Many cancer patients juggle care along with financial pain

May 22, 2018 by Tom Murphy
Many cancer patients juggle care along with financial pain
In this April 13, 2018, photo Josephine Rizo sits in her home with her stack of bills from her ongoing battle with cancer in Phoenix. As treatment costs soar and insurance coverage shrinks, hospitals and patient advocates around the U.S. are rushing to offer more help to patients like Rizo, who had no financial counseling. (AP Photo/Ross D. Franklin)

Josephine Rizo survived chemotherapy, surgery and radiation, but breast cancer treatment wrecked her finances.

Money was already tight when doctors told the Phoenix resident she had an aggressive form of the disease. Then she took a pay cut after going on disability leave, and eventually lost her job and insurance coverage. During treatment, Rizo got swamped with more than $50,000 in medical bills.

"My concern was, 'Am I going to die?'" she said. "I had to kind of focus 100 percent on my health to make sure I was around for my kids."

As treatment costs soar and insurance coverage shrinks, hospitals and patient advocates around the U.S. are rushing to offer more help to patients like Rizo, who had no financial counseling. Cancer centers are hiring experts to help patients navigate the insurance system, while nonprofits are teaching people to think about handling costs when treatments starts instead of waiting for a financial crisis to hit.

"We know a lot of very solidly middle class families, they were fine and then ... their financial lives changed," said Jean Sachs, CEO of the nonprofit Living Beyond Breast Cancer. "They're not prepared for the cost of cancer, let alone the care."

Cancer has long been an expensive disease to treat, but several factors have made the financial sting more intense in recent years, prompting more patients to delay treatment or cut back on their medications.

Insurers are tightening their prescription drug coverage and raising patient costs like deductibles as treatment prices soar. That means patients may have to pay several thousand dollars a year for a drug like the leukemia treatment Gleevec—a pill taken daily, sometimes for the rest of a person's life.

The Affordable Care Act sets limits for how much people have to spend on care each year. But cancer treatments often extend beyond a year, and those limits don't apply to care sought outside the increasingly narrow network of doctors and hospitals that some insurers offer.

Patient costs also can rise because newer cancer treatments are more tolerable, so people can stay on them longer, said Dr. Yousuf Zafar, a Duke Cancer Institute oncologist who studies financial distress.

A few years ago, Zafar and colleagues surveyed 300 adult, insured patients at the cancer institute. Nearly 40 percent reported a higher-than-expected financial burden, while 16 percent dealt with what he called "overwhelming financial distress."

Many cancer patients juggle care along with financial pain
In this April 13, 2018, photo Josephine Rizo sits in her home with her stack of bills from her ongoing battle with cancer in Phoenix. As treatment costs soar and insurance coverage shrinks, hospitals and patient advocates around the U.S. are rushing to offer more help to patients like Rizo, who had no financial counseling. (AP Photo/Ross D. Franklin)

More than a quarter of that patient population said they didn't take their medicines as prescribed. That meant skipping doses, taking smaller amounts or not filling prescriptions because of the cost.

Other research has found that cancer patients are more than twice as likely as those without the disease to declare bankruptcy.

More than 1.7 million new cancer cases will be diagnosed this year, according to the American Cancer Society. Who winds up in financial trouble will depend on factors like the patient's income, savings and insurance coverage.

It's not just the treatments that cause financial strain. Patients or parents of children with cancer often miss work or take on unexpected costs while traveling for care.

Shauna McLaughlin left her job as a dialysis technician the day her daughter, Madison, was diagnosed with leukemia. Doctors told the single mom that her 18-month-old would be hospitalized for at least a month.

McLaughlin lived for a while off credit cards, help from family and friends and income from odd jobs. But she fell behind on bills and eventually ran out of propane to heat her home in Massachusetts in the winter of 2012.

"You're learning about cancer and ... (chemotherapy) and all the side effects," McLaughlin said. "People don't understand that your whole life is falling apart around you as you're trying to worry about those other things."

McLaughlin, whose daughter has been cancer-free since December 2016, regrets brushing off a social worker's offer to help. She eventually turned to the nonprofit Family Reach for assistance with several bills.

Doctors say patients should meet shortly after diagnosis with someone who can guide them on paying for prescription drugs and other financial matters.

"A lot of times people don't realize there are resources available until they've already gone broke," said Dr. Veena Shankaran of the Fred Hutchinson Cancer Research Center in Seattle.

