Triage Cancer Joins the Metastatic Breast Cancer Alliance!

Metastatic Breast Cancer Alliance

Triage Cancer is proud to announce that we are a new member of the Metastatic Breast Cancer Alliance! We are committed to providing education and support in an effort to ensure that the metastatic breast cancer community has access to crucial information about practical issues to improve their quality of life.

What is MBC?

Metastatic breast cancer (MBC) is cancer that originated in the breast but has spread to other parts of the body, such as liver, lung, bones and brain. MBC is the cause 40,000 deaths every year in the U.S. Learn more about MBC.

MBC Alliance Mission

Triage Cancer believes that collaboration is the key to providing valuable information and practical tools on the many issues that arise after a cancer diagnosis, particularly to underserved members of the cancer community. In alignment with our goals, the MBCA’s mission is to:

Unify the efforts of MBC Alliance members to improve the lives of, and outcomes for, those living with metastatic breast cancer and their families through increasing awareness and education about the disease and advancing policy and strategic coordination of research funding – specifically focused on metastasis – that has the potential to extend life, enhance quality of life and ultimately
to cure.”

One of the resources offered by the MBC Alliance is the Metastatic Trial Search, which is the first-ever clinical trial search engine designed specifically for people with MBC.

Metastatic trial search

Triage Cancer Resources & Tools

As a member of the MBC Alliance, we are committed to providing up-to-date and relevant resources to those coping with MBC. We offer a number of educational resources that have particular relevance to the metastatic community, such as our Quick Guides on disability insurance, clinical trials, and estate planning. Click here to watch our recent webinar on Taking Time Off Work & Disability Insurance.

Given the long-term treatment that many in the metastatic community receive, the financial burden can be significant. Triage Cancer hosts, which provides tailored information on topics that can have an impact on finances after a cancer diagnosis.

We also offer a number of free educational events throughout the year, which cover topics that pertain to the metastatic community:

Triage Cancer looks forward to working with the Alliance to continue to support the MBC community. For more information about the Metastatic Breast Cancer Alliance, visit

Medicaid Work Requirements & the Cancer Community

There has been discussion in the news over the last few weeks about the President’s decision to allow states to require that people “work” in order to receive Medicaid. This is referred to as the Medicaid work requirement. We want to break down these changes for you and how this might impact the cancer community.

If you live in one of the states that is about to make changes to its Medicaid program, you should definitely keep reading.

What is Medicaid?

Medicaid is the federal health insurance program that covers more than 74 million individuals who have a low income, low resources, and meet some other category of eligibility, such as being a senior, a minor child, or having a disability (receiving Supplemental Security Income (SSI)). In 2014, the Affordable Care Act expanded access to Medicaid to all adults with an income level up to 138% of the federal poverty level ($16,753 for an individual in 2018).  Eliminating the low resource requirement and the requirement to be receiving Supplemental Security Income, made it much easier for someone with a cancer diagnosis to get access to Medicaid coverage, and ultimately get access to care.

While Medicaid is a federal program, it is administered by both the federal government and states. Since 2014, 32 states have expanded access to their Medicaid program under the ACA.

There is a lot of discussion about the number of people who receive Medicaid, but don’t work, and whether or not that is fair. Those who are in favor of work requirements for Medicaid believe that “able-bodied” adults should be working if the federal government is going to pay for their health insurance coverage.

Those who are opposed to work requirements are concerned how they might impact people who are unable to work for a variety of reasons or who live in communities where work is difficult to find. Advocates are concerned that the additional administrative requirements will cause people to lose vital coverage, that people will be discouraged from applying for coverage, and that the number of uninsured people will start to rise again.  One of the many benefits of lower numbers of uninsured individuals was that it decreases the amount of uncompensated care that hospitals provide. When hospitals have high levels of uncompensated care, they are more likely to close, which impacts access to care for everyone.

Who Receives Medicaid?

According to an analysis by the Kaiser Family Foundation, most Medicaid and CHIP enrollees would be actually be automatically exempt from the requirement because of their age or disability status.

Medicaid Work Requirements & the Cancer Community

What are the New Medicaid Rules?

