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Cancer Care



Understanding the Provisions of Your Managed Care Plan

Understanding the Provisions of Your Managed Care Plan

The type of plan you have can affect who directs your medical plan of care (the doctor), where that care can be delivered (the facility providing services), the length of time certain services can be administered (precertification/predetermination), and any additional cost of treatment to you (coinsurance).

Managed care, by definition, is a comprehensive method of managing and coordinating medical care you receive. The goal of case management is to coordinate and facilitate access to medical care, while adhering to the guidelines and provisions of your health benefit plan. A wise course of action is to be proactive by finding out what your policy covers and how to access medical care services.

Questions about your coverage

Whether you are newly diagnosed with cancer or facing choices of new or additional treatment recommendations, review your policy for clarification of benefits available regarding health care providers. Providers of medical care mean the doctor managing your medical plan, as well as the facility where that care is delivered. Review all of your covered benefits. Obtain the most current copy of the Provider Membership Directory and read it thoroughly to be sure the providers you want to use are included in it.

The following questions and points of discussion are areas for your review and may serve as a guide to help you solve potential problems.

What do the words usual, customary, and reasonable mean? Is there a limit to the coverage for my particular type of cancer or its treatment?

Usual, customary, and reasonable, often abbreviated on insurance forms as UCR, is a method of determining payment the insurance company will allow for a claim. UCR is determined by the insurer by comparing charges of providers of care to those of like providers of service in the same region or community.

The extent of benefits the insurance company will cover for your particular type of cancer is defined under Limitations. They are important to understand:

  • Limitations are restrictions placed on a benefit. Usually this refers to the number of times for use or the circumstances of use for a particular service or treatment.

  • Exclusions are those services not covered at all. Excluded services can not be accepted as within the scope of medical practice, conditions not considered related to health or illness, or may be specific services excluded from the plan by request of the plan contract parties (generally the insurance group health agent and the group or employer). Experimental Procedures as defined by the insurance company may be found in the list of exclusions.

How is experimental care defined and funded?

When selecting a plan, look closely at the marketing materials supplied by your plan and your employer to see how the plan defines experimental care, and under what conditions the plan might cover such care. This is very important for cancer patients who are joining a new insurance plan, or consumers who believe they are at high risk for the disease (for example, because of a strong family history of cancer). If the plan's materials do not clearly define the term, and how the plan uses it, consumers can ask their employers to let them see the contract with the plan. Consumers also can call the plan and ask plan administrators to provide them with information on the plan's coverage of experimental care, such as use of off-label drugs and care in clinical trials, which are discussed in greater detail below, and guidelines on how the plan decides what care is experimental.

Some consumers in managed care plans have reported problems getting access to care because their plan considers a particular product or service experimental. When plans deny coverage for a service on this basis, the plan will not pay for the care. Most managed care plans routinely exclude experimental care from coverage in their contracts.

While there is no widely accepted and utilized definition of experimental care, plans typically regard it to mean that the medical benefit of a particular service has not been proven to the plan's satisfaction. Thus, each plan defines the term as it wishes and may apply it differently from contract to contract. Some of the things that plans commonly exclude from coverage as experimental are the following:

  • Off-label use of some drugs. In some cancers, health providers and patients want to use a drug for a diagnosis other than what the drug is approved for by FDA. Plans make case-by-case decisions on whether to cover off-label use of the drug and may deem some off-label uses experimental, if the plan believes there is insufficient scientific basis to justify it.

  • New tests or treatments. As medical technology produces new services for cancer patients, managed care plans evaluate these new services to make policy decisions about what they will cover and pay for. They review published medical studies of the new test or procedure and government approvals (where applicable), and consult with leading oncologists. After this review, if the plan's administration believes that a new test or procedure has not been sufficiently evaluated, or its effectiveness is uncertain, the plan may designate the service as experimental and refuse to provide coverage and payment.

  • Clinical trials. Plans may refuse to cover the costs of having their patients treated in clinical trials. Because clinical trials are research studies, some plans may conclude that care in a clinical trial is, by definition, experimental, and therefore, excluded from coverage. For many cancer patients, clinical trials offer state-of-the-art treatment.