Many cancer patients juggle care along with financial pain
In this April 13, 2018, photo Josephine Rizo holds up just one of a stack of bills she has from her ongoing battle with cancer in Phoenix. As treatment costs soar and insurance coverage shrinks, hospitals and patient advocates around the U.S. are rushing to offer more help to patients like Rizo, who had no financial counseling. Rizo would have welcomed more help. She didn't know that disability pay would amount to only 40 percent of her income when she went on leave from her job processing pre-authorization treatment requests for a health insurer. (AP Photo/Ross D. Franklin)

Patients and doctors need to keep talking throughout treatment about their ultimate goal. Eventually, that may include discussing whether an expensive drug that improves a patient's quality of life is worth the cost, said Dr. Ali Thaver of the University of Chicago Medical Center.

"There's no black-and-white solution ... and that's hard, but just because it's hard doesn't mean it shouldn't be done," Thaver said.

Most hospitals and cancer centers offer some help for patients facing financial challenges, and many are bolstering the assistance they provide. That help might include a counselor who finds drug coupons and connects patients with charities, or a financial planner who helps people scrutinize their income and debt levels.

Dan Sherman, a Grand Rapids, Michigan-based consultant, has helped launch some 35 patient navigation programs in U.S. hospitals in the past six years to help people deal with problems like high deductibles or find better insurance coverage based on their prescriptions and medical needs.

Sherman noticed last year that one of his patients had surgery scheduled for Dec. 29. He arranged for it to be delayed a few days until after the patient's coverage reset. That saved her from having to pay a $5,000 deductible for the surgery and then face a fresh deductible in the new year.

"This concept is let's try to fix the problems before they actually develop," he said.

Rizo, the 39-year-old Phoenix breast cancer patient would have welcomed more help. She didn't know that disability pay would amount to only 40 percent of her income when she went on leave from her job processing pre-authorization treatment requests for a health insurer. She also didn't realize she'd have an insurance coverage gap before qualifying for the government-funded Medicaid program for the poor.

Now, she says, she's basically starting life over.

"It was something that was out of my control and I didn't know how to fix it," she said.

Explore further: Out-of-pocket costs exceed what many insured cancer patients expect to pay

Related Stories

Out-of-pocket costs exceed what many insured cancer patients expect to pay

August 10, 2017
A third of insured people with cancer end up paying more out-of-pocket than they expected, despite having health coverage, researchers at the Duke Cancer Institute have found.

Treatment costs can be another blow to cancer patients

July 27, 2017
(HealthDay)—The emotional and physical costs of cancer can be staggering. But the financial side of cancer is also a great burden, with many patients in the United States struggling to pay for treatment, new research ...

Talking money with the hospital trying to treat you

June 7, 2017
The financial counselor will see you now.

If the cancer doesn't kill you, the drug prices might

May 12, 2017
The medical community is growing alarmed about a creeping malady that can diminish the quality of life for patients in treatment and even shorten their lives.

Financial toxicity of cancer treatment 'an underestimated problem'

March 6, 2018
Besides side effects such as hair loss and nausea, a great many cancer patients in the US have to deal with stress and anxiety as a consequence of the high costs of their treatment. Pricivel Carrera of the University of Twente ...

Breast cancer places greater financial burden on black women

May 2, 2018
Having breast cancer placed a significantly greater financial strain on black women than white women, according to study by researchers at the University of North Carolina Lineberger Comprehensive Cancer Center.

Recommended for you

First immunotherapy success for triple-negative breast cancer

October 21, 2018
There is new hope for people with an aggressive type of breast cancer, as an immunotherapy trial shows for the first time that lives can be extended in people with triple-negative breast cancer.

Healthy diets linked to better outcomes in colorectal cancer

October 20, 2018
Colorectal cancer patients who followed healthy diets had a lower risk of death from colorectal cancer and all causes, even those who improved their diets after being diagnosed, according to a new American Cancer Society ...

Why some cancers affect only young women

October 19, 2018
Among several forms of pancreatic cancer, one of them specifically affects women, often young. How is this possible, even though the pancreas is an organ with little exposure to sex hormones? This pancreatic cancer, known ...

Scientists to improve cancer treatment effectiveness

October 19, 2018
Together with researchers from the University of Nantes and the University of Reims Champagne-Ardenne in France, experts from the National Research Nuclear University MEPhI have recently developed a quantum dot-based microarray ...

Mutant cells colonize our tissues over our lifetime

October 18, 2018
By the time we reach middle age, more than half of the oesophagus in healthy people has been taken over by cells carrying mutations in cancer genes, scientists have uncovered. By studying normal oesophagus tissue, scientists ...

Study involving hundreds of patient samples may reveal new treatment options of leukemia

October 17, 2018
After more than five years and 672 patient samples, an OHSU research team has published the largest cancer dataset of its kind for a form of leukemia. The study, "Functional Genomic Landscape of Acute Myeloid Leukemia", published ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.