For Sara Maloney, Lead Patient Navigator at UPMC Magee-Womens Hospital, discussing cancer diagnoses is a familiar yet difficult part of the job. In fact, often when working with a patient who just received their diagnosis, Sara’s first task as a social worker is to address the unimaginable shock and panic that accompanies the news.

“[The patient] didn’t ask for this, and they didn’t plan for this,” Sara says. “So, it’s not something that you can make sure you have ‘X’ amount of money saved up for or ‘X’ amount of PTO from work.”

As Sara describes it, her job is to do “everything but treat the cancer.” She learns from patients about the emotional, social, and financial difficulties that arise, and works to support and assist them and their families in navigating the challenges they may encounter. Those with advanced-stage diagnoses, such as metastatic breast cancer, also face added realities like long- term treatment and end-of-life decisions.

The tremendous toll that cancer has on patients is something Dr. Margaret “Peg” Rosenzweig knows well. As a Distinguished Service Professor of Nursing at the University of Pittsburgh and a certified nurse practitioner, her experience and research has focused on equity in cancer treatment. She has found through her research and work that, unsurprisingly, socioeconomic insecurity has a negative impact on patient outcomes.

“We have a 22-year database of patients that have had advanced stage metastatic breast cancer,”
Dr. Rosenzweig says. “From that database and from our experience in working with patients, we realized how patients with certain [financial] vulnerabilities have a more difficult time with the experience of advanced stage breast cancer, and we certainly see that clinically as well.”

Dr. Rosenzweig decided to do something about it.

In 2017 she wrote a grant application to the Pittsburgh Susan G. Komen affiliate for a supportive care pilot program. Each week, the care team of primarily nurses and social workers (otherwise known as navigators) gathered to review the needs of advanced stage cancer patients and then both refer and connect them to appropriate resources.

“There are multiple sources of support for women with breast cancer — agencies offer house cleaning, acupuncture can be offered for symptom management, or we can provide transportation and food support, but it takes the navigators to pull all that together,” Dr. Rosenzweig says. “Each patient may need something. In addition, there are patients that need dietary referrals. There are patients that need pain management or palliative care referrals. The needs can include all sorts of things.” It was also clear that patients had numerous emergency financial needs that developed over the course of illness.

According to the paper published on the pilot program in the American Journal of Hospice and Palliative Medicine, after the inception of the program, patients had increased referrals to existing resources, improved patient reported outcomes (such as symptoms), and there was a decrease in calls to the clinic, and fewer emergency room visits — all suggesting improved coordination.

Dr. Rosenzweig documented these needs and then secured a grant from the Ladies Hospital Aid Society for something quite tangible: emergency patient funds. The fund was used for numerous needs, including food, a wheelchair ramp, durable medical supplies, childcare (so children do not have to accompany a mother to treatment), transportation to treatment, and parking support. In other words, a fund for necessities that occur during metastatic breast cancer illness. Patient navigators documented the needs and tracked every penny spent.

“The fund just makes it so that everything isn’t such an emergency — so everything isn’t so stressful for the patients,” Dr. Rosenzweig says. “We can’t pay copays, and we can’t pay the cost of cancer medications, but we can help with these things that just come up all the time.”

The fund provided financial help during an already tumultuous time in the lives of these patients.
But once the initial grant money was depleted, the program needed a way to replenish the funds.

Dr. Adam Brufsky, Professor of Medicine at the University of Pittsburgh, Co-Director of the Comprehensive Breast Cancer Program, and Medical Director of the UPMC Magee Cancer Program, has been supporting breast cancer research with philanthropy for more than 20 years along with his brother Seth (a Founding Partner of the Ares Group), in honor of their mother who died of pancreatic cancer in 1994. In 2020, Dr. Rosenzweig gave him a suggestion: fund the supportive care program.

He took to the idea immediately, having witnessed how cancer impacted his own patients' lives. “When you’re hit with a diagnosis of cancer like this, in particular, metastatic breast cancer, it disrupts your life immensely,” Dr. Brufsky says. “A lot of people who are maybe not in a great financial position and suddenly [the diagnosis] brings things to the edge.”

Dr. Brufsky recalls a patient who brought this reality into relief. “I remember the story; she was getting therapy for metastatic breast cancer and was doing well. She was coming to clinic all the time to get her chemo, which is every week, and seeing me every month. And I thought she was doing pretty well,” he recalls. “The navigators told me that she was homeless. She was living in a car by the airport, and that really struck me. I had no idea. I’m just in there trying to help someone get through their cancer.”

He adds that funds like this are a good adjunct to supporting research, as they provide immediate support while therapies are being developed for five to 10 years from now. Not to mention, the biggest cause of bankruptcy in the United States is medical expenses. “Financial aid has a substantial impact, even small amounts for people who are undergoing cancer and are financially stressed,” Dr. Brufsky says.

In 2021, Dr. Rosenzweig and her husband matched the original funds from Dr. Brufsky and his brother Seth for the program and credits the team of navigators for their skill in overseeing the program as it continues. “I know these navigators are so fantastic and meticulous about the ways that they distribute this money,” she says.

Navigators like Sara, who has worked at UPMC Magee for three years and UPMC for 15, are thankful for being part of a multidisciplinary care team that supports many elements of the patient’s experience — not just the medical ones.

“The multidisciplinary approach to the care team is so needed in cancer since it touches not only the medical side, but all these other aspects to it too. So, we need good team members for that,” Sara says. “And honestly, my team is excellent.”

To learn more about ways to support patients, visit MageeWomens.org/Support