- In one large survey, approximately 4 in 10 people with cancer said their out-of-pocket (self-paid) expenses were higher than they expected. 1
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Financial Impact of Cancer Pocket Guide
If you or a loved one are diagnosed with cancer, financial worries may be the last thing on your mind. Learning more about the cancer, treatment options, and expected outlook are probably first. So, it might surprise you to learn that cancer and its treatment can have serious, sometimes lasting effects on your finances. This pocket guide is designed to help you assess your situation, spot financial pitfalls, and avoid what many health-care providers call “financial toxicity.” Financial toxicity happens when the cost of having cancer—including treatment, sick time, or in some cases being unable to work—causes problems for you and your family. Problems can include: The financial effects of cancer can affect your family and future plans, whether you are paying for ongoing treatment or receiving care for post-treatment side effects, called late effects. 4 Raymond Wadlow, MD, is a medical oncologist at the Inova Schar Cancer Care Institute in Fairfax, Virginia. “I see a lot of variation in how cancer affects people’s finances,” he says. “Some have insurance but not enough to prevent them from having financial difficulty from the cost of care. Others have no insurance.” Each U.S. state has options for people without insurance, such as a state-funded plan or high-risk insurance pool. Your cancer center may also be able to help with payment plans, reduced rates, patient assistance, or connections with charitable organizations. People without health insurance may apply for public insurance, such as care through the state where they live, Medicaid, or Medicare. However, applying and being accepted takes time and quite a bit of work. This can be difficult for someone who is not feeling well, has relatively low health literacy, is not a fluent English reader and speaker, or is not a computer user. Waiting to be accepted into an insurance program can also cause risky delays in getting cancer treatment, according to Dr. Wadlow. Many cancer centers have financial counselors on staff who can help walk patients through their options to pay for cancer care and connect them to resources for additional support. Some health-care systems have charity care, so that may be worth exploring before deciding where to receive treatment.
Dr. Wadlow offers this advice to reduce or avoid financial toxicity: “You’re much better off bringing the question of finances to your health-care team’s attention than trying to avoid it,” says Dr. Wadlow. This is particularly true if you are already facing some financial challenges, such as going without insurance or coping with another health condition. Dr. Wadlow says, “There are resources available! It is much easier for us to personalize your care for maximum benefit if we hear about your needs and concerns.” Our top tips to lessen the financial impact of cancer include: Many people with health insurance are accustomed to paying a modest amount for appointments, tests, and prescriptions. But cancer is one of the most expensive medical conditions to diagnose and treat. 5 Staging scans alone may run thousands of dollars, and these tests occur well before any expensive treatment is delivered. Factors that make cancer treatment especially costly include: Providers may assume that because someone with cancer has health insurance, the cost of treatment won’t be a concern. Unfortunately, it can be, even for people with “good” insurance. Someone with a high deductible may have to pay $3,000 to $6,000 out of their own pocket before insurance begins paying any part of the cost. With a short-term health insurance plan, the policy may pay very little. Co-insurance is the percentage of each bill the insured person must pay (the insurance company pays the rest). If someone’s co-insurance rate is 20 percent, their out-of-pocket cost is modest for a treatment that costs $100. But if a cancer medication costs $10,000 per month, the person with cancer just acquired a new monthly bill of $2,000—more than the average mortgage payment in some parts of the country. According to the National Cancer Institute, prices higher than $10,000 a month for individual drugs are “common.” Asking questions about cost can help you avoid overwhelming financial impacts. You may need to bring this up with your oncologist and other team members. Dr. Wadlow says most providers don’t realize how big a financial burden cancer places on the people they care for. “Doctors don’t know much about this, and patients often don’t tell them much,” he says. “People may be apprehensive about sharing financial concerns with the cancer care team because they are wary of having the ‘budget’ option recommended. They want to hear about the best care, not the lowest-cost option, because that may seem like it’s less effective.” Financial toxicity may lead some to skip supportive services, such as physical therapy or nutrition counseling, without first talking with their doctor. This may be an opportunity to ask about integrative options that are low cost or even free. See our chart, Free and Low-Cost Integrative Health Resources, for examples of services that support healing. Research shows that most people who choose integrative