In January, the Trump Administration announced its decision to make significant changes to the Medicaid program, by allowing states to apply for waivers to impose work requirements on Medicaid enrollees in their state. The Centers for Medicare and Medicaid Services (CMS) released rules for the states who want to apply for those waivers.

The rules forbids states from imposing work requirements on certain populations, such as the elderly, minor children, individuals who are pregnant, and those receiving SSI.

CMS also requires states to exempt individuals who are “medically-frail.” CMS defines “medically frail” as those who have “disabling mental disorders; chronic substance abuse disorders; serious and complex medical conditions; physical, intellectual, or developmental disabilities that significantly impact the ability to perform one or more activities of daily living; and those who meet Social Security disability criteria.”

While CMS does remind states to consider how some communities have high unemployment rates due to economic factors, it gives states significant flexibility to design their own requirements. CMS also suggested that states could allow for “community engagement” alternatives to work, such as job search, job training, volunteering, community service, or education.

Work requirements are likely to have an impact on everyone receiving Medicaid in a particular state, because everyone will have to document that they meet the requirements. And, the CMS rules allow for states to ask enrollees to certify they are still eligible as often as monthly.

Which States Want Medicaid Work Requirements?

These eleven states have already applied for waivers to add work requirements: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi (still in process), New Hampshire, North Carolina, Utah, and Wisconsin.  Additional states are considering submitting requests.

Medicaid Work Requirements

Since the CMS announcement, Kentucky and Indiana’s waivers have already been approved and those states are moving forward with implementing plans for a Medicaid work requirement.

Click here to learn more about the impact of the Medicaid waivers and to see what the states are asking for in their waivers.

What is in Kentucky’s Waiver?

Kentucky’s waiver requires people to work 80 hours a month, or alternatively to engage in job searching, job training, community service, or education. Drug treatment and caregiving for a non-dependent relative or another person with a disabling medical condition are also considered work activities.

Kentucky Medicaid enrollees can obtain an exception to the work requirement if they can verify one of the following during their month of noncompliance with the work requirement:

  • Disability, hospitalization, or serious illness of enrollee or immediate family member in the home;
  • Birth or death of a family member living with the enrollee;
  • Severe inclement weather including natural disaster; or
  • Family emergency or other life-changing event such as divorce or domestic violence.

A primary caregiver of a dependent minor child or adult with disabilities per household is also exempt.

In addition to the medicaid work requirements, the waiver also establishes premiums, deductibles, benefit restrictions, and six-month coverage lock-outs, while eliminating non-emergency medical transportation.

Also included in Kentucky’s waiver is the elimination of the 3-month retroactive coverage for most adults, including those who are medically frail. This was very useful for someone diagnosed with cancer, so that they could start receiving care while their Medicaid application was being processed.

To read a breakdown of Kentucky’s waiver, click here. These changes are set to begin being phased in on April 1, 2018.

However, advocacy groups in Kentucky have filed a lawsuit to stop the implementation of Kentucky’s waiver. Kentucky Governor Matt Bevin has signed an executive order stating that if the court does stop the work requirements, that the Governor will eliminate the expanded access to Medicaid in Kentucky entirely. This would result in 48,000 people in Kentucky losing access to their health insurance coverage.

What is in Indiana’s Waiver?

Indiana’s waiver was approved on February 2, and requires adult enrollees to work an average of 20 hours a month and it is phased in over time. It also has a long list of exemptions and alternatives to employment. In addition to the work requirement, Indiana will also implement a “lockout” provision.  Medicaid enrollees who fail to submit their paperwork showing that they still qualify for the program, will be blocked from coverage for three months. Click here to read Indiana’s Medicaid waiver.

More Information

Triage Cancer will continue to follow the changes to state programs and how those changes might impact the cancer community and share that information on our blog.  Stay tuned.

Changes Coming to Medicare

There are a number of changes coming to Medicare. Individuals who are already enrolled and new enrollees should both be aware of these Medicare changes.

A New Medicare Card

Sometime between April 2018 and April 2019, you will be receiving a new Medicare card that will not have your Social Security number on it. The cards will have Medicare Changesa new Medicare Number on them, which will be unique to you. This change will keep your Social Security number more secure, and help protect your identity.

