Why you should care
Almost half of stage 4 breast cancer patients face extreme financial hardship on top of their diagnosis.
Piles and piles of bills mounted in front of Krishale Fitzgerald, but that wasn’t what was at the top of her mind. Her neurofibrosarcoma, a cancer of the material that insulates nerves, had metastasized twice in two years, resulting in expensive surgeries and treatments, and her inability to work. Even though Fitzgerald had insurance, “just to survive I had to choose where I spent my money, and credit card bills and medical bills became the last thing on my priority list,” she says. To get the calls, letters and legal judgments to stop, she decided to file for bankruptcy.
If you live in the United States, you likely spend more on health care than you would if you lived in Switzerland or Canada or any other developed country. But what if you have a condition that requires intensive, long-term care and instead of spending the average $10,000 a year, you have to spend $30,000 or $60,000 or more? And what if you can’t afford to?
The percentage of Americans who are uninsured reached a four-year high recently, with nearly 14 percent of adults saying they have no coverage. But health insurance doesn’t protect against illness; it doesn’t even ensure you’ll get the treatment you need. In fact …
In a recent study of people with metastatic breast cancer, nearly half had been pursued by debt collectors — including approximately one-third of patients with insurance.
The survey included more than 1,000 patients who were members of the Metastatic Breast Cancer Network. Dr. Jennifer Spencer, one of the study’s authors, says they chose to focus on metastatic breast cancer patients because they are often underrepresented in breast cancer studies, yet because of the nature of their disease have a very different experience. “That population is already at risk. They are more likely to be low income at the time of diagnosis, and experience additional struggles,” she says. Fifty-four percent of patients surveyed had stopped or refused treatment due to the cost — and among the uninsured, 98 percent had.
Metastatic breast cancer is also referred to as stage 4, when cancer has traveled from the breast and lymph system and created tumors in the brain, liver, lungs, bones or other parts of the body. Metastatic cancer is incurable and requires treatment until a patient decides to switch to hospice or end-of-life care. Only 22 percent of patients with metastatic breast cancer will survive four years; the median survival is just over two years.
Spencer acknowledges that the study’s sample size was small and that it only looked at some measures of what’s known as financial toxicity — something researchers aren’t even sure how best to measure. “Is it that you are to pay for your care; going into debt; being pursued by debt collectors; feeling stressed or experiencing mental health issues?” says Spencer. “What is the most important piece?” In the case of metastatic breast cancer patients, she believes a larger, nationally representative study is necessary, as well as a comprehensive study of financial toxicity in metastatic cancer patients in general.
While the study applies to only one disease, it involves a much larger issue. In 2013, NerdWallet found that medical debt was the largest driver of personal bankruptcy. And unconventional avenues of funding often don’t work: In 2015, an analysis of several crowdfunding sites found that 41 percent of campaigns were to pay off medical debt, but only 11 percent of those were fully funded. Cancer survivors report borrowing money, going into debt, being unable to pay for care, making other financial sacrifices and experiencing psychological hardship associated with costs of medical care, even when they have jobs and insurance.
When the debt collectors come calling, cancer patients are more than two times more likely to file for bankruptcy than other patients facing financial hardships. For many cancer patients, though, the risks of doing so outweigh any benefits: Another study found that filing for bankruptcy after a cancer diagnosis is a risk factor for early mortality. Although Fitzgerald still faces health and financial challenges, she feels declaring bankruptcy was the right decision: “I am able to focus on my health and happiness better now.”