Using Communication to Build Stronger Relationships After a Cancer Diagnosis

Ali Schaffer, LCSW
Manager, Patient and Family-Centered Care at Vanderbilt-Ingram Cancer Center

Many people feel a loss of control after a cancer diagnosis.  This feeling, along with the triage-cancer-blog-relationshipsother emotional responses, can impact many areas of life, including intimate relationships.  Even without a cancer diagnosis, relationships are complicated and require time, energy and work to be successful.

Cancer is happening to both of you.  “The unique dynamics that define each couple are in precarious balance during good times and easily upset during crisis.” -Jane Hill, CURE Magazine

For many people, cancer represents a crisis and a lot of change(s).  During a crisis, such as cancer, it can be helpful to stop and return to the basics as a way to stabilize yourself and/or your relationships.  Through clear, honest and open communication you may experience a stronger relationship.

People cope differently…in life and with cancer.

In addition to acknowledging each persons’ individual coping style and response to cancer (which may change over time), communication is one of the most valuable tools that can help you and your partner connect during this stressful time and build/maintain a strong relationship.  Each relationship, with or without a cancer diagnosis, has unique strengths and weaknesses.  And, the pre-existing dynamics of the relationship will likely continue to impact the relationship post-cancer diagnosis.

Many couples benefit from working with a licensed professional for additional guidance to navigate the common issues and communication challenges associated with the unique experience of living with cancer.

Here are some tools and thoughts for creating meaningful and productive communication within your relationship:


  • Discuss ALL of your feelings.
  • Set aside some time to create safe space in which to talk about your feelings and work to understand the other persons’ feelings.
  • Listen with a sense of curiosity, reflecting back what you hear, acknowledge your partner’s feelings and take in what he/she has said before you respond, even if you disagree.
  • Take relaxing breaths.
  • Ask for a time-out.
  • Use “I” statements.
  • Be willing to ask for help.
  • Share expectations of yourself and others.
  • Assumptions can be
  • Sometimes you don’t need answers, you just need someone to listen.


  • “We’ve never talked about this before.”
  • “I’m embarrassed.”
  • “I get so emotional/angry/mad/sad when we talk and it makes it difficult for me to clearly say what I mean.”
  • “He/She doesn’t want to talk about it.”
  • “It never seems to be the right time.”
  • “I don’t know what to say, or how to start a conversation.”
  • “He/She won’t listen to me.”


  • Priorities-does anything need to be changed?
  • Meaning of cancer and impact of treatment
  • Intimacy and sex
  • Needs and wants
  • Personal/Caregiver/Couple/Family goals
  • Finances
  • Feelings
  • “I see you…and I appreciate…”
  • What is fun?
  • Healthcare navigation
  • Getting back couple time
  • How can we create a cancer-free zone?
  • What happens after treatment ends?
  • Changes in roles

Initially, it may feel difficult or awkward to use these communication tools or to initiate these types of conversations.  Overtime, it will likely become easier and feel more natural to communicate with your partner and ultimately feel heard, understood and supported.  The information and tips included are suggestions, and it might take multiple attempts to find what works for you and your partner.  It is also important to revisit these topics and techniques as your needs and responses will change.  Hopefully, this will help you and your partner to create meaningful dialogue that can strengthen your relationship and aid your ability to cope with cancer.

For more practical tips and tools to strengthen your relationship, tune into to the webinar on March 22, 2017! Register today!

Prescription Drug Coverage: New Recommendations from the National Association of Insurance Commissioners

As someone dealing with cancer, you are probably no stranger to the exorbitant costs of triage-cancer-blog-rx-drugs-naicprescription drugs.  In fact, the cost of all drugs, not just cancer drugs, has received quite a bit of news coverage lately. Everyone admits there is a problem, but very few have identified any solutions.  Now, the National Association of Insurance Commissioners (NAIC) has done just that.  At the NAIC’s summer meeting in August, a report was issued with a list of recommendations for state and federal policymakers to improve access to affordable prescription drugs.