The Social Security Administration is asking you to make sure that your mailing address is up to date.  If you do need to update your address, you can do so by calling 1-800-772-1213 or at They are also warning you to be aware of anyone contacting you about your new card.  The Social Security Administration will never call you and ask you for private information to get your card.  And finally, don’t worry if your neighbor gets their card before you do.  It will take some time to mail our cards to every Medicare member.

2018 Medicare Costs

For 2018, the Medicare Part B Deductible will be $183.  The Part B Standard Premium will be $134 or higher, depending on your income (see chart).  However, most people who get Social Security benefits pay less than this amount ($130 on average). You pay the standard premium amount of $134 (or higher based on the chart below) if:

  • You enroll in Part B for the first time in 2018.
  • You don’t get Social Security benefits.
  • You’re directly billed for your Part B premiums.
  • You have Medicare and Medicaid, and Medicaid pays your premiums.
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.
If your yearly income in 2016 was You pay (in 2018)
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less Your plan premium
Above $85,000 up to $107,000 Above $170,00 up to $214,00 Not applicable $13 + your plan premium
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $33.60 + your plan premium
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $54.20 + your plan premium
Above $160,000 Above $320,000 Not applicable $74.00 + your plan premium


The 2018 standard Medicare Part D (the prescription drug benefit) Deductible is $405. Once that deductible is met, your costs break out as follows:

Deductible: $0-$405 100% paid by Participant until the deductible is met
Initial Coverage Limit $3,750 in total drug costs 75% Paid by Medicare 25% paid by Participant


Between $3,750 and $7,508.75 in total drug costs

Brand Name Drugs:

50% Manufacturer Discount

15% Paid by Medicare


Generic Drugs:

56% Paid by Medicare


35% Paid by Participant




44% Paid by Participant


Above $7,508.75 in total drug costs 95% Paid by Medicare 5% Paid by Participant


Medigap Plans C and F

One useful way to reduce your out-of-pocket Medicare expenses is to buy a Medigap Plan. These are supplemental Medicare plans that cover some of the costs that Medicare Parts A & B don’t cover, deductibles, and co-insurance amounts.  There are 10 different Medigap plans, each labeled with a different letter, each having a different level of coverage.  One of the most comprehensive plans is Medigap Plan F, which includes coverage of:

  • Part A hospital and coinsurance costs up to an additional 356 days after Medicare benefits are exhausted
  • Medicare Part A hospice care copayment or coinsurance
  • Medicare Part B coinsurance
  • Medicare Part B excess charges
  • Medicare Part A deductible
  • Medicare Part B deductible
  • First three pints of blood used in an approved medical procedure (annually)
  • Skilled nursing facility coinsurance
  • Foreign travel emergency coverage (80%, up to plan limits)

Another popular plan is Medigap Plan C.  Plan C covers almost everything Plan F covers.  The one difference is that Part C doesn’t cover something called “Part B excess charge”.  The definition of that is “If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.”

You can see why these 2 plans are so popular.  In 2015, Congress voted to close these plans to new people in 2020.  Meaning, if you are new to Medicare in 2020, you won’t have the option of choosing these plans or if you are a current Medicare recipient looking to change Medigap plans, these plans won’t be available.

Between now and 2020, seniors and people with disabilities need to think about this carefully.  Right now, people turning 65 or just switching to Medicare from an employer plan can be accepted into any Medigap plan they choose, regardless of their health.  If they want to switch Medigap plans later on, insurance companies can look at their health, and either turn them down for that reason, or charge them a hefty premium for a pre-existing health condition. So, your first choice is important.

That said, should you just jump and buy Plan F while you can?  Maybe not.  Experts expect the premiums on Plan F to rise after they close the plans because there won’t be any new, relatively healthy 65 years olds to offset the costs of the aging people already in Plan F.  So choosing a Medigap Plan F now could lock you into a very expensive plan in the future.

Experts are recommending people look at Plan G.  This is a plan that is almost as comprehensive as Plans F and C, but it does require you to pay the Medicare Part B annual deductible.

Will Medicare Plan F premiums go up too much?  Will you develop a medical condition that makes moving from Plan F to another Medigap plan too expensive? These are things to consider.  Medicare offers a really helpful grid comparison of the different Medigap plans at Without a crystal ball, these choices are really hard, but know this, the clock is ticking.

