Toxicidad financiera y cáncer de mama (seno): cómo pueden ayudar los médicos

This podcast episode is made possible by AstraZeneca and Daiichi Sankyo.

Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here’s your host, Breastcancer.org Senior Editor, Jamie DePolo .

Jamie DePolo: Hello, I'm Jamie DePolo, senior editor at Breastcancer.org. I'm podcasting live from the 2025 American Society of Clinical Oncology annual meeting. My guest is Dr. Fumiko Chino, assistant professor of radiation oncology at MD Anderson Center. She’s also one of the directors at the Cost of Care organization, a non-profit working to improve affordability in healthcare. At this conference, she was part of an educational session on addressing financial toxicity in breast cancer care. Her presentation discussed ways doctors can help ease financial issues and resources for people receiving care. Dr. Chino, thanks for joining us. 

Dr. Fumiko Chino: Thank you so much for having me today. 

Jamie DePolo: Just to give everybody an idea, could you summarize your talk for us?

Dr. Fumiko Chino: Absolutely. So, I participated in a panel that was an education panel focused on breast cancer and the affordability gap. The panel was really lovely in that it was quite a diverse range of voices. We had someone who was actually practicing breast cancer treatment in Europe. We had someone who was actually evaluating essentially how to improve affordability at the system level, meaning within the clinical trial design or how drugs are delivered or approved within health systems. And then, my talk was specifically on the kind of patient and provider institutional focus that we can do to improve affordability. 

Our last speaker was actually a patient advocate that spoke quite eloquently about her experience with breast cancer and the affordability gap, and also what she has done as a motivated and engaged patient to actually try to close that gap. So, it was a really nice perspective from a broad range of speakers. 

My focus was on what we can do sort of within our institutions, within our clinics, and at the bedside. And I tried to focus on, you know, really discreet ways that we can improve things like education for both patients and providers, how we can be more proactive versus reactive in terms of providing financial assistance, and how we can really think about what are the friction points that our patients are feeling and how do we work to eliminate those. Some of those are really practical barriers, like decreasing wait times so that patients can go back to work after their clinic visit, or eliminating things like parking fees, which I've been mad about for years now and I know that patients and providers feel equally frustrated with them. 

Jamie DePolo: Well, sure. And as a radiation oncologist, you're treating people who…perhaps not everybody anymore, but in the past had to come in every day for three to seven weeks. So, that’s a significant amount of money for parking. 

Dr. Fumiko Chino: Every single day for parking, yes. And it’s frustrating. I've actually done a study that showed that there are centers that are actually charging every single day for parking. And it’s just infuriating, especially because a lot of cancer centers are not in places that are…I mean, I used to practice in New York City. I understand parking there is expensive. But parking in, let’s just say, North Carolina or in Tennessee or in some areas of Florida is not something that is a precious resource. And so, if you're on active cancer treatment, I actually lobby everyone to really work it out with your health system to eliminate parking fees for people on treatment. 

Jamie DePolo: Yeah. Let me ask you this. This session that you were in was specifically on breast cancer. Do you think that people who are being treated for breast cancer…is the financial toxicity worse in that group than any other types of cancers?

Dr. Fumiko Chino: That’s a really excellent question. I do think that people with breast cancer are uniquely at risk and some of it has to do with the patient population itself. So, people with breast cancer are primarily women, not all, but they are primarily women. Women do tend to have a lower income at baseline. They also have more caregiving roles. And so, we are…I speak as a woman, we’re wearing many hats and we’re trying to juggle many different obligations. 

And then, treatment for breast cancer does tend to be pretty complex, meaning you need multi-modality treatment often. So that means something like surgery, radiation, potentially chemotherapy and hormone therapy. Potentially the treatment actually can last years. For example, someone on anti-estrogen treatment might be on it for five to 10 years. Someone who’s on a HER2-based therapy will have a year of treatment. Someone with a triple-negative cancer will have a year of treatment at a minimum. And so, we’re talking about really prolonged, potentially complex treatment paths that require a lot of visits, that require a lot of follow-up care. So, I really do feel like this population is unfortunately enriched for financial hardship. 

And it’s a blessing and a curse to say that a lot of breast cancers are incredibly treatable and incredibly curable. That means that we have an incredibly large survivorship population. So, that means things like financial toxicity can really cause durable problems for someone within their lifetime. Where you may have survived cancer, but you're not able to thrive in survivorship because of these lasting effects of financial burden.

Jamie DePolo: Right. Well, and it also, you know, there’s such a large survivor population, the treatments, especially some of the newer ones, have long-term potential side effects, heart side effects, you know, liver, all those kinds of things. So, that’s another thing that then adds to the cost of care. 

Dr. Fumiko Chino: Yeah. And that’s actually a really good point, which is why I love the term financial toxicity because it values the financial burden of a cancer diagnosis and treatment similar to how we value any other toxicity. Understanding that a toxicity for your heart or if you have peripheral neuropathy or if you have bad bone pain that requires additional things like physical therapy or acupuncture, or if lymphedema you need a wrapping for that. That creates an additional financial burden as well. And so, those durable physical toxicities additionally contribute to the durable financial toxicity. So, it’s an additive burden. 

Jamie DePolo: Are there areas of the country…when we were talking about parking, you know, in some rural areas parking isn’t at such a premium, but are there areas of this country where financial toxicity is a bigger burden than other places?

Dr. Fumiko Chino: I think that there’s a significant geographic variation in terms of burden. We certainly know that from some of my other research looking at how care is delivered and afforded within disparate healthcare systems and states and regions. There are certainly some states where there is better access to care. There’s more affordable care. Sometimes that is related to states making larger investments in social services and sometimes it’s related to the population dynamics that obviously people can't necessarily control. So, I do feel like there are big geographic gaps. And the example I’ll give is that I'm a radiation doctor, as you said it’s, you know, a daily treatment, often weeks of treatment. And as a daily treatment, if there’s only one cancer center that provides radiation in your area, you gotta to drive to that area or you have to take time off of work to live in that area for your treatment, and that is a huge affordability gap. 

