A June 19, 2017 editorial in the New York Times opens with a quick summary of the current state of health care in America: “The problem with American health care is not the care. It’s the insurance.” Although advances are being made every day in the area of treating breast cancer and the five-year survival rate for localized cancers is now 99 percent (85 percent for cancers that have spread regionally and 26 percent for cancers that have metastasized to distance parts of the body), paying for these advanced treatments seems ever more difficult for some patients, especially given the current climate of uncertainty surrounding the health insurance and job markets.
And research suggests the financial toll of a breast cancer diagnosis may impact your health. A 2016 study conducted at the Fred Hutchinson Cancer Research Center in Seattle “found that the financial toxicity resulting from the high cost of cancer care is almost as deadly as cancer itself.”
[See: Breast Pain? Stop Worrying About Breast Cancer.]
Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research, said in a press release about the study that “it varies from cancer to cancer, but for those who are in a bankruptcy situation — and about 3 percent of cancer patients go bankrupt — the risk of dying is just very, very high.” In a related study published in 2013, Ramsey found that cancer patients, on average, were about 2.5 times more likely to declare bankruptcy as people without cancer. That’s because cancer treatment is expensive and exhausting; treatment for breast cancer could mean you’ll have to take a medical leave of absence from work, and for some that means a loss of income and the health insurance you’ll need to pay for the treatment.
A Canadian study published in 2005 found that “one year after diagnosis, 85 percent of breast cancer survivors who remained free of disease during the 3-year study period were absent from work for four weeks or more compared with 18 percent of healthy women.” The study noted that six months was the average time most of the women with breast cancer took off from work after receiving their diagnosis.
Molly MacDonald, founder of The Pink Fund, a nonprofit that provides 90 days’ worth of nonmedical cost-of-living expenses to breast cancer patients in active treatment, knows from experience just how precarious a patient’s finances can be during treatment for breast cancer. She was just about to start a new job in 2005, when a routine mammogram returned suspicious findings resulting in a breast cancer diagnosis. In an abundance of honesty, she let her would-be employer know, and she ended up not taking the job. “I didn’t want the employer to see me as a potential liability,” she says, but she was paying more than $1,300 per month for COBRA health insurance coverage. Within three months, she says she was potentially facing homelessness and bankruptcy and was worried about what would happen to her children. “I thought my kids are going to end up in this poverty cycle.”
She founded the Pink Fund to help patients like herself bridge the “huge chasm you have to cross over” between state and federal funds that are available to patients in the direst of financial circumstances and those who are “not making enough money to afford their care but are making too much to qualify” for financial assistance that would make a big difference. The aim of programs like the Pink Fund is to help patients have some time off and freedom from financial worries to help them focus on getting healthy again.
But getting time off work can be a real challenge for some patients, particularly hourly wage earners. People in those jobs only get paid if they show up, which can be exceedingly hard to do while receiving treatment. Side effects of chemotherapy and other breast cancer treatments can take a heavy toll on your energy levels, and when you feel as lousy as some of the medications make you feel, the very last thing you probably want to do is sit or stand somewhere all day trying to be pleasant to coworkers or customers. But to make ends meet, many patients must find a way to slog through it. For some patients, this means strategically scheduling treatments around a weekend or days off so the worst of the side effects hit on a day you’re not scheduled to be at work.
[See: 7 Innovations in Cancer Therapy.]
But your doctor or a social worker at the hospital may be able to help, both with scheduling treatments in a way that impacts your work life less or with financial help. Some hospitals have funds set up for low-income patients or those struggling to maintain a job or health insurance. The Susan G. Komen organization reports that “most hospitals and treatment centers have financial counselors. They can help you with the details of your insurance paperwork and give you an estimate of the cost of your treatment.” They may also be able to help devise a treatment payment plan, or if you’re eligible, waive the cost of some services. The Komen page linked above lists a range of financial resources that may be available to you, so check there for contact information.
Medicaid is a federal government program that’s intended to cover some patients who can’t get health insurance through their work or other means. Breastcancer.org recommends calling your local social services department to find out if you’re eligible. Your local public health department may also be a good resource for finding other programs that can help you pay for treatment.
The federal Affordable Care Act was intended to address the gaps in coverage out there for people who aren’t able to get health insurance through work, but that law is currently being repealed and replaced in Congress, and we simply don’t know yet what future health care legislation will look like. Meanwhile, private nonprofit organizations like the Pink Fund may be a way to address some of your financial needs while you’re in active treatment for breast cancer. The Susan G. Komen organization also sponsors programs that can help connect you with free or reduced rate care in your community. Similarly, the Avon Foundation for Women funds community-based safety net programs around the country. Through 2015, that organization has reportedly awarded more than 760 grants totaling upwards of $232 million to a network of more than 200 hospitals around the United States to help patients secure “access to high-quality, timely treatment.”
[See: What Not to Say to a Breast Cancer Patient.]
And before you’re even diagnosed, there are programs out there that can help you access free screening and diagnostic services. In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act, which directed the Centers for Disease Control and Prevention to create the National Breast & Cervical Cancer Early Detection Program. This program covers screening for patients in all 50 states, the District of Columbia, five U.S. territories and 11 American Indian/Alaska Native tribes. The CDC reports “the program helps low-income, uninsured and underinsured women gain access to breast and cervical cancer screening and diagnostic services,” including clinical breast examinations, mammograms and diagnostic testing for abnormal results. Eligibility baselines are set at 250 percent of the federal poverty level, and the CDC reports that 9.8 percent of U.S. women are eligible for breast cancer screening through the program.
Subsequent federal bills have helped fund access to breast and cervical cancer treatment through Medicaid for low-income patients in all 50 states and the District of Columbia. Although finding and navigating these resources can be challenging, there are programs out there that can help you pay for treatment.
If you’re having trouble making ends meet or are unsure how you’ll pay for treatment, be sure to speak with your doctor or another health care professional who can direct you to additional resources that may be available to help ease the burden so you can focus on healing.
More from U.S. News
Breast Pain? Stop Worrying About Cancer
7 Innovations in Cancer Therapy
What Not to Say to a Breast Cancer Patient
Making Sense of Breast Cancer, Health Insurance and Time Off Work originally appeared on usnews.com
