Even with insurance, many breast cancer survivors struggle with financial burden after treatment.
Breast cancer treatment is saving lives.
But its extreme expense is also causing a different kind of hardship for many survivors, saddling them with lifelong financial burden.
A new study finds that many physicians believe they’re adequately addressing patients’ financial concerns before treatment. However, many patients say doctors need to do more.
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The researchers surveyed 2,502 patients who were treated for early stage breast cancer.
They also surveyed 845 doctors, including medical oncologists, radiation oncologists, and surgeons who treat breast cancer.
Among women surveyed, close to 38 percent were at least somewhat worried about finances due to breast cancer treatment.
Some experienced extensive hardships.
14％的人表示，由于乳腺癌，他们失去了10％以上的家庭收入。7％的百分比报告报告超过10％的家庭收入，以上的医疗费用。
争夺和种族的反应有所不同。
Approximately 21 percent of white respondents and 22 percent of Asian respondents reported spending less on food due to financial difficulty. That compares to about 45 percent of black respondents and 35 percent of Latina respondents.
Overall, African-American and Latina women reported more debt from treatment. They were more likely to report losing their home, having utilities turned off, and cutting back on food spending.
在有经济问题的人中，73％的人表示，他们的医生办公室没有帮助解决它们。
Doctors’ responses show there might be a communication gap.
关于50 percent of medical oncologists and 43 percent of radiation oncologists said someone in their practice often or always discusses financial burden with patients.
Only about 16 percent of surgeons said they did.
“To cure a patient’s disease at the cost of financial ruin falls short of our duty as physicians to serve. It’s simply not acceptable to ignore patients’ financial distress any longer,” said Dr. Reshma Jagsi, deputy chair and professor of radiation oncology at Michigan Medicine and the study’s lead author, in a新闻稿.
有些人有低推卸和复制的计划，让他们通过最小的费用来实现治疗。
Many others have deductibles as high as $5,000 a year.
然而，达到扣除并不意味着保险公司，然后涵盖100％的成本。仍然有共同支付和超出口袋最大值。当治疗延伸到另一年时，循环重新开始。
Jackie Weber is a senior practice manager atUF健康癌症中心at Orlando Health. Her job responsibilities include making sure the financial aspects of treatment go smoothly.
She told Healthline that things can get quite complicated, and she should know. She’s also a breast cancer survivor.
尽管通过她的工作熟悉这个过程，但是当它归结为自己的健康保险时，韦伯有很多东西要弄清楚。
“You may have health insurance, but until you really need it most people don’t know what it will cover and what the out-of-pocket expenses will be,” she said.
Dr. Sean Fischeris a medical oncologist and hematologist at Providence Saint John’s Health Center in California.
He told Healthline that the direst circumstances are the cancer patients with no insurance or financial means.
“你真的想确定他们eligible for benefits like Medi-Cal [California’s Medicaid]. We get the necessary paperwork submitted with some degree of urgency so they can get tentative approval and start much-needed therapy and be retroactively covered from the date of submission,” said Fischer.
必要时，他的练习将患者关心转向医疗提供者的设施，这将使治疗更加经济。
费斯特解释说，对于那些具有高成本分享健康计划的人，有复制援助计划，普通财务援助方案，慈善基础计划和毒品公司援助。
However, eligibility for some of these programs depends on income.
2017年，一个粉红色的基金民意调查found that 36 percent of the female breast cancer patients who responded reported losing their job or being unable to continue working. And 47 percent reported reaching into their retirement accounts to pay for out-of-pocket expenses.
“工作是一个主要的压力师[那]，不幸的是，患者必须随着他们的战斗癌症应对，”费舍说。
For some, time off for surgery, chemotherapy, or radiation treatment translates into loss of income. Too many days off can jeopardize their job and the health insurance that comes with it — just when they need it the most.
Fischer said many are forced into taking temporary disability, noting that these problems affect people with all types of cancer.
“Some have no income, and the cost of cancer mounts,” he said.
It’s a problem that affects patients at every income level.
Kathy Flora这首第一手知道。
Fifteen years ago, she was a high-earning vice president at an HR consulting firm.
然后她被诊断出患有第1阶段的乳腺癌。她的雇主提供了一项出色的健康政策，最初将她留下了少量的口袋费用。
However, Flora told Healthline her financial concerns began when her supervisor started pressuring her to leave her job, a move that would threaten her family’s financial security.
Her doctor wrote a letter to her employer to confirm that she could — and needed — to work.
Despite that assurance, her responsibilities were downsized. Then she was transitioned into a lesser position. Finally, she was forced to relocate to another state in order to keep the job and associated medical coverage.
搬迁四个月后，她的雇主让她走了。
乳腺癌复发意味着更多的治疗，这次随着8,000美元的速度达到了港口达到的。
其他费用，包括COBRA保费，然后是个人健康保险，搬迁费用，工作丧失和法律费用，接近300,000美元。
With the help of an attorney, Flora was able to get some of the retirement benefits she’d built up over the years.
“We had assistance from the right people who helped me fight for what I deserved and needed,” said Flora, who is now a career coach at癌症和职业生涯.
She advises those undergoing cancer treatment to take advantage of all the medical, financial, and legal support services available.
Fischer said that he typically focuses on patient-centric aspects of breast cancer care with respect to diagnosis, treatment, and prognosis.
“We will recommend specific treatment protocol,” said Fischer. “Then a nurse will have a separate appointment with the patient to review the protocol and specific supportive care aspects of the protocol. Then they segue into financial care.”
菲舍尔表示，一旦议定书提交给保险公司，该实践的财务顾问与患者讨论其预计责任。
“We have a whole financial team. They’re far savvier than physicians when it comes to which programs benefit which patients. It has a lot to do with which treatments will be used,” he said.
韦伯说，曾经在金融人士和照顾之间的沙子中曾经是一条线，但他们与彼此的关系已经进化。
“The doctors were very driven to get patients into care as quickly as possible. They felt the process of obtaining authorization was slowing their ability to treat patients. We had to get our doctors to understand that concerns about the financial impact of this disease can outweigh actual treatment of the disease,” she explained.
Weber said doctors have begun to tune in to this reality.
“We’re now working in partnership. The doctors really try to raise a flag if they see something we can do. They’re not just tuned in to the physical piece, but the emotional piece [as well].”
As the healthcare cost-sharing burden has changed over the last decade, some practices have adjusted and are becoming better at dealing with it, according to Fischer.
但是，仍有很大的进展，以及那些有助于课程的这些做法仅在患者与其护理提供者交谈时才有效。
Weber said some don’t say anything at all until things get desperate.
这就是为什么她建议在他们的实践中与医生，护士和其他人公开发言。她还建议患者考虑支持群体。
“当你是支持小组的一部分时，它有助于打开讨论，以便在局面变得绝望之前开始思考事物，”韦伯说。
Working together can help keep the cost of the cure from becoming as difficult to survive as the cause.