Key Recommendations:

  • Limit consumer out-of-pocket costs, by, for instance, prohibiting co-insurance for prescription drugs
  • Prohibit insurance companies from changing their formulary mid-year, if it negatively affects enrollee access to drugs
  • Limit the number of drug tiers that insurers can use
  • Require formularies to be updated weekly and include information about drug tiering, the actual dollar amount of any cost-sharing, any utilization management or network restrictions, and the process to request a drug exception, among other information
  • Adopt standardized plans with meaningful cost-sharing limits to lessen the effects when an insurance company uses drug tiers
  • Collect standardized, plan-level data to enable the development of consumer tools and apps
  • Solicit feedback from external stakeholders—such as advocates, other state agencies, ombudsmen, and independent medical experts—to inform the formulary review process.

Frustratingly, these recommendations won’t translate into meaningful change for quite some time.  Still, without consumer advocates starting the conversation about reform, change would never happen.

Your Year End Tax Planning Starts Now!


Back to share more expert advice is financial planner, Kristi Sullivan! Today she is sharing some practical end of year tax tips for individuals and small business owners.

Think you can wait until December 31st to do tax planning for 2016?  Think again!  Starting your tax to-do’s earlier in the year makes life easier for your CPA, financial advisor, AND you.

Thanks so much to Elizabeth Moore, CPA and Partner at Ryan, Gunsauls & O’Donnell, LLC for these top 5 actions to take NOW.

  • Get your books and records in order for the year (i.e., record all of your cash receipts and disbursements in QuickBooks or the software of your choice, reconcile your bank and credit card accounts, update your mileage logs, gather receipts to document expenses, etc.).
  • If you haven’t met your deductible, get all of those medical and dental appointments out of the way and PAID for by check or credit card prior to year-end.
  • Take inventory of your business fixed assets (i.e. furniture, fixtures, equipment, vehicles, etc.) NOW and determine what you need to buy this year, instead of waiting until 12/31.  Not only must the purchase occur prior to 12/31, it must be placed in service prior to 12/31 to be eligible for depreciation.
  • Start researching the business vehicle of your choice, NOW, instead of on 12/31.  To establish adequate business use (i.e. 50% or more) of a vehicle to get the maximum amount of depreciation deductions, buying well before year-end is a must.
  • Donate to your favorite charity including churches, schools, or other 501(c)(3) public charities.  You can even donate up to $100,000 directly from your IRA to a charity of your choice, which counts toward your Required Minimum Distribution (RMD) for the year and isn’t includable in your adjusted gross income for the year, which is a huge tax benefit.

The post Your Year End Tax Planning Starts Now! first appeared on Sullivan Financial Planning.

The Patient Protections in Clinical Trials

This is the sixth blog in a series on clinical trials.  To read the other blogs in the series, visit:

For more information about clinical trials, visit:

If you are eligible and decide to join a clinical trial, you will be required to review and sign informed-consentthe informed consent forms. This can be an overwhelming process, but it is how you will learn all the details of the trial, including the potential benefits and the possible risks, and give your permission to be treated.

Who Does It Protect?

Informed consent provides patient protection as much as does for health care providers. Included with informed consent comes your right to privacy, as well as your right to a full and complete understanding of the trial.

Am I Signing Away My Rights?

Signing your informed consent papers forfeits none of the rights you might expect.  For instance, you do not forfeit your right to protections if your health care provider acts in a negligent manner.  You also do not forfeit your right to leave the trial at any point, with no penalty.

Will I Have Time to Consider This?

Informed consent is many pages of detailed information.  You will be given time to take that document home to review with our loved ones.  You will also have time to ask for clarification if you do not understand something you read.  Treatment cannot begin without your informed consent and a complete understanding of the details, benefits, and risks of participating in a trial.

By participating in a clinical trial, you are helping to advance medical science.  It is no small gift that you are giving and your rights are going to be protected.  Read your informed consent closely, talk with your health care team, and make sure that you fully understand the study before you sign it.

Balancing Cancer & School

After a cancer diagnosis, children, adolescents, and young adults are likely to experience triage-cancer-blog-schoolmedical and non-medical complications in school. Therefore, parents and teachers should be aware of the educational issues related to cancer in order to meet their needs.

