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Transcript
Katherine Banwell:
Managing a bladder cancer diagnosis can bring emotional challenges like anxiety and fear of recurrence. Why is it important for patients to share emotional concerns with their healthcare team?
Dr. Piyush Agarwal:
I think that a big part of managing one’s cancer is also to manage one’s mind and emotions. Personally, I feel that if you can’t manage those other symptoms, unfortunately, your outcome may not be as good. I do believe in this thought of the mind having an important role in healing the body. I just think emotionally, we need to provide support for our patients to get through this really rough time. I often will tell patients, “Look, it’s normal to have what we describe as an adjustment reaction to bad news.”
It’s normal to feel angry and agitated and anxious, but if that’s debilitating and the patient is having difficulty coping with that, then I often recommend discussing with their primary care provider potentially the use of a low dose antidepressant for a short period of time. And I think there should be no shame in considering something like that. I think of that just as another way, an adjunct to proper treatment for the cancer. There are some patients who have the ability to cope with this type of news and have a very supportive family, but there are other patients that may not have those assets, and so they need some help.
I do think that there is a role for that, and we as providers should discuss that and bring that up with our patients so that they’re aware that those are available to them should they need them. I also like to set expectations for them, and I think that can be helpful. I tell them, “Look, for low-risk tumors, I tell patients it’s really unlikely there’s going to be progression. And as long as you keep up with appointments, we can usually manage your bladder. We may have to do some procedures along the way, but usually as long as your bladder is functioning, you can maintain your bladder.”
Whereas for my high-risk patients, I tell them, “Look, we’re going to do our best to preserve your bladder, but you have to understand that if none of these therapies work, then potentially bladder removal or radiation are things down the road.” And I think if I set expectations for people, it’s a little bit less traumatic if their tumor is not responding to the treatments that we’re using, and we start escalating therapy. I think if they know that that’s a possibility, it’s a little bit easier for them to comprehend and adjust to it in the future.
Katherine Banwell:
Financial concerns are also common. Where can patients find financial assistance and resources?
Dr. Piyush Agarwal:
Yeah, so, unfortunately, there is this term of financial toxicity, and it’s a real entity, especially for patients under 65 who are self-employed and may not have insurance. Fortunately, a lot of medical centers will work with patients on providing reduced cost for evaluations. A lot of the manufacturers of some of these agents can offer their medications at a significant discount and in some cases just for a small co-pay. If patients – obviously we ask them to, if they have government benefits that they can potentially leverage, that is also an option.
Fortunately for bladder cancer, the average age is around 65, 66. Most of these patients have some sort of Medicare plan, and that usually will provide most of these standard treatments for bladder cancer. I find we really have to work with our underinsured patients under the age of 65. Those are patients that it’s challenging sometimes to provide appropriate care and limit the cost of that care, especially for those who kind of have their own small business and they really don’t have the insurance. There are things we can do to give them time to get insurance.
And there are procedures we can do and sort of one-time treatments we can do that will sort of treat their bladder and buy them some time to get the insurance they need. Unfortunately, I think this is a problem that affects all of healthcare in the U.S., is that we don’t have, unfortunately, universal insurance for those under 65. And it can be challenging for those patients in whom they don’t have insurance through employers.