The issue of whether something is or is not experimental is not black and white. There is often disagreement among plans, patients, and doctors about whether a service, such as a bone marrow transplant, is an experimental treatment for a particular diagnosis. There have also been many state and federal court cases in which patients and doctors have challenged plans' decisions not to cover and pay for care of a plan labeled experimental, but which the patient and doctor believed appropriate. The courts have ruled that whether a service is or is not experimental may depend not only on published medical studies, but also on whether the doctors in a community believe it is appropriate for a particular diagnosis, as well as expert opinion. Thus, standards of care vary around the country. If a managed care plan refuses to cover and pay for a treatment or test on the grounds that the service is experimental, consumers and their doctors need to work closely together to challenge the decision.

When consumers and their managed care plan disagree over whether a test or treatment is experimental, consumers can appeal the plan's decision. This process starts with notifying the managed care plan. All managed care plans have an appeal process for reviewing denials of care. Consumers should file an appeal by writing a letter to the plan, and get a letter supporting their position from their doctor. The doctor also should submit to the plan copies of medical studies and expert opinion that support the appeal.

If a consumer and a plan cannot resolve their differences, the consumer may want to consider filing a complaint with a state regulatory agency, such as the state health department, insurance department, or attorney general's office. A complaint to these agencies should include copies of all correspondence with the plan and copies of relevant medical studies. The state agency may be able to help mediate a resolution to the complaint, or it may intervene directly on the consumer's behalf if it discovers that the plan is not adhering to the terms of its contract with you or is violating a provision of state law. State laws vary in how much authority these agencies have over managed care plans.

In some cases, consumers need legal help, and might consider filing a lawsuit against the plan to get the care they need. Consumers in a self-insured plan (employers or plans can identify that ones are self-insured) cannot turn to state regulatory agencies for help. They need to speak with a lawyer who has experience helping consumers pursue complaints against self-insured plans. Self-insured plans are regulated by the federal Department of Labor, which generally does not help consumers with complaints over a denial of care on the grounds that it is experimental.

An ethics committee is now part of the formal review system in many managed care organizations. These committees may have medical and legal representatives, ethicists and other health care providers as members. One of the functions of an ethics committee is to review cases in order to develop coverage policies and criteria for benefit application.

What questions need to be answered to define breast cancer coverage?

If you have breast cancer, the following questions may be of particular interest to you. Are the following covered as part of my benefits:

  • Treatment for recurrence of the primary cancer

  • Wigs and hair pieces, breast prosthesis

  • Surgical repair of both breasts even if single mastectomy covered (breast reconstruction)

  • Counseling/supportive services

  • Coverage for new/innovative therapies and biologies

  • Genetic testing for inherited breast cancer, such as BRCA 1 and BRCA 2

  • Contralateral prophylactic mastectomy

  • Molecular/special testing on the tumor to determine recurrence risk (Oncotype DX, Mammoprint)

Is the specialist doctor you want available?

Some policies limit your access to medical care to doctors listed in the Provider Membership Directory. This publication should be available from the customer service department of the insurance company. Obtain the most current copy available. Be sure the specialists listed in the directory are ones with expertise in the treatment of your particular problem and that they are available to you at the time you need them. Confirm with your employer's benefit manager and with the Customer Service Department of the insurance company whether this specialist is included with your plan. Call the doctor's office directly to verify what you have been told by the plan representative and make your appointment. Once you are receiving treatment from the specialist, be sure to periodically check that he remains a participating provider in the network. Do not assume the Provider Membership Directory remains current or accurate for any length of time.

What is the procedure if you need to have tests, to see a specialist or to be hospitalized?

Most health maintenance organization (HMO) plans require you to obtain a referral from your primary care physician to see a specialist or receive special tests and procedures. Plans may vary in the process. HMOs, preferred provider organizations (PPOs), and most fee-for-service plans require approval before admitting patients to the hospital; this is known as precertification. Precertification has a predetermined set of guidelines for hospital admission and length of stay in the hospital. You may want to ask the plan representative what those guidelines are and how many days are approved for a planned hospitalization. Emergency hospitalizations generally have additional or different guidelines. Check your plan.

If you are approved to have a certain type of procedure or treatment, ask where it can be performed. HMOs may use only certain hospitals or a designated medical center as the only place you may go to have a specific treatment.

What if the primary care physician or the plan will not give approval for a referral to a specialist you request?