How Medicare Covers Chemotherapy

Throughout our lifetimes, we enroll in health insurance for a variety of reasons. Medicare-ChemotherapyIt gives us access to doctors and provides preventive care and screenings for early detection of medical conditions. There’s no question, however, that the main reason we buy health insurance is to help us pay for major treatment if we are diagnosed with a serious illness such as cancer.

Many people who are new to Medicare or have been recently diagnosed wonder how Medicare covers various cancer treatments, such as chemotherapy. The good news is that Medicare provides extensive coverage of cancer treatment and cancer-related services.

Medigap supplemental coverage is also available to round out that coverage, help pay for your deductibles, and protect you from catastrophic out-of-pocket medical spending. Let’s look at how Medicare’s coverage of chemotherapy and other cancer treatments works:

The Parts of Medicare

Original Medicare has two parts. Part A is your inpatient hospital coverage, and this provides for your hospital room and some skilled nursing care. Part B is your outpatient coverage, which includes physician services, lab work, diagnostic imaging, preventive care, durable medical equipment, and much more. Part D provides prescription drug coverage. Click here for an explanation of Part C.

Although chemotherapy is often administered in a hospital or clinic setting, it generally falls under Part B, since chemotherapy is a treatment administered by a physician. Radiation treatment and some anti-nausea medications are covered under Part B as well, if the doctor prescribes them to you within 48 hours of a chemotherapy session. Otherwise, these would be covered under a Part D drug plan. Click here for a complete chart comparing drugs covered by Parts B vs. Part D.  In terms of chemotherapy coverage, this is how it breaks out:

  Covered by Part B Covered by Part D
Infusion drugs Drugs administered by an implantable infusion pump




Drugs administered by an external infusion pump that you use at home and your local DME contractor covers them under Part B.

Drugs administered by an external infusion pump outside of the home (i.e., in a skilled nursing facility or hospital) and your stay is not being covered by Part A or you do not have Part A.


Drugs administered by an external infusion pump that you use in the home, but your Durable Medical Equipment contractor does not cover them under Part B for use in the home.


Infusion drugs administered at home without an infusion pump at home. One example of this is an IV push.

Injectable Drugs The drug generally cannot usually be self-administered and your doctor provides and administers the drug to you. You can buy the drug at the pharmacy and it is either administered by your doctor or you administer the drug yourself.
Oral Anti- Cancer Drugs It is an oral anti-cancer drug that was once available only in an injectable form that was covered by Medicare. You or your doctor can administer the drug. It must be used to treat cancer. You use the drug to treat a condition other than cancer.
Oral Anti-Nausea Drugs (antiemetics) Must be related to cancer, used as a full replacement for intravenous treatment, and administered within 48 hours of cancer treatment. It can be administered by yourself or by a doctor. The drug is used for conditions other than cancer.


It is used more than 48 hours after cancer treatment or is not a full replacement for intravenous treatment.

Part B has a small annual deductible that you must pay. That deductible is $183 in 2018. Then, Part B pays for 80% of covered services that you receive. You are responsible for the other 20%. This is called your Part B co-insurance. There is no out-of-pocket maximum for Part B, so your expenses could be high.

That is why a Medigap plan can be helpful to pay for that co-insurance and other Medicare-related out-of-pocket costs, such as deductibles and copays. You can find out more information about Medigap plans here.  You may also find a Medicare Advantage plan helpful to lower your out-of-pocket costs.  For more about Medicare Advantage, click here.

Creating A Sanctuary At Home For Your Loved Ones

By Jane Jenkins, a freelance writer

More than 1.6 million new cases of cancer are diagnosed every year. When cancer Home-Sanctuarypatients hear their diagnosis, they know that a potential struggle lies ahead of them including surgery, treatment, and a change in lifestyle habits. If you’re living with a loved one who’s going through cancer, you can ensure that your home is a sanctuary for them. Research has found that one’s environment can have a large impact on mood, but a happy home environment is about more than having bright colors on the walls. Your loved one who’s been diagnosed with cancer will need privacy when they want to be left alone with their thoughts and a stress-free space where they can rest between treatments, for instance. Here are other things you can do to make them comfortable and happy.