health options such as massage, acupuncture, chiropractic, or biofeedback pay for them personally. Insurance often does not cover them. In addition to buying higher-quality foods, such as fresh fish and organic produce, paying for these types of care takes a bite out of the family budget. “There is a barrier to leveraging the benefits of integrative medicine if you have financial stress,” says Dr. Wadlow. “You have stress related to paying for your regular care. This may keep you from taking advantage of integrative approaches that would help your stress—so even more stress builds up.” Bringing integrative care further into the mainstream can help. When insurance companies begin to cover these treatments, doctors are more likely to prescribe them in addition to standard cancer care. “Integrative treatment should be integrated into the care plan, so everyone understands that it is every bit as important as chemotherapy or surgery in terms of whole-person care—not an added luxury,” says Dr. Wadlow. “When that happens, financial stress can be distributed across the whole spectrum of treatment, so it is less likely to prevent people from choosing integrative modalities.” Doing this will require changing some government rules. For example, Medicare does not cover treatments it considers “alternative,” such as acupuncture, except for very specific purposes. Some cancer centers offer financial assistance programs. One such program at the Karuna Precision Wellness Center in Indiana offers financial assistance to clients regardless of income level. Unite for HER, a Philadelphia-based organization, recently launched a wellness program that covers the cost of integrative health services for breast and ovarian cancer patients. The national program is available for those within 18 months of diagnosis or who have been diagnosed with metastatic disease. Patients receive a care box with educational resources as well as a $2,000 passport that covers the cost of integrative therapies such as nutritional counseling, virtual fitness and yoga classes, sexual health counseling, and meditation. Many patients use crowdfunding platforms such as GoFundMe to ask friends, family, coworkers, and others to assist with the costs of cancer treatment. This provides the patient with an easy link to share through social media, text, or email that can be an easy and non-awkward way to ask others for financial assistance. Another way that friends and family can offer help is through Meal Train. This platform creates an easy, organized tool for friends and family to plan meals for a loved one who is going through cancer treatment or surgery or just needs help planning meals. For health-care providers Let everyone with cancer know that financial counselors or navigators are available and can be helpful in planning to meet the cost of cancer care. Also let them know social workers can help them locate free or low-cost care resources and practical support connect them with other organizations that offer free or low-cost help for people with cancer. Knowing that the very latest chemotherapy drug or treatment is extremely expensive “creates a lot of anxiety,” says Dr. Wadlow. His approach? Talking about financial options with every person who needs treatment, without guessing who might face financial challenges. “I simply say, ‘We could do this treatment, or here are some other less costly options.’” This can help start a discussion about which treatment is the best choice overall. A cancer survivor’s advice Jenny Leyh, a breast cancer survivor and mother of two, felt the strain of financial toxicity after having to quit her job following her diagnosis in 2016. Her advice is to keep a binder of important documents and tap a family member to play the role of patient advocate and manage the medical bills. “A cancer diagnosis is an overwhelming experience and cannot be solely managed by an individual. It’s important to ask for help in areas where you need assistance. Explore free or less expensive options such as online yoga classes, going for walks, imagery and mindfulness apps, or books on meditation. Complementary practices are so important in supporting healing during treatment, and they do not have to add to the financial burdens of cancer care,” says Leyh. CancerCare.org offers a Helping Hand tool — a searchable database of organizations that help people with cancer. You can search by your type of cancer and the type of assistance you’re interested in, such as meal delivery, help paying for prescriptions, and much more. A magazine called CONQUER: the patient voice, from the Academy of Oncology Nurse and Patient Navigators, offers a wealth of information on financial issues and cancer. The HealthWell Foundation offers assistance to people who are underinsured and dealing with a serious illness. They also provide coverage for some medications. Triage Cancer offers a tool to help guide patients through the potential financial burdens of cancer care.Fast Facts
THE FINANCIAL IMPACT OF CANCER
“Financial toxicity” – A lesser-known side effect
No health insurance?
An oncologist’s advice
More finance and insurance tips
The impact of out-of-pocket costs
Talking with health-care providers
Integrative care and finances
More financial assistance options
Crowdfunding
Resources
References
Topics: Cancer | Stress
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