If your primary care physician or the plan administrator refuses to allow the referral or services you believe you need, find out how you may appeal the decision. The appeal or grievance process is defined in your health plan.

What questions do you need to ask your employer if you become totally disabled?

 If you become totally disabled from cancer and cannot return to work, check for answers to the following questions from your employer benefits manager:

  • How long will the policy stay in effect during a medical leave of absence?

  • How much of the premium must you pay?

  • Are benefits changed or reduced while on disability?

  • If you become eligible for Medical Disability, will the managed care plan agree to become your secondary insurance?

  • What are the short term benefits available through the company disability coverage?

  • What are the long term benefits available through the company disability coverage?

  • Are there specific services or benefits excluded from coverage through the disability plan?

What is the role of utilization review?

Utilization review, or UR, is a process by which an insurer reviews the care a patient receives to assess whether it was appropriate and provided in a cost-effective manner. UR is most often associated with indemnity insurance plans, but also is used in other forms of managed care, such as HMOs and PPOs. In all these cases, UR is a means of controlling the use of services by patients, and thus, the costs of care. Managed care plans use UR in a number of ways:

  • Assess hospital lengths of stay, and keep patients in the hospital no longer than is necessary,

  • Limit the number of visits a patient makes to a particular health care provider, for example a specialist,

  • Choose the setting in which a patient receives care, such as inpatient versus outpatient care, and

  • Manage catastrophic illness, to help coordinate the care provided and to move the patient along from one phase of care to the next.

Ideally, UR should help a consumer get the best care at the best price in the right setting. Consumers in managed care plans can appeal decisions by the plan's UR departments that they believe are inappropriate. They should work with their doctor to document for the UR department their disagreement with the decision and outline why another treatment option is preferable. In fact, under the Affordable Care Act, when treatment is denied, you have the legal right to ask for an internal review and, if this appeal is denied, an independent, external review. This right applies to plans created after March 23, 2010. Finally, if necessary, consumers can also file a complaint with the state agencies, such as the health or insurance departments, or the attorney general's office.