Keep It Clean

Cleanliness is important for cancer patients, whose treatments can lower their immune systems. Clean floors, counters, and pay special attention to the bedroom. If your loved one spends lots of time in there, it should be spotless to prevent infection. Bedding should be washed in hot water once a week to kill dust mites. Mop the floor and make sure you use antibacterial household cleaners to kill germs.

It could also be a good idea for your loved one to get into the habit of kicking off shoes before entering the bedroom as any germs or pollen collected from the garden could end up in this room, where they can cause allergies. Allergic reactions are commonly reported with most chemotherapy medicines, so you want to avoid any triggers, such as dust and pollen.

Keep It Quiet

Many people who undergo cancer treatment experience sleep problems such as insomnia. It’s important to ensure quietness in the home as noise can create further stress by increasing one’s heart rate and blood pressure. Make sure your loved one’s bedroom is in an area of the house where there’s not a lot of noise from the road or neighbors as this will help them to relax. Cancer patients require lots of rest between radiation or chemotherapy treatments to regain their strength.

Make It Safe

You will need some important features to make your home safe and user-friendly for your loved one. Toilet grab bars that are mounted to the wall can make it easier for your loved one to lower and lift themselves up when they’re feeling weak or fatigued. Chairs in the shower can also prevent falls. Weakness and fatigue are common during cancer treatments, so you want to be sure that your loved one will be safe when walking around the house. Make sure that there aren’t any snags in the carpet that can trip them up. Place some chairs in risky spots, such as on the staircase landing or in the middle of a long passage, so that they can rest if they need to.

If your loved one is struggling with treatment side effects such as fatigue, having a resting place on or moving their bedroom to the ground floor of your home can help them avoid having to use staircases multiple times a day, which can be exhausting.

Boost Their Interaction With Nature

A lot of research has shown that just a few minutes of being in nature can decrease stress, anger and fear, while boosting one’s mood. If you don’t have a garden in which your loved one can walk and sit, make sure you bring more pictures of nature into the home. Even these have been shown to alleviate stress and boost feelings of wellness.

Pictures of nature can be good replacements for real plants if you don’t have a garden, or your loved one is receiving chemotherapy. Research has found that patients undergoing chemotherapy shouldn’t be around plants in the house. This is because indoor plants and flowers release mold into the air, which can cause infection.

Fill The Space With Love

It’s important that people feel that they can do the things they love in a space that allows them to enjoy this activity. For instance, if your loved one enjoys reading, a room with good lighting and a comfortable sofa can be a relaxing retreat for them. On the other hand, if they love to fix things, a workspace can be invaluable. Time to do what they love can provide a good distraction while providing a sense of normalcy.

Turning your home into a safe and comfortable sanctuary is important way to support your loved ones and allow them feel that they can relax, do things they love, and regain their energy in a healing place.

The Benefits of Exercise During Cancer Recovery

Many people resolve in the new year to get more exercise. Today we are delighted to provide information from Karen Wonders, Ph.D., FACSM, a member of the Triage Cancer Speakers Bureau and Executive Director of Maple Tree Cancer Alliance.  

Cancer and its associated treatments often result in long-term physical and Exercise-after-cancerpsychological side effects that impact the survivor’s quality of life. More than two decades of research support the efficacy of exercise and positive physiological and psychological changes in cancer survivors. These include improvements in VO2 max, which in turn improve heart and lung function and promote a healthy blood pressure, blood volume, and gas exchange. In addition, improvements in quality of life, muscular strength and endurance, fatigue reduction, anxiety, depression, body image, immune function and emotional well-being have been reported. In response to this overwhelming research, organizations like the National Comprehensive Cancer Network, Commission on Cancer, and American Cancer Society have recommend that exercise serve as an integral part of an individual’s cancer care plan.

Patients should talk with their health care team prior to starting an exercise regimen. Once clearance is obtained, the ideal exercise program would be individualized to uniquely meet each patient’s strengths and weaknesses. Each person responds differently to treatment, and it is important for the cancer exercise trainer to understand and identify limitations that could hinder patient progress. The overall goal of the exercise program should be to minimize the general de-conditioning that often results from cancer treatment so that the cancer treatments are better tolerated.  In general, the exercise prescription should include a slow progression and demonstrate adaptability to changes in the patient’s health status, which frequently will change from day-to-day during treatment.

