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Cancer Survivor Support Squad

Kara D. Minoza

Hahn School of Nursing and Health Sciences, University of San Diego

HCIN 541 Introduction to Health Care Delivery Systems

Dr. Brenda Boone

Mar. 20, 2023

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Cancer Survivors Support Squad

Cancer Survivors Support Squad (C3S) is a non-profit organization founded in March

2023 with two goals in mind: (1) Provide transportation to and from doctor’s appointments; (2)

Deliver groceries and continence supplies to the patient’s home. Cancer patients and survivors

frequently experience fatigue, nausea, bowel, and urinary symptoms, among other things

(Myung & Soon-Rim, 2018). Simple chores like driving or grocery shopping might be difficult

for those that suffer from those symptoms. Our mission is to alleviate some of the hardships

experienced by cancer patients and survivors, particularly those who have few support groups

available to assist them with these basic needs and requirements. C3S relies on generous

donations and grants from the local community and state government to cover transportation and

grocery costs. C3S also accepts donations of unused and unopened incontinence products such as

diapers and underpads.

C3S is working towards establishing a nonprofit(c)(3) status and raising $40,000

by May 25, 2023, through community grants, donations, and local fundraisers supported by the

San Diego Padres Foundation. With the community’s joint effort and contribution, C3S will be

able to purchase incontinence supplies in bulk, rent a climate-controlled storage unit ensuring

that stocks remain free from heat and cold damage, cover costs of groceries, transport patients

and supplies, as well as employ a bookkeeper to manage finances. We believe that our

organization will reduce some of the daily challenges that patients and survivors encounter,

allowing them to focus more on recovery and navigating their new normal.

Background of Problem

The estimated economic burden of cancer care in the United States in 2019 is $21.09 

billion, making cancer a public health priority (Centers for Disease Control and Prevention,

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2021). The estimate includes time cost, or the value of time spent traveling and receiving care,

which can be a significant financial burden for cancer survivors and their families. (Centers for

Disease Control and Prevention, 2021). Some cancer patients/survivors are under the care of

informal caregivers such as their spouses, family, and friends. The caregivers provide an average

of 33 hours per week of care, often at the cost of changing work schedules and other financial

sacrifices (Borsky et al., 2021). It is our belief at C3S that if we can alleviate some of the burdens

associated with long-term cancer survivorship, we not only help the patient but also enable their

caregivers to maintain a working status.

Modern medicine has improved the life expectancy of many cancer patients/survivors. As

cancer medical technology advances, so will the number of cancer survivors, with an estimated

26.1 million cancer survivors expected to live in the United States alone by 2040. (Morgans &

Partridge, 2022). Some cancers have become a chronic condition for many cancer survivors,

who live for years and even decades with the combined effects of the disease and its treatment

(Morgans & Partridge, 2022). Even after treatment, a cancer survivor frequently requires care

from numerous doctors to manage the illness's and therapy's long-term consequences (Myung &

Soon-Rim, 2018). Physician follow-up appointments are necessary to monitor disease

progression and symptom management. Lack of transportation is a primary problem preventing

patients from following up with their doctors (Imaduddin et al., 2022). The same lack of

transportation may have an impact on a patient's ability to purchase necessities such as groceries

and miscellaneous healthcare supplies such as incontinence products.

Unfortunately, not every insurance plan covers incontinence products, and those that do

frequently have monthly cost limits, leaving the patient with insufficient daily supply coverage if

they are unable to purchase supplies out of their own money (National Association for
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Continence, 2022). As part of C3S's commitment to cancer patients and survivors, we also

provide incontinence products on an as-needed basis since we believe that assisting cancer

patients/survivors in managing incontinence is critical in preventing infection and potential

hospital readmission in their immunocompromised state.

Proposed Solution

Initial explanation and coordination of services will be done by the C3S founder. Once a

schedule is determined, a patient will be contacted by a C3S employee to maintain open

communication in case any changes occur. C3S currently employs two full-time drivers and five

part-time volunteer drivers who transport cancer fighters/survivors to and from medical

appointments, deliver groceries from our community pantry, including incontinence supplies, to

their homes, and pick up and deliver groceries that patients/families have purchased online if the

community pantry does not carry an item they are looking for. C3S relies on generous donations

from the community and our sponsors to fund transportation costs, supply the community pantry,

and pay our personnel. In addition, the community pantry provides all groceries to patients free

of charge, and each patient may get up to $200 in groceries from the pantry per month.