 
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  Experimental Therapy Shows Promise Against Type of Adult Leukemia
  Gene Variations Leave Infants at Risk of Leukemia, Study Suggests
  Avastin Shows Mixed Results Against Different Cancers
  More Evidence That HPV Vaccine Might Lower Cervical Cancer Risk
  Thyroid Tumors May Be More Dangerous for Cancer Survivors: Study
  Surge in Thyroid Cancer Cases May Be Due to Overdiagnoses: Study
  Advanced Tonsil Cancer May Respond Well to Targeted Radiation
  Vitamin E, Selenium Supplements Might Double Chances of Prostate Cancer
  Healthy Adults Shouldn't Take Vitamin E, Beta Carotene: Expert Panel
  Ovarian Cancer Gene May Point to Early Removal of Ovaries: Study
  Late-Stage Cancer Diagnosis More Likely in Uninsured Teens, Young Adults
  Necks, Butts Growth Areas for U.S. Plastic Surgeons
  Skin Cancer May Have Driven Evolution of Black Skin
  Study Sees No Evidence Linking Diabetes Drugs With Pancreatic Cancer
  After Skin Cancer, Removable Model Replaces Real Ear
  Experimental Drug Helps Body Fight Advanced Melanoma: Study
  Yoga May Help Breast Cancer Patients During Radiation Therapy
  Study Adds to Evidence That HPV Vaccine Helps Guard Against Cervical Cancer
  Younger Skin Cancer Survivors May Be at Risk for Other Cancers
  Surgery May Benefit Younger Prostate Cancer Patients
  Meditation May Help Teens Cope With Cancer
  Ways to Cut Your Colon Cancer Risk
  Targeted Radiation Might Help Fight Advanced Breast Cancer: Study
  U.S. Could Face Shortage of Cancer Doctors
  Excess Weight a Risk Factor for Ovarian Cancer: Report
  Newer Radiation Therapy Treats Prostate Cancer More Quickly: Study
  Whole-Genome Scans Not Quite Ready for Widespread Use: Study
  Experimental Drug May Boost Leukemia Survival, Without Chemo
  FDA Panel Recommends HPV Test As Replacement for Pap Smear
  Diabetes Linked With Lower Cancer Survival: Study
  Wider Waistline May Mean Shorter Lifespan: Study
  Colon Cancer Cases Decline for Older Americans
  For Women's Cancers, Where You're Treated Matters
  Study Supports Radiation When Breast Cancer Spreads to Few Lymph Nodes
  Serious Health Issues May Await Survivors of Childhood Cancer
  New Stool Test Shows Promise as Colon Cancer Screen
  Daily Exercise Lowers Breast Cancer Risk: Study
  Still Too Few Minority Participants in U.S. Clinical Trials, Study Finds
  Colonoscopy Is Good, Not Perfect
  HPV-Linked Throat Cancer May Have Telltale First Symptoms
  Diabetes Tied to Higher Risk of Pancreatic Cancer in Study
  New Guidelines Might Limit Need for Lymph Node Removal for Breast Cancer
  Routine Mammograms Found Not Helpful for Most Women Over 70
  Experts Warn About Skin Cancer 'Treatments' Sold Online
  Anti-Seizure Drug May Guard Against Some Cancers
  Treatment May Prevent Esophagus Condition From Progressing to Cancer
  Many Breast Cancer Survivors Suffer Financially, Study Finds
  Experimental Drug Shows Promise for Drug-Resistant Lung Cancer
  Slight Drop in Rate of Advanced Cancers, CDC Says
  Lung Cancer Diagnosis Takes Toll on Patients' Sex Lives, Experts Say
  Fruits and Veggies May Reduce Death Risk, Study Suggests
  FDA Advisory Panel Recommends Approval of At-Home Colon Cancer Test
  Certain Colon Cancer Patients Might Benefit From Aspirin, Study Says
  Fertility Drugs May Not Raise Breast Cancer Risk: Study
  More Doctors Than Consumers Favor Legalizing Medical Marijuana: Survey
  New Review Suggests Benefits of Annual Mammograms Are Overstated
  Cialis May Not Prevent Impotence in Men Treated for Prostate Cancer
  Melanoma Death Risk Higher for Men Living Alone?
  Doctors' Skill at Colonoscopy May Affect Patients' Colon Cancer Risk: Study
  Obesity May Shorten Colon Cancer Survival
  DNA Test May Gauge Risk of Prostate Cancer's Return
  Experimental Breast Cancer Drug Seems Safe, Effective for Advanced Disease
  Vegetables in Childhood May Benefit Breast Health
  Could Daughter's Cancer Risk Be Affected by Father's Age at Birth?
  High-Fat Diet May Boost Breast Cancer Risk
  Chemo Might Give Certain Lung Cancer Patients an Edge
  Age a Big Factor in Colon Surgery Complications, Study Finds
  Experimental Drug Shows Early Promise for Some Cases of Advanced Melanoma