High-risk Cancers and Treatments

There are some cancers that cause children to have a higher risk of educational difficulties. These include brain tumors, tumors involving the eye or ear, Acute Lymphoblastic Leukemia (ALL), and Non-Hodgkin’s Lymphoma. There are also treatments, such as methotrexate, cytarabine, surgery involving the brain, and radiation to the brain, ear/infratemporal region, cisplatin, or carboplatin, that place children at a higher risk for developing learning and memory problems. In addition, research continues to uncover the connection between cognitive function and treatment for all types of cancer.

Common Problems Areas

The cancers and treatments mentioned above may potentially pose challenges with:

  • Attention/ability span
  • Ability to complete tasks on time
  • Concentration
  • Handwriting
  • Math
  • Memory
  • Organization
  • Planning
  • Problem-solving
  • Processing
  • Reading
  • Social skills
  • Spelling
  • Vocabulary

Dealing with Learning Problems

After treatment, it can be valuable for children to undergo a specialized evaluation by a pediatric psychologist; the examination will reveal how he/she processes and organizes information. If your child or student is having difficulties in school, make an appointment with the parent/teacher to establish a specialized plan. The plan should consist of specifically tailored strategies that will help the child better succeed. Examples of strategies that often help children with cancer-related educational problems are:

  • Seating near the front of the room
  • Modifying the test
  • Prolonging assignment due dates
  • Allowing the use of a calculator, keyboard, or tape-recorded textbooks and lectures
  • Assigning of a classroom aide

There are resources available. For example:

 For more information about navigating cancer and college, visit:

Laws That Protect the Rights of Students with Disabilities

The Individuals with Disabilities Education Act (IDEA), the Rehabilitation Act of 1973 (section 504), and the Americans with Disabilities Act (ADA) were established to protect the rights and meet the needs of people with disabilities, such as cancer.

Individuals with Disabilities Education Act

The IDEA provides “free, appropriate public education which includes special education and related services, to meet the unique needs of all disabled individuals between the ages of three and 21” (34 Code of Federal Regulation [CFR], Sec. 300.1[a]). This law focuses on protecting students from kindergarten through 12th grade. To receive these services, children must qualify under one of these disabilities: autism, deaf/blind, deafness, hearing impaired, mental retardation, multiple disabilities, orthopedic impairment, serious emotional disturbance, specific learning disabilities, speech or language impairment, traumatic brain injury, visual impairment including blindness, and other health impairments. If the child qualifies, school districts are required to provide access to special services and accommodations. Children are reassessed every three years.

Rehabilitation Act of 1973 – Section 504

Section 504 of the Rehabilitation Act states that no individual with a disability “be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance or any program or activity conducted by any executive agency” (34 CFR, Sec. 104.4). This law focuses on protecting students from kindergarten through 12th grade and at any or college or graduate school that receives federal funds. Accommodations are provided for students with chronic illnesses such as cancer, and other disabilities that inhibit them from performing one or more major life activities. Some accommodations include extra time for assignments and tests, seating near the front of the classroom, using a calculator, or having a note-taker.

Americans with Disabilities Act (ADA)

This law prohibits discrimination in the workplace, transportation, communication, government, and public accommodations for people with disabilities. As adolescents and young adults begin to seek jobs and pursue their career goals, the ADA can provide protection against discrimination and access to reasonable accommodations. For more information about the ADA and reasonable accommodations, view these Triage Cancer Quick Guides: and

Do You Need a Special Policy for Cancer?

Some employers offer supplemental health insurance policies to cover the costs that your Triage Cancer Blog Cancer Policytypical health insurance policy doesn’t. These policies could cover things related to a “critical illness” or a specific medical condition, like cancer.

These are policies that your employer pays for as part of an employee benefits package, or that you can buy directly from the insurance company through your employer.  AFLAC would be an example of a company that offers these policies.  If you aren’t sure if this type of policy is available to you at work, you’re your human resources representative, or whomever handles the employee benefits at work.

Depending on where you live, you may be able to buy a supplemental cancer insurance plan directly from an insurance company.

Be aware

Before you considering buying a supplemental plan, here are some things that you should consider.