Incontinence supplies are also provided on an as-needed basis to patients at no additional costs

and are not included in the monthly grocery limit. Most of the volunteers at C3S are nursing

students. C3S is working with various nursing schools in San Diego to provide community

nursing rotation hours for nursing students so that C3S can have a steady influx of volunteers to

assist with providing services to cancer patients/survivors.

Most people are unaware that the fight against cancer continues even after rigorous

chemotherapy regimens, costing significant social and economic burdens to the patient, their

families, and society. Exposure to this patient population increases awareness about cancer
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survivors’ plight. Moreover, C3S is true to our organization’s name. It aims to build a support

system that ensures survivors know our city of Escondido rallies behind them through difficult

times. Social support has been found to improve general well-being and mitigate the impact of

stressful circumstances, such as life-threatening illnesses like cancer (Myung & Soon-Rim,

2018). We believe that through the compassionate services C3S provides, we can provide some

caregiver relief, ensure patients can attend necessary physician follow-up appointments, provide

groceries, and ensure that each patient has sufficient monthly coverage of incontinence supplies.

Gaps and Roadblocks

Some various gaps and roadblocks may prevent C3S from meeting our aim of serving

this community. The most notable gap is the lack of available drivers to provide service at a

specific time and place. As mentioned earlier, 3CS only employs two full-time drivers to provide

transportation to patients and deliver groceries and other supplies to homes. In addition, due to

commitments with other survivors, it is possible that a schedule provided by the hospital at a

specific time frame will not be feasible for our team members. While we presently have five

part-time volunteer drivers to assist us in serving more individuals with greater flexibility, this

may not always be the case as volunteer numbers tend to fluctuate throughout the seasons.

Furthermore, because most C3S volunteers are nursing students doing mandatory community

nursing hours as part of their academic studies, collegiate holidays such as spring/summer/winter

break may impact our ability to accommodate various schedules.

When assigning a driver to a survivor, we also evaluate proximity, road, and weather

conditions that may affect travel time. While we understand the significance of time for both our

drivers and survivors, recent weather changes, such as more regular rainfall, have caused

increased traffic, road damage, and sinkholes throughout San Diego. As of the end of March, San
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Diego had already received 178 percent of its typical rainfall (NBC 7 San Diego, 2023). We

anticipate that if the current weather trends persist, travel times will be affected. We appreciate

your patience since these factors are beyond our control and may affect travel time and wait.

C3S relies on community donations, sponsors, and individual fundraisers to fund our

organization's ambitious efforts to serve this community. However, there may be periods when

the community and our sponsors face financial difficulties, in which case funding may be

limited, reducing our ability to provide groceries, supplies, and transportation, posing as a

significant roadblock. C3S accepts donations of unopened groceries, incontinence products, and

monetary support all year round to help minimize the burden of such circumstances. C3S aims to

achieve nonprofit(c)(3) status, allowing all donations to be tax deductible for our wonderful

supporters.

The final impediment that C3S sees as a critical issue is the rise in out-of-pocket medical

costs for advanced cancer treatment. While we are dedicated to serving and providing for as

many patients as possible, it is unavoidable that we will be unable to serve and provide for

everyone, especially as the number of people in need grows faster than we can currently handle.

Logistics for Success

Cancer treatment frequently creates a financial burden, which can lead to bankruptcy,

among other things, for the typical family, even those insured (National Cancer Institute, 2022).

Approximately 25-50% of cancer patients encounter financial difficulties (National Cancer

Institute, 2022). While C3S' primary goal is to assist cancer patients/survivors, we are also aware

that the fundamental struggle is not due to the cancer diagnosis alone but also the escalating out-

of-pocket medical bills. Therefore, part of our commitment involves advocating and lobbying for
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reforms involving cancer treatment cost caps, particularly for more common and established

treatment regimens.

According to the American Cancer Society Cancer Action Network (2022), a maximum

out-of-pocket limit (MOOP) is the amount patients must pay directly for healthcare expenses

during a plan year. MOOPs are defined by federal law and change each year. In 2022, the

individual plan limit was $8,700, while the family plan limit was $17,400 (American Cancer

Society Cancer Action Network, 2022). Cancer treatment often requires specialty involvement,

prescription drugs, and miscellaneous services. Cancer patients frequently reach their deductible

soon after diagnosis due to all the necessary tests and treatments, and the co-pays and co-

insurance costs quickly escalate. Considering that healthcare costs are on the rise and that co-

insurance is used by plans more frequently, patients are still responsible for substantial payments

even after they have reached their deductible. After a positive screening test, cancer patients

generally hit their out-of-pocket maximums within the first three months (American Cancer

Society Cancer Action Network 2022). Without MOOP, they would have to be financially

responsible for covering all costs. Many people already struggle to pay their minimum

obligations.