  Irregular Periods May Be Risk Factor for Ovarian Cancer, Study Suggests
  Study Links Coffee to Lower Liver Cancer Risk
  Cervical Cancer Vaccine Program in England a Success, Researchers Report
  Cheaper 'Gene Panel' Screening May Reveal Cancer Risks
  Blood Test Aims to Predict Breast Cancer's Return
  Cancer 'Vaccine' for Advanced Disease Passes Early Hurdle
  Placing Donor Windpipe First in Patient's Arm Helps With Transplant
  Quarter of Prostate Cancer Patients May Abandon 'Watchful Waiting' Approach
  So-Called 'Apple Shape' Not a Risk Factor for Breast Cancer: Study
  FDA Warns Against Procedure for Uterine Fibroids
  False-Positive Mammograms Don't Deter Women From Future Screening: Study
  People Seek Out Health Info When Famous Person Dies
  People With Kidney Disease Show Higher Cancer Risk in Study
  Aspirin's Ability to Prevent Colon Cancer May Depend on Your Genes
  Smoking, Drinking Combo Raises Odds for Esophageal Cancer
  FDA Approves HPV Test as Initial Screen for Cervical Cancer
  Joblessness an Unwanted Side Effect of Chemo for Breast Cancer
  Radiation May Equal Surgery, With Easier Recovery, for Cancerous Lymph Nodes
  'Freezing' Technique May Work for Some Women With Early Breast Cancer
  Lung Cancer Surgery May Be Safest at High-Volume Hospitals, Study Finds
  Y Chromosome Loss Linked to Higher Cancer Risk in Men
  HPV-Linked Oral Cancers May Not Be 'Contagious'
  Skin Cancer Prevention Tips
  Nail Salons' Drying Lamps Carry Small Cancer Risk
  Low Vitamin D Linked to Aggressive, Advanced Prostate Cancers: Study
  Ultrasound of Lymph Nodes No Less Accurate for Obese Women, Study Says
  Southeastern States Have Highest Rates of Preventable Deaths
  New Colon Polyp Removal Method May Be Easier on Patients
  Screening May Help Boost Liver Cancer Survival Rates
  Use Your 'ABCDE' to Spot Deadly Skin Cancer
  Schizophrenia May Raise Dementia Risk in Older Adults
  One Woman's Cancer Battle Highlights Promise of New Treatment
  Exercise Linked to Improved Bladder Cancer Survival
  Just Seeing a Doctor May Boost the Odds of Surviving Melanoma
  U.S. Cervical Cancer Rates Higher Than Thought
  Lung Cancer Not on Many Women's Radar: Survey
  Prescription Drug Use Continues to Climb in U.S.
  Some Prostate Cancer Patients Might Safely Delay Hormonal Therapy: Study
  Unneeded Cancer Care Is Rare, Study Finds
  It's Better to Prevent a Sunburn Than to Treat One, Dermatologist Says
  Stepped-Up Screening Would Uncover More Lung Cancers, Study Says
  Obesity May Raise Breast Cancer Death Risk for Some Women
  Scientists Get Closer to the Stem Cells That May Drive Cancers
  Could a Blood Test Predict Breast Cancer's Return?
  Surgery Isn't Only Option for Women With Ovarian Cancer Genes
  Dogs May Help Spot Human Prostate Cancers, Study Finds
  Experts Debate Value of Self-Exam for Testicular Cancer
  Pancreatic Cancer Will Be 2nd Deadliest Cancer by 2030: Study
  Diet, Lifestyle Affect Prostate Cancer Risk, Studies Find
  Two-Thirds of U.S. Adults May Carry HPV
  Type of Kidney Disease May Dictate Cancer Risk
  Blood Test May Spot Pancreatic Cancer Earlier
  Gene Tests May Improve Lung Cancer Care: Study
  Double Mastectomy Often Not Needed, Study Finds
  Cancer Center Ads Focus on Emotions More Than Facts, Study Finds
  New Guidelines Recommend Longer Tamoxifen Treatment
  Abnormal Lung Scan May Be 'Teachable Moment' for Smokers
  Task Force Recommends Hep B Screening for High-Risk People
  Your Income Might Influence Your Risk for Certain Cancers
  Memory Problems After Chemo Linked to Brain Changes
  Animal Trials Show Promise for Treating Eye Cancer
  New Drug Shows Promise for Resistant Thyroid Cancer
  Viewing E-Cigarette Use May Keep Smokers From Quitting
  Lower Risk of Prostate Cancer Seen in Circumcised Blacks: Study
  Immune-Based Treatment May Fight Advanced Cervical Cancer
  New Approach May Boost Survival From Advanced Prostate Cancer
  Drug May Lower Odds of Early Menopause in Breast Cancer Patients
  Indoor Tanning Ups Melanoma Risk, Even Without Burning: Study
  Some Breast Cancer Patients May Get Drug-Linked Heart Failure: Study
  Melanoma Drug Trials Show Significant Promise
  Stopping Statins for Terminal Patients a Safe Option: Study
  5 or More Bad Sunburns While Young Tied to Higher Melanoma Risk
