September 05, 2024

Introduction

Around the world, cancer is a growing area of concern for employers, with cancer incidence expected to increase more than 60% through 2050.¹ In the U.S., cancer remains a primary factor driving health care costs for employers, as indicated by the 2025 Employer Health Care Strategy Survey. More than half of the employers surveyed (55%) cite cancer as the primary driver of health care costs, with 80% ranking it among their top three cost factors.²

In a recent Thought Leadership Series post, we explored the challenges employers face with cancer. The impact of delayed care, the yet unexplained wave of cancers diagnosed in younger populations, and increases in health risks contributing to cancer, such as obesity, environmental factors and substance use, all point to cancer continuing to exacerbate health care costs.

To address, and ultimately reverse, this alarming growth in cancer-related cases and costs, employers must revisit programs focused on the prevention and early detection of cancer. But prevention alone is not enough. Employers must also commit to supporting treatment strategies that focus on high-quality, cost-effective care, while curating a more supportive patient experience. In doing so, they need to thoughtfully navigate the balance between supporting innovation in cancer care and providing affordable coverage.

Clinical progress has led to improved outcomes and survival rates but has increased the complexity of treatment pathways and their cost. Many clinical innovations, including advanced testing, are built on the foundation of precision medicine. Unfortunately, access to these advancements is inconsistent in the U.S. and around the world. Furthermore, the complexity of cancer care and fast-changing evidence-based treatments have led employers to increasingly rely on their partners to support clinically sound coverage decisions and to manage utilization with the highest level of precision in targeting the right patients. Partners also play a critical role in not adding unnecessary administrative hurdles while managing appropriate treatment utilization, which may add to the patient and provider burden and may slow down the initiation of treatment.

Prevention and Early Detection

Recognizing that 30–50% of all cancer cases are preventable, employers must play an active role in helping to avoid cancer.³ One of the leading causes of cancer is smoking, which also contributes to heart disease and respiratory illnesses. To support a healthy and productive workforce, employers have been offering tobacco cessation programs to help employees reverse all nicotine addiction and should continue to offer innovative and compelling resources and incentives to keep such efforts relevant. The reduction in smoking rates has likely been the single most impactful contributor to reducing lung cancer deaths.

Early detection of cancer improves survival rates, reduces treatment costs and enhances overall productivity.⁴ New data reveals that certain cancers like colorectal and breast cancers are increasingly being diagnosed at later stages and younger ages.⁵ Employers can have a significant impact on improving early detection rates by promoting advanced screening measures and maintaining full coverage for recommended screenings. Employers also have an opportunity to promote access to less invasive and new screening methods, deploying effective primary care strategies and holding providers accountable for prevention and screening outcome measures.⁶

To increase screening rates, especially in areas where provider resources are scarce and for populations facing socioeconomic barriers to accessing screenings, prioritizing alternative and innovative cancer screening options that focus on personalized recommendations and early detection presents an opportunity to improve detection rates and broaden access to care.

While employers play a role in promoting prevention and early detection, it's essential to acknowledge the pivotal contribution of governments in this effort. Allocating resources towards public health initiatives—such as vaccination against cancer-causing infections (e.g., human papillomavirus), supporting advanced detection research, and ensuring equal access to preventive care at 100%—is vital.

For these collective efforts to have maximum effect, employers will need to inspire individuals to be more accountable for their health behaviors. It's important for employees to participate in regular screenings and embrace healthier lifestyles. Workplace health and well-being culture in general can play a role in enhancing that accountability.

Key areas of focus for a successful strategy:

1 | Conduct preventive care and screening education campaigns:

Conduct frequent, simple but targeted communication campaigns to drive utilization.
Incorporate screening incentives into existing well-being incentive programs.
Educate members frequently on the importance of screening and the evolving ways in which they can access age and health risk appropriate screening.

2 | Reduce barriers to accessing care:

Offer paid sick leave to employees for preventive care and screenings.
Reduce or remove age requirements for preventive screenings.
Cover all types of breast cancer screenings as preventive.
Enhance coverage of skin and lung cancer screenings.
Offer multi-cancer blood-based detection tests.
Provide mobile screening facilities to reach employees in dispersed locations.
Encourage employees to establish relationships with a primary care physician (PCP) for better access to timely care and preventive services.

3 | Engage with partners in steering members to appropriate testing:

Ensure third-party vendors such as insurers, health plans, navigators and patient advocacy teams are equipped to steer members to the appropriate tests, testing sites and to educate patients.
Cover genetic tests to identify elevated disease risks to modify screening frequency and improve early detection.