While federal law already limits MOOP on patients, better laws and mandates are needed

that obligate pharmacies, hospitals, and insurance companies to charge appropriate and

consistent overhead fees for providing cancer treatment, regardless of insurance type or lack

thereof. Furthermore, vigilance and awareness are required to ensure that the MOOP limits are

not overturned in the near future.

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Conclusion/Call to Action

Surviving some cancers is now comparable to surviving other chronic diseases, such as

diabetes and certain heart disorders. C3S attempts to raise awareness of cancer survivors'

situation, extending far beyond cancer remission. The disease's devastation impacts many

elements of their lives, including financial and social aspects. C3S addresses this by providing

free services aimed at alleviating some of the strain associated with cancer survival.

We can handle or work around local concerns such as enough staffing, weather pattern

fluctuations, and finances. However, there is a global concern that impacts not only our

organization and cancer survivors but also the rest of the country's general population. Rising

out-of-pocket costs continue to strain our healthcare system, hurting people with and without

insurance. Therefore, we implore the public to join us in assisting cancer survivors and

campaigning for a better healthcare system that serves the people and prioritizes health over

profits. This can be accomplished by enacting more vigorous laws and mandates that require

pharmacies, hospitals, and insurance companies to charge reasonable and uniform costs with or

without insurance.
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References

American Cancer Society Cancer Action Network. (2022, January 4). Out-of-pocket spending

limits are crucial for cancer patients & survivors. fightcancer.org.

https://www.fightcancer.org/policy-resources/out-pocket-spending-limits-are-crucial-

cancer-patients-survivors

Borsky, A. E., Zuvekas, S. H., Kent, E. E., De Moor, J. S., Ngo-Metzger, Q., & Soni, A. (2021).

Understanding the characteristics of US cancer survivors with informal caregivers.

Cancer, 127(15), 2752–2761. https://doi.org/10.1002/cncr.33535

Centers for Disease Control and Prevention. (2021, October 26). The Cost of Cancer.

https://blogs.cdc.gov/cancer/2021/10/26/the-cost-of-cancer/

Imaduddin, M., Sultania, M., Vigneshwaran, B., Muduly, D. K., & Kar, M. (2022). Psychosocial

Factors in an Oral Cancer Survivor Leading to Delay in Seeking Help. Oral oncology,

124, 105438. https://doi.org/10.1016/j.oraloncology.2021.105438

Morgans, A. K., & Partridge, A. H. (2022). Overcoming Obstacles in Transitions of Cancer

Survivor Care. JNCI: Journal of the National Cancer Institute, 114(6), 785–786.

https://doi.org/10.1093/jnci/djac037

Myung K.L., & Soon-Rim S. (2018). Effects of Peer-Led Interventions for Patients With Cancer:

A Meta-Analysis. Oncology Nursing Forum, 45(2), 217–236. https://doi-

org.sandiego.idm.oclc.org/10.1188/18.ONF.217-236

National Association For Continence. (2022, October 27). Incontinence Products & Insurance.

https://nafc.org/insurance-coverage-incontinence-products/

National Cancer Institute. (2022, January 26). Advanced cancer causes money problems, even

for the insured. cancer.gov.

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https://www.cancer.gov/news-events/cancer-currents-blog/2022/financial-problems-

advanced-cancer

NBC 7 San Diego. (2023, January 17). San Diego County's rain totals already 178% above

average to date: NWS. nbcsandiego.com.https://www.nbcsandiego.com/news/local/heres-

how-much-rain-fell-in-san-diego-county-from-weekend-storm/3143224/

Somayaji, D., Melendez, M., Kwon, M., & Lathan, C. (2021). Access to Cancer Care Resources

in a Federally Qualified Health Center: a Mixed Methods Study to Increase the

Understanding of Met and Unmet Needs of Cancer Survivors. Journal of Cancer

Education : The Official Journal of the American Association for Cancer Education,

36(3), 591–602. https://doi-org.sandiego.idm.oclc.org/10.1007/s13187-019-01669-1