Each exercise training session should include a whole-body workout that targets all the major muscle groups, and consist of the following components:

  • Warm up: Begin each session with a 5- to 10-minute warm-up that stimulates blood flow to the working muscles. Warm-up activities may include walking or jogging to increase the body temperature and other physiologic responses, as well as decrease the chance of injury. Warm-up activities are also important to help ensure that the muscles and cardiovascular system are prepared for the activities to come in the training session.
  • Aerobic Component: ACSM recommends aerobic training 3-5 days each week, for 20-60 minutes each session. Appropriate modes of aerobic exercise include walking, cycling, or swimming (if infection is not a concern). During the aerobic component of exercise, it is important to frequently monitor blood pressure and heart rate. If the patient is on a medication that effects heart rate, the Borg Scale of Exertion may be used to monitor intensity. Based on this scale, a light-to-moderate intensity (RPE of 11 to 14) should be encouraged. If dizziness, nausea, or chest pain occurs, all exercise should be stopped. Frequent short breaks are sometimes encouraged to accommodate therapy-related fatigue.
  • Resistance Training: The type of resistance exercise performed will depend on the patient’s range of motion, tissue removal, and wound healing. Ideally, the patient should strive for 2-3 days/week of 1-3 sets, 8-12 reps per exercise. Appropriate modes include free weights, machines, resistance bands, as well as traditional body weight exercises. ACSM recommends at least 48 hours of rest between each resistance training session. Therefore, it may be advisable to plan a whole-body approach to resistance training, where all major muscle groups are targeted in one day. If the patient is unwilling or unable to participate in traditional modes of strength training, Yoga or Pilates may serve as an alternative form of strength exercise.
  • Flexibility Training: Aerobic exercise should be followed up by static stretching and range of motion exercises for all major muscle groups. Muscles should be stretched to the point of mild discomfort and held for 10-30 seconds per stretch.
  • Cool Down: Cool-down activities provide a reduction in injury risk occurring after an intense bout of exercise. The cool down should consist of less intense exercises and stretches to relax and lengthen the muscle and promote range of motion. The cool-down allows for a gradual reduction in the level of metabolic activity achieved during exercise training.

Initially, the intensity of exercise will depend on the patient’s functional status and exercise history prior to cancer diagnosis. Typically, previously active cancer patients may continue their exercise regimen, although intensity may need to be decreased during treatment.  Progression should consist of increases in frequency and duration rather than intensity.

Maple Tree Cancer Alliance is a national organization with a growing platform that can help patients get started with an exercise program. For more information about our programs, check out our website:

With the right support in place, the patient will be encouraged to adopt an active lifestyle for life!

Triage Cancer Mourns a Great Loss

jhollandDr. Jimmie Holland, a pioneer in the field of psycho-oncology, served as a member of the Triage Cancer Scientific Advisory Council.

Words cannot adequately express the loss. Not only was Dr. Holland a valued advisor and supporter, she was a role model for us all. During her life Dr. Holland shattered glass ceilings and truly improved the lives of many.

To learn more about her life and work:

We thank her for her service to the cancer community. We will miss her greatly.

What Influences Initial Treatment Decisions?

There is a research study being conducted out of Stanford University in California looking at factors affecting breast cancer treatment decisions. Read more about the study and please spread the word to anyone you think may be interested.


We need women living in (or willing to travel to) the San Francisco Bay Area who were diagnosed within the last 12 months with ductal carcinoma in situ (DCIS) or stage I-III breast cancer to participate in a study on factors affecting breast cancer treatment decisions.

Women diagnosed with breast cancer face many treatment decisions about how to treat the affected breast and whether they should remove the unaffected one. A research team at Stanford University School of Medicine in Stanford, California, wants to learn more about the thoughts and feelings that influence women’s treatment decisions.

Please read further to learn more about what’s involved and who can participate. If you are not interested in participating but know someone who may be, please help us pass it on!

What’s the study about?

The goal of this study is to better understand what women are thinking about and feeling as they decide on their cancer treatments. The results of this study may help researchers develop new interventions that may better assist women newly diagnosed with breast cancer with their treatment decisions.

