Project Title Goes Here Second Line Optional Beyond the Disease: The Impact Goes Here Survivorship Subhead of Cancer on employers, benefit managers, health & disability insurers Implications & Opportunities Kristin Tugman, MS, CRC, LPC Director, Health and Productivity 1
Five-year Relative Survival (%)* during Three Time Periods by Cancer Sites 1975 -1977 1984 -1986 1996 -2002 All sites 50 53 66 Breast (female) 75 79 89 Colon 51 59 65 Leukemia 35 42 49 Lung and bronchus 13 13 16 Melanoma 82 86 92 Non-Hodgkin lymphoma 48 53 63 Ovary 37 40 45† Pancreas 2 3 5 Prostate 69 76 100 Rectum 49 57 66 Urinary bladder 73 78 82 *5 -year relative survival rates based on follow up of patients through 2003. †Recent changes in classification of ovarian cancer have affected 1996 -2002 survival rates. Source: Surveillance, Epidemiology, and End Results Program, 1975 -2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006 2
Cancer Survivorship: A Unum Snapshot • Point of Reference: Over the past 5 years, cancer has been the number one long term disability claim within the Unum US book of business. There has been a 16% increase in paid cancer claims from 2001 to 2005 • Cancer Claims Account for: – Distribution: • 12% of all LTD claims - 28, 400 LTD claims (2001 – 2005); 31, 000 STD malignant cancer claims were filed over the same 5 year period (2001 – 2005) – Gender: • 65% LTD cases are female, 21% of LTD cases are breast cancer cases • 73% STD cancer cases are female – Age: • 87% LTD cancer cases are > age of 40 53% LTD cancer cases are between 50 to 65 • Average STD cancer claim - 52; Average of LTD cancer claim - 51. 4 • Age of cancer claimant trending up over 5 year time frame – Claims Source: • The healthcare industry is #1 employer source of LTD cancer claims (18%) • 50% of LTD cancer claims originate from employers with > 2, 000 employees 30% come from employers with a work force size of < 500 employees – Outcomes: • 19. 6% of LTD cancer cases closed as RTW • 26. 0% of STD cancer cases closed as RTW • 23% of LTD cancer cases close due to death 3
Selected Cancer Disability Claim Summary 2001 -2005 LTD STD 8, 400 estimated cases 17, 000 estimated cases By percent Open Died RTW Closed* Breast 10. 3% 24. 3% 51. 0% 14. 4% 2. 0% 46. 9% 51. 1% Colon 13. 6% 44. 5% 30. 2% 11. 7% 4. 9% 41. 4% 53. 7% Prostate 12. 7% 34. 9% 31. 0% 21. 4% 1. 1% 66. 3% 32. 6% *Other reasons to close a claim: ● Maximum benefits ● Not disabled – no RTW ● Not own occ. disabled ● Required information not provided © 2007 Unum Group. All rights reserved June, 2007 4
STD RTW Rates LTD RTW Rates • Return to work, STD by year of claim receipt • Return to work, LTD by year of claim receipt • Increased STD RTW success over 5 year claims period • Increased LTD RTW success over 5 -year claims period © 2007 Unum Group. All rights reserved June, 2007 5
Short Term Disability: Observations & Findings • STD Profiles & Patterns There was a significant improvement in RTW by year of claim receipt. STD Breast cancer 96% increase STD Colon cancer 65% increase STD Prostate cancer 72% increase Some variation in RTW outcomes was seen by the industry. Manufacturing had uniformly better than average RTW results. Hospitals and other healthcare were uniformly worse. • STD RTW Predictors: Age does not predict RTW success during the STD claim period. Claimants with higher salaries have a greater chance of a RTW in STD period. © 2007 Unum Group. All rights reserved June, 2007 6
Long Term Disability: Observations & Findings • Patterns & Profiles: There was a significant improvement in RTW rates by year of claim receipt. LTD Breast cancer 14% increase LTD Colon cancer 23% increase LTD Prostate cancer 36% increase RTW decreases rapidly as claimant age increases and time on claim. STD to LTD integration was a positive factor in RTW for breast cancer claimants, a negative factor for prostate cancer claimants, and made no difference for colon cancer claimants. • LTD RTW Predictors: Age does predict RTW success. Claimants with higher salaries have a greater chance of a RTW. Females with colon cancer have 47% more likelihood of a RTW. © 2007 Unum Group. All rights reserved June, 2007 7
Points of Impact *Indicates statistical significant difference at 95% confidence. © 2007 Unum Group. All rights reserved June, 2007 8
Cancer Survivor Critical Issues: Productivity: “Chemo. Brain, ” i. e. short term memory, word association difficulties, a type of dyslexia was reported as a common experience. Fatigue was felt to be the single biggest productivity barrier. Fatigue was not resolved by sleep or rest. Work-site flexibility was considered the key to continued productivity – work tasks need to be adapted to chemotherapy demands. Work transitions out and back to work are an absolute. Benefits & Financial Security: Beyond survival, loss of job was reported to be the #1 concern of the survivors. An early affirmation of job security or continued connection to company was felt to be a critical part of the treatment process. Providing benefit programs that support continued work and cover the ongoing cost of medical care (especially pharmacy) were considered a necessary part of the ongoing work life of a cancer survivor. Emotional Survival & Coping Strategies: All reported significant depression during the course of treatment. The depression fluctuated daily, weekly by the outcome of the treatments, changing lab tests. For some, a chronic depression continues. All indicated that a dramatic change in their point of view and priorities occurred. A new identity was shaped to a new reality. © 2007 Unum Group. All rights reserved June, 2007 9
Transitional Work & Work site Accommodations Employer Applications for Fatigue • Flexibility at work station • Time/space for breaks • Set expectation upfront • Address co-workers issues • Plan most productive work schedule around worst fatigue times Employer Applications for Chemo-brain • Accurately define impairments that enhance or limit work capacity • Set productivity expectations clearly and up-front • Coach and provide feedback on performance • Define solutions for specific job tasks issues, such as checklists to ensure accuracy 10
Covering Financial Gaps • Opportunities for employers – PTO or vacation donation – Flexible schedules – Setting expectations – Communication to other employees – Workplace accommodations • Offer employees: – Access to a comprehensive health plan (employer and/or employee paid) – Access to disability plans through work – Option to buy additional coverage (cancer, critical illness) through the worksite. • Education regarding the value of benefits and benefit options – Case Study #1 – Working and in treatment 11
A Product/Research Application: Critical Illness ** "Illness and Injury as Contributors to Bankruptcy, " Himmelstein et al. , Health Affairs Web Exclusive, http: //releases. usnewswire. com/Get. Release. asp? id=42456. Cited Feb. 2, 2005. 12
Employer Message: A Productivity Rx • Manage the productivity impact @ diagnosis: • Avoid premature work or career decisions. Diagnosis does not mean disability or death. • Provide appropriate communication with co-workers. • Give “permission” to engage in treatment. • Understand employee & caregiver presenteeism. • Build transitions: • Expect financial gaps created by non treatment costs – fill the gaps. • Explore employer-healthcare insurer partnerships that create accessibility to new therapies. • Performance Management: Understand the “good” employee to “bad” employee progression. Transitional Work Full work Capacity Stay at work Stay at Work ) (preserve productivity) Absence from Work from work Return to Work work ) (restore productivity) 13
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