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Reimbursement and quality-of-life care for cancer survivors

Author: CHU de Liège

Even prior to receiving funding from the European Commission, the Liège University Hospital (CHU de Liège) was particularly interested in the PERSIST’s concern for life after cancer. At present, our hospital wishes to pave the way through PERSIST in order to help the Belgian government in its role regarding the quality of life (QOL) of patients who have completed their cancer treatment.

Once their treatment is finished, all Belgian cancer survivors have follow-up consultations at least every 3 to 6 months. According to the state of the patient, consultations may become progressively more spaced. In Belgium, all these consultations are reimbursed up to 80%, allowing patients to pay only 12€ per consultation. Despite our social security that many countries envy us, cancer remains in Belgium a financially heavy or even unbearable burden for some patients. Especially when various medical costs are accompanied by an income decrease due to long absence from work.

Thus, if patients have great difficulty with payment, CHU de Liège allows them to spread their bills.

Belgium has implemented a Cancer Plan in 2008. It encompasses several actions that benefit both oncology patients and cancer survivors within our hospital. Among them, free of charge psychology consultations, which also cover those related to onco-sexology. The Cancer Plan also offers free consultations with a neuropsychologist for patients with memory loss or any other cognitive disorder that may have appeared during or after the cancer treatment.

Moreover, due to strong demands of the CHU Liège psychologists, cancer survivors suffering from anxiety disorders, depression or alcohol dependence can be referred to frontline psychologists working outside the hospital.

The fee of a frontline psychologist in Belgium is 76 euros/consultation. Nevertheless, to support this type of patients, the Belgian government allows them to benefit 6 consultations/year at a cost between 5 to 11€ each. If necessary, at the end of these 6 sessions, the frontline psychologist can refer the patients to a specialist psychologist who will be able to see him/her 6 more times/year for again 5 to 11€/consultation. Thus, in total, a cancer survivor suffering from anxiety, depression or alcohol dependence can benefit from 12 sessions/year with a psychologist for a modest price.

Unfortunately, frontline and specialist psychologists can only charge for 8 reimbursable consultations/week. Thus, extra efforts are claimed to the Belgian government from cancer survivors so that psychologists can increase the number of these type of consultations.

Cancer patients including survivors are entitled to 8 consultations with a tobacco specialist. The first of these consultations is completely reimbursed. To help patients quit smoking, the following 7 consultations are reimbursed at 66%. Thus, cancer survivors have to pay only 10€/consultation.

Importantly, the scientific literature points out that physical activity is one of the major factors that may improve the QOL and psychological health in cancer survivors. Following this recommendation, our hospital created a physical rehabilitation program offered to survivors of breast cancer and colorectal cancer since 2014. This program has been very successful with patients who pass a stress test allowing them to register for physical activity. The price of each session varies between 13 and 18 €, however the cancer survivor only pays between 6 and 8 €. Currently 50 people/year benefit from these revalidation sessions at CHU de Liège.

Moreover, CHU de Liège rehabilitations have paved the way  to offer physical activity adapted to cancer survivors living in other municipalities in the Liège region.

This physical exercise program is a unique agreement between our hospital and the Belgian Ministry of Health. Thus, the program is not offered to all Belgian cancer survivors. Nevertheless, the excellent results already obtained could lead the Belgian health authorities to promote reimbursable physical exercise for all cancer survivors who can undergo physical rehabilitation.

The CHU de Liège recently opened the doors of a 7-storey Comprehensive Cancer Center dedicated to cancer treatment and research. Inside the center, OASIS Wellness center offers to cancer survivors free of charge well-being activities for one year after the end of their treatment. The project wishes to place the human being at the center of all considerations through the implementation of activities of sensations, emotions and better self-awareness. Concretely, OASIS allows patients to benefit from massages, gain self-image, a kitchen for dietary advice and the preparation of dishes adapted to the situation of the cancer survivors. OASIS also offers stretching, relaxation, and yoga sessions as well as group discussion. Notably, family caregivers can also participate free of charge in some of these activities.

In addition, our hospital has a long experience in training patients in self-hypnosis. Our hospital systematically offers cancer survivors self-hypnosis lessons through 8 sessions (€39/session).

CHU de Liège runs at present a non-ordinary states of consciousness research project entitled “Hypnosis and cognitive trance on cancer patients: impact on quality of life and neurophysiology”. In the frame of this project self-hypnosis, meditation and cognitive trance are at present free of charge for cancer survivors. The project aims to evaluate the therapeutic effects of these three states of consciousness on pain, sequelae and side effects of cancer treatment. Improving the quality of life of cancer survivors through these techniques could enable them to be integrated into the post-cancer care pathway in the future.

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