What’s involved?

Screening for eligibility If you decide to sign up for the Treatment Decision Study, the research team will email you a link to participate in a two-part online screening survey (approximately 60 minutes to complete both parts). Afterwards, they will contact you to review your survey responses to determine your eligibility for study participation.

Procedures After Study Enrollment   If eligible, you will be asked to go to Stanford University in Stanford, California, for 3 baseline study visits that will take a total of approximately 8 hours (for participants traveling from farther away, the 3 visits may be combined into 1 or 2 visits). After completion of the baseline study visits, there will be 3 online/at-home follow-ups that are six months apart from each other and will take about 1 to 2 hours to complete each.

  • Questionnaires Complete a set of online questionnaires at home (at baseline, 6-, 12-, and 18-month follow-ups). The questionnaires will take approximately 1.5 hours to complete.
  • Saliva samples Provide saliva samples (at baseline, 6-, 12-, and 18-month follow-ups). The saliva sample collection will be done at your home. At baseline, it will take approximately 1 hour total over the course of 3 days. At the 6-, 12-, and 18-month follow-ups, it will take a total of 15 minutes over the course of 1 day.
  • MRI Brain Scan and Related Tasks Participate in various emotion related tasks while undergoing a functional magnetic resonance imaging (fMRI) scan of the head at Stanford (at baseline only). fMRI is a non-invasive scan. This test will take about 3.5 hours (1 hour preparation, 2 hours in the scanner, and 30 minutes of debriefing).
  • Behavioral Tasks Complete behavioral tasks at Stanford (at baseline only; approximately 1.5 hours). Each of the behavioral tasks is computerized and involves responding to various graphics, words, and/or letters.
  • Provide 1 tube of blood (at baseline).

The Stanford research team will provide participants with a total of $550 for study completion.  If you are traveling from afar, the team will cover one night of your accommodations.  Participants diagnosed within the last 6 months may also receive compensation for airfare.

Who is conducting the study?

David Spiegel, MD, Amit Etkin, MD, PhD, James Gross, PhD, and Allison Kurian, MD, MSc, Stanford University School of Medicine. The study is funded by the National Cancer Institute.


Stanford University, Stanford, CA

Who can participate?

You can sign up for the Treatment Decision Study screening surveys if you match ALL of the following MAIN categories:

  • You are a woman 18 years of age or older
  • You were diagnosed with one-sided DCIS or Stage I-III breast cancer within 12 months of study enrollment
  • You are proficient enough in English to be able to fill out questionnaires and participate in the required tasks
  • You are a US citizen or resident (eligible to receive payment for participation)
  • You are willing to participate in a fMRI assessment
  • You live near or are willing to travel to the Stanford, California area.

If you are interested in study participation, please click on the link below to enter your contact information on a Stanford University secure site. You will receive their screening survey shortly after completion of the contact form.

Cancer Hope Network: talk with someone who’s been there.

Triage Cancer believes strongly in partnership. There are so many wonderful organizations in our community and today we are delighted to be highlighting the Cancer Hope Network. Cancer Hope Network provides one-on-one support for cancer patients and their loved ones. Because no one should face cancer alone.


After weeks (months!?) of tests and scans and sleepless nights spent worrying, the doctor sits across the desk from you, looks up from the chart on her desk and says, “Unfortunately, it’s cancer.”Cancer Hope Network

Your care team recommends a new treatment protocol. You’ve heard horror stories of the side effects it brings.

Your beloved spouse has reached an especially difficult point in their treatment. As a caregiver, you find yourself physically and emotionally exhausted.

More than 1.6 million new cases of cancer will be diagnosed this year. Millions more will be treated. If you’re reading this post, chances are, you’ve experienced a moment like the ones above. If you haven’t, your loved one has.

Getting a cancer diagnosis can be time-stopping, world-spinning, forcing you to make choices between treatment options, worrying about side effects and facing fears about the future. It is, as they say, a lot.

