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Changing the Trajectory: How the Little Things Make a Big Difference in Cancer Treatment

When someone is fighting cancer, they’re fighting more than a disease. Patients often face serious strains on their time, energy, and ⎯ most severely ⎯ finances. Nobody is more familiar with this struggle than the case workers who witness it first-hand day after day.

“Research clearly shows that concerns around affording care is far and away the number one stressor faced by our patients,” Greg Bankoski, a case worker at Duke Cancer Institute, told us. “There’s not even a close second.” 


We recently spoke with Greg and his fellow caseworker Terri Stong to learn more about how they help patients get the resources they need to make it through. We wouldn’t be able to serve our community without the tireless work of these heroes, and we’re excited to share with you a little more about their work on the front lines of cancer treatment.



Caring Community Foundation: What is an issue cancer patients face that most people might not be aware of?


Terri Stong: We’re seeing more and more patients struggle to take care of their medical needs because of what we call “social determinants.” These are patients who are under immense practical pressures. Housing problems. Food insecurity. Transportation issues. Unemployment. Disabilities. Illiteracy. Depression or anxiety. The list goes on. All of these practical pressures directly affect the success of treatment and remission rates. 


When patients first come to the clinic, we determine if they are facing any social determinants that could get in the way of their treatment. As social workers, it’s Greg’s and my job to ensure these factors don’t affect their outcomes.


CCF: Can you talk more about the financial struggles a patient might face and how it can affect treatment? 


Greg Bankoski: The average out of pocket cost for a cancer patient with employer-sponsored insurance is $50,000 or more. Often these people struggle to keep working because of fatigue or full-on pain. Their spouses struggle to keep working because of their caretaking responsibilities. As you’d imagine, financial concerns begin to snowball. For financially vulnerable patients, this situation can quickly become toxic. 


If a patient and their family was stretched thin to begin with, a cancer diagnosis can feel like financial catastrophe.

When we can step in and help with urgent needs ⎯ something Caring Community Foundation is amazing at ⎯ these patients experience real astonishment and joy. I can’t count how many times I’ve seen tears. It could be something that seems small. A gift card. A rent payment. Those things are powerful. Patients are so surprised and moved by the generosity of other people.


TS: It can literally change the trajectory of someone’s treatment. It can take them out of a very bad moment and launch them into a better outcome. I’ve seen it happen.


GB: Research has shown that stress can seriously affect outcomes for cancer patients. So when we can help with a rent payment, transportation to treatment, whatever it is ⎯ that can positively impact their fight with cancer. We see it every day.

CCF: Do any specific examples or stories come to mind?  


TS: There’s a patient story I share a lot. We had a young, 39-year-old patient with a very treatable form of cancer. They’d caught it early. She was also recovering from substance abuse and had recently gotten her daughter returned to her. Her husband worked a seasonal job outdoors, so their income was inconsistent. This young woman was motivated to get treatment, but her situation had a lot of red flags. She was at risk of not being successful at her treatment. We were also worried about her risk of relapse. We were worried that she might lose her family, that she wouldn’t treat her cancer, and that it would kill her even though it was completely treatable.


For her, we were able to tap into resources that provided taxi vouchers for her rides to treatment. We connected her with Medicaid support. We worked also with her landlord to get part of her rent covered through CCF. She was diligent about following through with every resource we could connect her to. She was so incredibly grateful and followed through with every resource we connected her to. She got herself to every single appointment, successfully completed her treatment, and today she’s cancer free.


I share her story a lot because it’s a great example of someone who had a treatable cancer but a lot of barriers. She just needed a little help and access to resources.

GB: We’ve seen how reducing anxiety can reduce stress and inflammation in the body. It can help your immune system get better. Anything we can do to mitigate that anxiety can really help these patients focus on their treatment and have a great outcome.

Terri and Greg had a lot more to share with us about their work. Read part 2 of our interview!

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