  • The two types of policies
    • There are two different types of cancer insurance plans. The first is very similar to a typical health insurance plan in that it pays for a certain portion of your medical expenses. The second pays a predetermined lump-sum for various expenses, such as transportation and lodging when you need to travel to receive treatment. It may also pay cash payments when you have surgery or receive other types of medical care. The lump sum payments can be used for anything, including your daily living expenses.
  • Different plan = different coverage
    • Depending on the cancer insurance plan, a policy can cover a lot of medical and nonmedical expenses, including co-pays, hospital stays, treatments, fertility preservation and dietary assistance. However, there are very few plans that will cover this range of expenses. Additionally, they won’t pay for costs that are already covered by another health insurance plan.
  • Critical illness insurance is a reasonable option
    • Some insurance providers offer critical illness insurance along with a cancer plan. This kind of insurance provides coverage for strokes, heart attacks, and other critical illnesses.
  • You may not be able to purchase cancer insurance if you had cancer in the past
    • If you have been diagnosed with or treated for certain kinds of cancers or other medical conditions in the last three or five years, some companies will deny you coverage The protections against pre-existing condition denials that are available for regular health insurance coverage, do not apply to these supplemental plans.
  • Know your history
    • A family history of cancer may be a good indication to purchase cancer insurance for yourself of your family members.
  • Cancer insurance is not a stand-alone product
    • Cancer insurance is meant to cover the gaps in your regular health insurance plan, not serve as a stand-alone product to cover your medical expenses.
  • Read the fine print
    • Read everything before you buy a policy because many have gaps in the terms. For instance, some policies’ coverage kicks in months after purchasing while others stop paying out after a certain time.

3 Steps to Building a Personal Medical Record

by Amy Thompson

A personal medical record is a compilation of all your medical information, including test personal-medical-record-blogresults, treatment reports, and notes written by your health care team. While each office and facility keeps a record of your care, it’s important to have a complete file for your own use, so you can share it with a new doctor, review at home to better understand your treatment, or manage your health insurance claims, taxes, and other legal matters. Here is what to include, how to compile it, and the best ways to organize it and store it for safekeeping.

Step 1. What to Include

A complete personal medical record should include the following information:

  • Your diagnosis, including the specific cancer type and stage
  • Date you were diagnosed
  • Copies of diagnostic test results and pathology reports
  • Complete treatment information, such as chemotherapy drug names and doses, sites and doses of radiation therapy
  • Start and end dates for all treatments
  • Results of treatment and any complications or side effects
  • Information about palliative care, including medications for pain management, nausea, or other side effects
  • A schedule for follow-up care
  • Contact information for the doctors and treatment centers involved in your diagnosis and treatment, as well as others who have cared for you in the past, such as your family doctor
  • Dates and details of other major illnesses, chronic health conditions, and hospitalizations
  • Family medical history
  • Details of past physical exams, including cancer screening tests and immunizations

Step 2. How to Compile Your Personal Medical Record

Keeping track of your medical records might feel like a huge task, but it’s worth it in the long run.  The American Society of Clinical Oncology (ASCO) offers cancer treatment plans and summaries that can help keep track of information about your diagnosis and treatment.

Compiling this information on an ongoing basis will create a complete and easily accessible view of your health. Remember these strategies to help you collect the latest copies of your records:

  • When you have a diagnostic test or procedure, ask for a copy of the results or report
  • At each appointment, ask your doctor or nurse for a copy of anything new that’s been added to your file or electronic medical record
  • If you spent time in the hospital, ask for a copy of your records when you’re discharged
  • Keep copies of your medical bills and insurance claims as they occur
  • Talk to your doctor if you need help figuring out which records to include
  • If collecting this information feels overwhelming, ask your friends or family for help. While you have to sign off on any requests for personal medical information, they can fill out forms or make phone calls for you.

Step 3. Organizing and Storing your Personal Medical Record

There are different ways to organize your medical records. To help figure out what works best for you, talk to other cancer survivors about what they have done, or visit a local office supply store to see what sort of organizers are available. Here are a few options:

  • Use a filing cabinet, 3-ring binder, or desktop divider with individual folders
  • Store files on a computer, where you can scan and save documents or type up notes from an appointment
  • Store records online using an e-health tool; certain online records tools may be accessed, with permission, by doctors or family members
  • Organize your records by date or by categories, such as treatments, tests, doctor appointment, etc.