That’s where Cancer Hope Network comes in. For more than 30 years, CHN has trained cancer survivors and their caregivers as Support Volunteers. Our 400+ volunteers have faced more than 80 cancer types. They’ve completed courses of chemotherapy and rounds of radiation, helped pioneer treatments and medications as clinical trial participants, received stem cell transplants, faced bisections, ostomy bags and surgeries. They’ve battled the crippling fear of leaving their children alone and grappled with the heart-wrenching realization they may never have children of their own.

They’ve been caregivers like Anne, a retired school secretary with grandchildren in Alabama. She’s a bladder cancer survivor who cared for her beloved husband through his last days of his own fight with bladder cancer. She encourages patients to keep the faith, “They’re coming out with new research, new information and drugs every day.” She’s also a voice of reason, reminding caregivers “You have to call and get help…You’re a person. You’re a human. You simply cannot do it alone.”

Others are survivors like Karla, a 7-year stomach cancer survivor who found purpose in sharing the lessons she’s learned. “Now that I had learned to eat and survived, I wanted to help.”

Patients and loved ones may contact Cancer Hope Network by calling 877-HOPENET (877.467.3638) or visiting  They’ll work with a member of our Patient Services Team to connect with the Support Volunteer whose experience most closely mirrors their own.

Whatever the challenge, chances are a CHN Support Volunteer has faced it. They understand the fine balance between gratitude and the survivors’ guilt faced by the “lucky ones” who are here to talk about it. They’re working through the challenges of survivorship and cancer’s new normal – and are willing to share.

Support Volunteers’ passion is to lend a listening ear and supportive presence for others on cancer’s journey. Their commitment is that no one face cancer alone.

It’s a commitment that pays off with satisfied, encouraged patients. “If all your volunteers are like the one I spoke to, then you have exceptional people volunteering for you,” reads one patient survey. “That make the illness I’m going through easier to contend with!”

“My volunteer was very informative and eased my real fears about my CLL,” another recalls. “It was wonderful speaking with someone dealing with the same blood-related disease. His knowledge helped to calm my nerves.”

Patients and loved ones may contact Cancer Hope Network by calling 877-HOPENET (877.467.3638) or visiting  They’ll work with a member of our Patient Services Team to connect with the Support Volunteer whose experience most closely mirrors their own.

The Twelve Sites of Social Security

By Essie Landry
Social Security Public Affairs Specialist in Sierra West Area

Gathering with family and friends during the holiday season reminds us we’re part of aThe Twelve Sites of Social Security strong community. And sometimes, in the spirit of the season, we break into song. Our take on “The Twelve Days of Christmas” — a holiday favorite since 1780 — highlights the national community we care for all year long. We call it “The Twelve Sites of Social Security.”

For the first site of Social Security, we give to you: our home page, It’s the place to go for all things Social Security. Everything you could want — from online services and benefit screening tools to publications and frequently asked questions — you can find all these and more on this site.

For the second site of Social Security, we give to you: our hub for Social Security news and updates at our blog, Social Security Matters at

For the third site of Social Security, we give to you: an easy way to learn how to replace your Social Security card at And in some states, you can replace it online at!

For the fourth site of Social Security, we give to you: an online application for retirement benefits that you can complete and submit in as little as 15 minutes at

For the fifth site of Social Security, we give to you: five estimates of your future Social Security benefits! Or as many estimates as you would like using different scenarios. Get instant, personalized estimates of your future benefits at

For the sixth site of Social Security, we give to you: a convenient way to apply for disability benefits at

For the seventh site of Social Security, we give to you: fun and informative videos on our YouTube channel at

For the eighth site of Social Security, we give to you: Extra Help with Medicare prescription drug plan costs. You can learn more and apply for a subsidy online at

For the ninth site of Social Security, we give to you: our convenient publication library with online booklets and pamphlets on numerous subjects, at

For the tenth site of Social Security, we give to you: one of our most popular social media outlets, our Facebook page. This is where we engage thousands of customers and you can join the conversation at

For the eleventh site of Social Security, we give to you: answers to your Social Security related questions at our Frequently Asked Questions page at

On the twelfth site of Social Security (and we saved the best for last): open your own personal my Social Security account, which will enable you to verify your earnings, get future benefit estimates, obtain benefit verification letters, update your Social Security information, and more at

And a partridge in a pear tree! Find all of this and more (except the partridge and pear tree) at