  Number of Cancer Survivors Will Reach 19 Million in Next Decade: Report
  FDA Orders New Warning Labels for Tanning Beds
  Pair of Pills Shows Promise for Recurrent Ovarian Cancer
  Newer Anti-Estrogen Treatment May Benefit Younger Breast Cancer Survivors
  1 in 4 Smokers With Gene Defect May Get Lung Cancer
  Experimental Drug May Extend Lung Cancer Survival, Study Suggests
  Certain Breast Cancer Patients May Need Little Treatment After Tumor Removal
  New Drug May Boost Survival for Advanced Prostate Cancer Patients: Study
  Breath Test May Spot Lung Cancer
  First-Time Colon Cancer Screening May Be Beneficial for Elderly
  Fish, Exercise May Help Thwart Colon Cancer's Return: Study
  Medicaid Patients Get Worse Cancer Care, Studies Contend
  Half a Million Cancers Prevented by Colon Screenings: Study
  Many Childhood Leukemia Survivors Aren't Taking 'Maintenance' Meds: Study
  Sophisticated Chest Scans May Raise Children's Lifetime Cancer Risk
  Many Women With Breast Cancer Get Too Little Exercise
  Are You Eating Enough 'Powerhouse' Vegetables?
  No Drop in Smokeless Tobacco Use Among U.S. Workers: CDC
  Breast Cancer Drug Herceptin Linked to Risk of Heart Problems: Study
  Low Cholesterol Levels May Spell Trouble for Kidney Cancer Patients
  Moles May Be Harbinger of Higher Breast Cancer Risk
  Childhood Cancer Survivors More Likely to Be Hospitalized: Study
  Red Meat May Raise Breast Cancer Risk, Study Suggests
  Tumor-Targeting Agent Attaches to Cancer Cells: Study
  Grill Safely This Holiday Weekend
  Breast Cancer Surgery Rates Vary Greatly in Canada
  Can Weight-Loss Surgery Lower Cancer Risk for the Obese?
  Cancer Survivors Face Mounting Costs of Continuing Medical Care: Study
  Timing of Day's First Cigarette May Influence Lung Cancer Risk
  Women With Breast Cancer Genes More Likely to Choose Extensive Surgery
  Lymphoseek Approved for Diagnosing Cancer Severity
  Older Breast Cancer Patients Do Follow Drug Therapy: Study
  Study Ties Too Much Sitting to Risks for Certain Cancers
  MRIs Plus Mammograms Best for High-Risk Women, Study Finds
  Vitamin D: A Key to a Longer Life?
  Soy Foods Don't Seem to Protect Against Uterine Cancer: Researchers
  Mammography Cuts Breast Cancer Deaths by 28 Percent: Study
  Popular Crohn's, Colitis Drugs Not Linked to Short-Term Cancer Risk: Study
  Cost of Prostate Cancer Surgery Varies Widely in U.S.
  When Is the Cost of Cancer 'Toxic'?
  Pavement Sealant Ban Linked to Cleaner Lake Water
  Mouse Study Supports Notion of 'Tanning Addiction'
  New Clues to Why Blacks Fare Worse With Colon Cancer
  Indoor Tanning Leads to Early Skin Cancer, Study Says
  Teens Who Prefer Menthols Are Heavier Smokers: Study
  Diets High in Dairy Might Boost Colon Cancer Survival, a Bit
  3D Mammograms May Improve Breast Cancer Screening
  Study: Daily Low-Dose Aspirin May Help Ward Off Pancreatic Cancer
  HIV Patients Less Likely to Get Cancer Treatment: Study
  Most Women Don't Need Regular Pelvic Exams, New Guidelines State
  Liver Cancer Drug Fails to Live Up to Early Promise
  Mammography Costs Soar for Seniors, But Detection Rates the Same: Study
  Possible Advance for Some Late-Stage Lung Cancer Patients
  Men Develop Breast Cancer, Too
  Childhood Vaccines Vindicated Once More
  'Generally Reassuring' Findings on Fertility Drugs, Women's Cancers
  Cholesterol Levels May Be Linked to Breast Cancer Risk
  Cervical Cancer Vaccine Doesn't Boost Clot Risk: Study
  Breast Cancer Drug Aromasin May Be Option for Some Premenopausal Women
  Study Links Vasectomy to Aggressive Prostate Cancer
  Depression May Make It Harder to Beat Prostate Cancer
  FDA Advisers Weigh Risks of Procedure for Removal of Uterine Fibroids
Adult Diseases and Conditions
  Grading and Staging of Cancer
  Diagnostic Procedures for Cancer: Overview
  General Information About Cancer: Overview
  Overview of Cancer
  Surgery
  Plastic Surgery Statistics
  Cancer Rehabilitation
  Online Resources - Cancer
  Breast Cancer Overview
Pediatric Diseases and Conditions
  About Cancer
  Alternative Therapy for Cancer
  Diagnosing Cancer
  Treatment for Cancer
  Causes of Cancer
  Coping with a Diagnosis of Cancer in Children
  Nutritional Requirements for a Child With Cancer