4 | Adjust coverage to include new, less invasive forms of screening that include home tests for colorectal and cervical cancers.
5 | Understand unique geographic or cultural factors that can impact screening rates or increase risk of cancer in specific countries or regions and seek to mitigate those factors through effective, culturally sensitive communications.

Related Resources:

Treatments and Therapies

Cancer care is a rapidly evolving field. New treatment protocols are emerging regularly, and care is becoming increasingly more complex and specialized. As a result, outcomes improved and survival rates have increased, along with the complexity of treatment pathways and their cost.

Employers, appropriately so, rely on their health plan partners and the clinical expertise of their medical boards for coverage decisions supported by the latest evidence. Health plans are also expected to implement appropriate utilization protocols to minimize waste. However, given the high cost of treatments and the increased specificity of treatment pathways, employers should be having increasingly frequent discussions with their health plans and access to the information that can help them assess the appropriateness of coverage decisions and the impact of those decisions on their population and cost. In addition, employers should hold their partners accountable for the effectiveness and appropriateness of prior authorization protocols.

Employers are increasingly considering offering Cancer Centers of Excellence to promote cost-effective, quality cancer care. They may also work with programs offering curated, quality provider networks or reducing the need for patient travel by partnering with vendors who can steer members to high-quality providers in local communities.

Employers must stay on top of the advancements in precision medicine—genomic and pharmacogenomic tests, biomarker testing, and immunotherapies and work with their partners to ensure appropriate coverage and utilization management decisions are made. They should also be aware that globally, coverage for newer therapies may not be the same through government-sponsored health systems, and the same treatment and diagnostic may not be universally recommended by providers.

Key areas of focus for a successful strategy:

1 | Remove barriers to access to high-quality providers and treatments by offering:

Access to Cancer Center of Excellence (COE) program and accredited centers for cell and gene therapies, which provide integrated cancer care options and can offer access to the most innovative treatments, particularly for rare, aggressive and difficult-to-treat cancers.
An incentive such as predictability of patient cost, lower deductible or coinsurance to encourage use.
Financial and travel assistance for employees and their families who must access care outside of the community they live in.

2 | Leverage a captive insurance approach to address coverage in countries with inadequate insurance provisions for emerging treatments.
3 | Consider coverage (either directly or through a supplemental medical plan) of personalized medicine, including genomics and immunotherapy.
4 | Steer employees to the sites of care that deploy evidence-based diagnostic and treatment protocols and ensure appropriate testing is covered. Offer a network-based program, ensuring adequate network coverage with a broad range of oncology specialists for increasingly unique cancer care scenarios.
5 | Review utilization management in place and its impact on timely and appropriate treatment.

Related Resources:

Patient Experience

Cancer is a devastating disease, but the diagnosis also too frequently leaves patients uncertain about available resources and seeking answers to questions regarding their treatment path and financial impact. With a growing number of care options available, it’s often difficult for cancer patients to navigate to the best option for them. By having the right supporting programs and partners in place, employers can ensure that employees dealing with cancer are being directed to higher-quality sites of care and can integrate virtual care with in-person care wherever possible. Finally, employers must reassess leave of absence policies globally to address the needs of employees undergoing cancer treatment.

Key areas of focus for a successful strategy:

1 | Utilize navigation and second opinion services to ensure easy access to the right care and necessary patient support.
2 | Consider offering and informing patients about other programs and services that may address significant concerns or their unique needs, such as fertility preservation services for patients of reproductive age, financial counseling and medical leave programs for those concerned about the high cost of cancer and their ability to work.
3 | Provide a flexible work environment to accommodate treatment and recovery needs.
4 | Encourage in-network providers to consider the unique needs and preferences of individual cancer patients, which may require flexibility in the programs offered.
5 | Foster a workplace culture that supports cancer as a chronic condition, including by providing necessary accommodations.

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Related Resources

Managing costs related to cancer care, staying current about innovations in the oncology space and maintaining awareness of fast-changing cancer patient and caregiver needs are complex tasks and key challenges for employers. As employers consider a comprehensive oncology strategy, they must keep in mind that the reality of cancer care and its affordability may be very different for individual members of their population, depending on the type of cancer and treatment recommended, as well as the patient’s geographic location and income level. Cancer is an inequitable disease, so it is incumbent upon employers to play a role in reducing the outcome gaps and using the best resources for those who need them most.