefit plan should cover elements of collaborative care for
patients who are diagnosed with a behavioral health disorder (e.g.,
depression) but are primarily treated in a medical setting.
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36. Pharmacy Benefit Recommendations
• Reasonable out-of-pocket thresholds should be established so that
cost is not a significant barrier for patients to obtain their
medications.
Specialty Pharmacy programs should counsel individuals who are prescribed
oral oncology drugs to reduce non-compliance and prescription abandonment .
• Medical plans, pharmacy benefit plans and specialty pharmacy
benefit plans should cover evidence-based cancer treatment,
whether paid under the medical or pharmacy benefit. This includes
coverage for off-label use of drugs and biologics when supported
by evidence, as indicated in NCCN Guidelines (categories 1, 2A & 2B).
• Benefit plan should establish parity of patient cost-sharing between
the medical and pharmacy benefits.
36

37. Short-term Disability, Family Medical Leave and
Employee Assistance Programs (EAP)
Common themes:
– Cancer creates productivity implications for employees
whether dealing with their own or a loved one’s cancer.
– A positive impact results when integration and coordination
across benefits and programs are made a priority.
– Vendors/Partners and Human Resources team need a basic
understanding of cancer-related issues (physical, cognitive,
emotional) that may occur during and after active treatment.
– Reasonable work accommodations should be offered by
employers when an employee is undergoing treatment,
returning to work or serving as a caregiver.
37

38. Short-term Disability, Family Medical Leave and
Employee Assistance Programs (EAP)
Common themes:
– Screening for depression and other behavioral health issues
can be done at many times and places by physicians or other
clinic staff, care management program nurses, disability
case managers, FML and EAP staff.
– Treating physicians can help employees remain at work,
whether the employee is the patient or a caregiver – impact
on retaining income, benefits and support system.
• Time and place of treatment
• Choice of treatment (e.g., oral vs. infusion)
• Side effect prevention and management
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39. Sample of Short-Term Disability (STD)
Recommendations
• Short-term disability benefit plan’s policies and practices must
require operational coordination with the EAP.
• Short-term disability programs should utilize cancer-specific
protocols, based on clinically validated information, for guidance
in certifying and managing cancer-related disability cases.
• Disability program case managers, in coordination with the
disabled employee’s supervisor, human resource
representatives and, when appropriate, legal department and
EAP staff, should establish criteria for determining reasonable
accommodations for employees with cancer.
39

40. Sample of STD Recommendations
• If an employee returns to work following disability leave but
periodically needs time off for ongoing medical treatment related
to the disability, the intermittent absences for treatment should
be considered one episode of disability. The episode is limited
in duration to the maximum allowable disability benefit.
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41. Sample of Family Medical Leave (FML)
Recommendations
• Employees who apply for FML for their own illness or for
caregiver leave should receive information about caregiver
stress and depression and available support resources.
• Employees who apply for FML should receive information about
financial counseling and assistance resources.
• FML should be integrated with HR planning and operations. HR
should encourage supervisors to consider offering alternative
work arrangements, reduced work schedules and assistance
with reentry into the workplace and to provide a supportive
environment for the affected employees and their coworkers.
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42. Sample of Employee Assistance Program
(EAP) Recommendations
• EAP professional staff should possess basic understanding of
cognitive, emotional, and physical issues associated with
serious and/or chronic illnesses, including cancer.
• EAP staff should be capable of providing consultation to
supervisors and HR professionals and work effectively with
employees coping with cancer and other serious and/or chronic
illnesses.
• The EAP should maintain a network of referral sources sufficient
to meet the needs of a heterogeneous and diverse workforce.
This network should be culturally competent and capable of
responding to the needs of parents of employees, spouses and
children.
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43. Preview of Tools for Employees
• Cancer Benefits and Resource Guide:
– Guidance for employees dealing with a cancer diagnosis, treatment
or recovery, and those concerned about their cancer risk
– Tools for employees caring for a loved one with cancer
– Companion Guide for employers, managers & supervisors
• Factsheets on Need-to-Know Topics:
1. Cancer Risk and Genetic Testing
2. Survivorship Issues of Concern
3. Palliative Care
4. End-of-Life
5. Advance Care planning
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44. To Access the Tools:
www.businessgrouphealth.org/cancer
Click on “All Cancer Resources” at the top of the page.
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45. Contact information
For additional information about the Toolkit, please contact:
Liz Danielson
Director, Payer & Employer Initiatives, NCCN
Email: danielson@nccn.org
Phone: 215-690-0296
www.nccn.org
Brenna Shebel
Director, Institute on Health Care Costs and Solutions, NBGH
Email: shebel@businessgrouphealth.org
Phone: 202-558-3024
www.businessgrouphealth.org/cancer
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46. Join Our Next Workforce Webinar
Why Talent Management Isn’t Enough: Using
HR Technology to Increase Productivity
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