However you decide to store your personal medical record, be sure to keep them in a secure location, like a safe deposit box, fireproof home safe, or password-protected files. If you decide to use an online service, carefully check the security and confidentiality measures the company uses to protect your information. A family member or friend could also keep a copy in case of emergency.

Get more tips for organizing your medical records.

This post originally appeared at on August 25, 2016. © 2005-2016 American Society of Clinical Oncology (ASCO).

Clinical Trials and The Cost

triage-cancer-blog-clinical-trials-costOne of the first questions you or your loved one should consider when thinking about participating in a clinical trial is the cost and whether your medical insurance will cover it.  There is not one answer to this question, but let’s look at a big picture.

In most cases, when a patient enrolls in a clinical trial, the study sponsor provides the new treatment at no cost and pays for any tests, procedures, or doctor visits. Some sponsors go even further and pay for things like travel time and mileage.  It is important to find out what cost are covered by the study and if you will be stuck with any of the expense.  At this point, you also should look at your insurance coverage.

Private Insurance

As of January 1, 2014, the Patient Protection and Affordable Care Act required that non-grandfathered health plans (i.e. those that were not in place before March 23, 2010) cannot deny a qualified individual participation in an approved clinical trial, or deny or limit the coverage of “routine costs” in connection with participation in the trial.  An “approved clinical trial” is deemed as one that test ways to prevent, detect, or treat cancer and are funded or approved by the federal government and have submitted an FDA Investigational New Drug application (IND) or are exempt from IND requirements.  Routine costs” are those that would normally be involved in standard of care, such as doctor visits, blood tests, imaging scans, etc.

State laws may go even further in protecting consumers’ rights to participate in clinical trials.  Thirty-seven states and the District of Columbia all have laws on the books regarding clinical trial coverage.  For specific information about your state, go to


Unfortunately, the federal government does not require states to cover clinical trials through state Medicaid plans, so coverage depends on the state in which you live.  For specific information about your state, go to


Like private insurance, Medicare covers routine costs of items and services in covered research studies. Examples of these items and services include room and board at a hospital, the treatment of side effects and complications that may occur as a result of the study, and operations to implant an item that is being tested.  For a full understanding of Medicare coverage for clinical trials, go to

TRICARE and Veterans Affairs

Our military members and families also have some coverage for clinical trials.  TRICARE will reimburse the medical costs related to taking part in National Cancer Institute (NCI) sponsored trials for cancer prevention and treatment.  Veterans Affairs allows eligible veterans to participate in NCI-sponsored clinical trials at VA Medical Centers.

There is good news out there about clinical trial coverage, but you have to your due diligence.  Make sure you ask what the study covers and then get a full understanding of what your insurance covers.

For more information about participating in a clinical trial, visit or read other blogs in this series at

A New Resource for Those Considering a Clinical Trial: About Clinical Trials (ACT)


About Clinical Trials (ACT) is a collaboration between the American Cancer Society and Genentech.  Its aim is to increase patient interest in and awareness of cancer clinical trials through educational patient resources.  The idea is to empower people to understand cancer clinical trials and discuss this option with their doctors and loved ones.

Visit to learn more about clinical trials and ACT, including:

  • Six informational videos
    • Why Should I Consider a Clinical Trial?
    • How Will I Know if a Trial Is Right For Me?
    • How Should I Prepare for Discussions With My Doctor?
    • What Standards Are in Place to Safeguard Trial Participants?
    • What Is Informed Consent?
    • Where Can I Turn for Information and Support?
  • A patient discussion guide
  • Responses to common misconceptions about cancer clinical trials
  • List of helpful resources

If you prefer to talk with someone by phone about your clinical trials options, you can call the American Cancer Society at 1-800-227-2345 to request an ACT patient kit, which contains and educational brochure with a DVD and a USB drive.

Considering a clinical trial can be an overwhelming process.  Take advantage of any and all the resources out there.

For more information about clinical trials, read the other blogs in this series: