Women With Metastatic Breast Cancer Report “Catastrophic” Financial Effects

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The costs of breast cancer treatment and follow-up care can be a financial strain for a number of people and their families, even with health insurance. Besides the cost of the treatment itself, you also may be facing extra expenses for travelling to and from a treatment center, child care while you’re having treatment, or lower income because you have to take time off from work.

This is especially true for people diagnosed with metastatic disease because they will be in treatment for the rest of their lives.

A national survey of more than 1,000 women diagnosed with metastatic breast cancer found that 35% had no insurance, and nearly 70% said they were worried about financial problems because of cancer.

The research was presented on Sept. 29, 2018, at the American Society of Clinical Oncology’s Quality Care Symposium. Read the abstract of “Cancer-related financial burden among patients with metastatic breast cancer.”

Nearly one-third who answered the survey had no insurance

To do the study, researchers at the University of North Carolina-Chapel Hill Lineberger Comprehensive Cancer Center partnered with the Metastatic Breast Cancer Network to survey women diagnosed with metastatic disease. The women were offered a $10 Amazon gift card to complete an online questionnaire about their background and the financial burden of treatment.

More than 1,510 women from 41 states responded; 35% of the women had no health insurance.

Compared to women with insurance, uninsured women were more likely to:

  • not pay non-medical bills
  • stop working after being diagnosed
  • be contacted by a collections agency

Overall, nearly 70% of the women said they were worried about having financial problems because they had been diagnosed with cancer.

Insured women are more likely to be stressed about finances

Women with health insurance were more likely than uninsured women to be worried or stressed about finances, said they were caught off-guard by the amount of out-of-pocket expenses they had to pay, and distressed because they didn’t know what their cancer care would cost.

"We were somewhat surprised to find that the uninsured/self-pay cancer patients who have the greatest material burden, in terms of inability to pay for medical and non-medical services, report lower overall distress and worry about their cancer costs relative to insured patients, although both groups report high levels of financial worry overall," said lead author Stephanie Wheeler, associate professor of public health at the University of North Carolina-Chapel Hill.

"This may reflect insured cancer patients being more caught off-guard by the high out-of-pocket cost of their cancer care if they expected that their insurance would more adequately cover expenses, when, ultimately, that was not the case," she added. "It could also be true that insured patients, who tend to have higher socioeconomic status, have more assets to lose to cancer than do uninsured patients, leading to greater worry about one's financial legacy and the effects of lost assets on the household."

The researchers said the results suggest health insurance is an important, but insufficient, protective factor against financial toxicity and that strategies to proactively identify and monitor multiple aspects of financial risk are needed to intervene appropriately.

According to Wheeler, the extent and severity of financial problems after being diagnosed with breast cancer reached unprecedented levels among women with metastatic disease.

"This is likely due to a few things that make metastatic patients unique: greater financial vulnerability at baseline, given the association between low socioeconomic status and advanced stage diagnosis, complex and rapidly changing treatments, and the added psychological burden of living with advanced disease," she said. "As such, providers should be especially attentive to the financial issues metastatic patients face and where possible, prioritize offering affordable and high-value treatments."

Financial resources are available

If the thought of paying for breast cancer treatment and follow-up care seems overwhelming, know that resources are available to help you. Don’t panic, and don’t skip any treatments or doctor’s visits.

Many doctors keep lists of organizations that offer financial assistance for breast cancer medicines and care, as well as local organizations that offer financial assistance for practical needs such as transportation, food, and child care. Many pharmaceutical companies have set up special funds to help pay for the cost of their medicines.

For much more information and links to resources, visit the Breastcancer.org Paying for Your Care pages.

Discuss your financial concerns with others in the Breastcancer.org Discussion Board forum Employment, Insurance, and Other Financial Issues.


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