Jamie DePolo: Okay. And then, what are some specific resources if people are feeling financially stressed during treatment? Are there specific places they can go? I know, Molly, the woman who started the Pink Fund was one of the speakers at your session because I ran into her, but are there other things like that?

Dr. Fumiko Chino: Absolutely. So, one of the great things about this education session at ASCO is that it actually comes with an educational book chapter. The book chapter is available open access, meaning that anyone can look at it. We actually kind of give one case example of financial toxicity along a care path for an individual, a hypothetical patient that we’ve modeled. And we actually give examples of ways to potentially intervene all along the care cascade for things like parking vouchers, but also for financial assistance for things like wigs. So, if you, you know, can't afford cold capping. Organizations like Cancer Care or Family Reach that can provide stop gap funds, and of course the Pink Fund, which has done phenomenal work. 

I was really enthused to see Molly on stage, as I feel that all sessions at ASCO should have a patient advocate on stage. She took her lived experience of a cancer diagnosis and financial hardship, and then she was very motivated to go do something to try to fix it. And so, her organization actually provides funding for people who may be transportation insecure, housing insecure, that may need that little stop gap money and it’s a really fantastic organization. It’s funny, I actually got off the stage, I thought about it, and I was like, the onus is on me to make a donation to the Pink Fund. So, I actually did that. I did that the day I got offstage with Molly. She really motivated me. 

Jamie DePolo: That’s great. I'm also curious. One of the things in your talk was ways that oncologists can bring up financial toxicity with the people they're caring for. If someone’s doctor doesn’t, should they bring it up with the doctor? Or is there somebody else in the care team that’s best suited to have that discussion with?

Dr. Fumiko Chino: So, each one of these discussions for cost conversations is unique. And so, it’s unique to the patient and what their comfort level is. It’s also kind of unique to the provider as well because some providers really don’t feel comfortable talking about costs. I would encourage everyone to strongly advocate for their self along the cascade of treatment with every individual that they can. So, to say, you know what, I'm having problems affording my care, or this drug is unaffordable, or I need to be able to work, and to bring it up with as many people that they feel comfortable bringing it up with. But if you don’t feel comfortable talking to your doctor about it, I think that is totally fine. 

You can request a consult with a social worker or you can request to meet with a financial care counselor. Really there should be multiple people that are going to be able to point you in the right direction about who’s going to be able to help you meet your unique needs.

I also want to be realistic and honest that there’s not endless resources for people. And so, often when we think about financial assistance it’s a limited amount and it may not be able to be repeated. And so, trying to think about sustainable solutions for the affordable crisis is also part of my larger work to improve health policy and care delivery in the United States.

Jamie DePolo: Okay. And then, finally, if someone’s listening to this podcast and they are having financial problems, feeling the stress, are there like two or three things that you would recommend they do that could be helpful?

Dr. Fumiko Chino: Yeah. So, again, everything is unique to the individual, but the No. 1 advice I have for patients is to actually really evaluate your health insurance and see what it pays for and what it doesn’t pay for. And to get a better estimation about what your expected costs will be for a standard treatment plan. So, that means that No. 1, you need to know what your treatment plan is, right? Which can sometimes be challenging because we don’t know the future. We have an idea of what the treatment plan is and then, you know, it can go off the rails in many different ways. But also to know what your health insurance pays for and what your maximum is for the year. So, that means that once you meet your out-of-pocket max for the year you will be fully covered from your health insurance and that number is actually quite different based on your health insurance plan. 

And then based on where you are in your care trajectory and your disease status, it may behoove you to, in the next able period, to actually enroll in a slightly different healthcare plan. So, for example, a lot of people are on high-deductible plans, meaning that they have low premiums, but their deductible is high and sometimes their benefit is low. And so, many people are actually benefited with a cancer diagnosis to go to a plan that is more comprehensive. So, their monthly premiums may be higher, but it will actually provide better services for them in the end. So, that’s actually in terms of the No. 1 thing I think that people can do, is actually to know their health insurance and take potentially better health insurance. 

I think the second thing is just to try to find the resources at your healthcare center. And so, that means typically speaking to a social worker to see what they are able to rally in terms of support around you, but then also to look at resources like for example, Breastcancer.org, and to use them as trusted tools to help you find what may best benefit you.

Jamie DePolo: I'm sorry. I just have one more question. When you were talking about switching healthcare, is that ever an issue with pre-existing conditions, or are you talking about looking for a different plan within the same company?

Dr. Fumiko Chino: Yeah. So, part of the Affordable Care Act is that the idea of a pre-existing condition, excluding you or precluding you from receiving all of the options for health insurance, was eliminated. So, some people still really are on grandfathered plans that don’t have this protection, but the Affordable Care Act really did help people with cancer, survivors with cancer, so that their prior diagnosis was not “counted” against them. So, it should not exclude you from having the options for your health insurance plan, but sometimes it’s actually quite challenging to figure out what is the right plan for you. And so, I always encourage people to do some research, to talk to the financial care counselor at their hospital, because often that person actually knows what the good plans are and what the bad plans are. 

Yeah. And the last thing I’ll say is that if you're, you know, about to turn 65 if you have a cancer diagnosis in your background. I would never enroll in a Medicare Advantage plan. 

Jamie DePolo: Dr. Chino, thank you so much. 

Dr. Fumiko Chino: Absolutely. It was a pleasure.

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