Cancer patients refusing care over high cost, study finds

http://www.suntimes.com/lifestyles/health/1232410,CST-NWS-cancer21.article

STRUGGLING | 1 in 8 with advanced disease spurned treatment

October 21, 2008

At a time when they're fighting for their lives, more cancer patients are now struggling to pay for their medicines, an analysis finds.

One in eight people with advanced cancer turned down recommended care because of cost, a new analysis from Thomson Reuters found. Among those making under $40,000, one in four with advanced disease refused treatment.

Of late-stage colon-cancer patients, 12 percent spent more than $25,000 out of pocket, according to the unscientific survey, in which 1,767 people answered an online questionnaire. Its findings are similar to a 2006 study in the journal Cancer which found that cost caused more than 20 percent of all cancer survivors to delay or miss needed care.

Experts say signs of stress are everywhere:

• • Nearly 20 percent of Americans have problems paying their medical bills, the Center for Studying Health System Change found.

• • One in four cancer patients or their families said they used all or most of their savings to pay for treatment, according to a 2006 survey of nearly 1,000 survivors and families by USA Today, the Kaiser Family Foundation and Harvard School of Public Health. One in 10 said they were unable to pay for basic necessities -- food, heat, housing.

My mom had cancer. Fortunately for her, my dad was in the Army so she was covered. But, my gosh, how can we as a nation stand for something like this????????! :mad:

if she is ever diagnosed with cancer. She has no insurance, no money to spare, no parents, no spouse, and no children.

We will have limited insurance that won;t cover most of the bills and I will be nearly 64. If I don't stay in remission I refuse to saddle myself or husband with thousands in medical bills when the end result will be the same. We are all gonna die and quality of life is more important that how long ya live anyway.

His surgery and hospital stay for removal of the sigmoid portion of the colon was over $100,000. And he's on Medicare and has supplemental insurance so all of this was covered.

And, interestingly, all this because his G.P. tries to save money by not sending people in for lots of specialized exams that may not be needed. He treated my husband for more than 8 months for "stress" and "irritable colon". My husband is 73 years old and has a previous history of polyps that had to be removed.

Lots of savings that was! And, my husband may yet die of a disease that should have been caught early since he had many of the classic signs and a history of polyps.

I don't know who to be more disgusted with. The physican who was trying to "save money" or the drug company who is trying to "get money".

The entire system sucks.

Even here in Michigan with our changed laws. It didn't meet the standard of care, and your husband has suffered harm. That's malpractice.

I am so sorry you both are going through that. What a horrific thing to deal with. :hug:

since I have no insurance now. I do have two children, however.

but I've learned that this nation, in fact and in action, hates those it claims to value. this isn't new. what's new is that the middle class is seeing it up close and personal.

before she gets in too much pain to stop the cancer, however, if you get my drift.

Really nothing more to say.

I have an elderly relative with prostate cancer who needs a $4500 shot every couple of months. One shot and he's in the infamous Medicare doughnut hole and even after the doughnut hole, these shots still cost him $225 each. The pharmaceutical maker has one of those patient assistance programs that helps patients who can't afford their medicine, but he apparently doesn't qualify because he has Medicare coverage. We're about to try the VA to see what they can do for him.

and not as a prescription drug.

He did get one paid for when he was in the hospital. Apparently, if you're in the hospital they pay for it. I don't understand it, but that's what he tells me.

My treatment was a weekly infusion of Gemsar along with daily dosages of Xoloda taken orally. The cost of the Xoloda was about 1200dollars for a two week supply. My cost was about 250 for two weeks. I was concerned about the "doughnut hole" and having to pay the entire amount. My oncologist told me to not worry as the Xoloda even though I was picking it up at the local Walgreen's by prescription was considered as "treatment" rather than a prescribed drug. So check with his oncologist, but better yet, take him to VA and the cost should be very modest.

Generally that means running though all your savings and assets in a few months, then going on some kind of government program to pay for your care.

This is how we treat our citizens?

Gone are the days of spending a fortune on the last days and weeks of treating terminally ill patients in the hopes of a few more weeks of life. Insurance companies are balking at the costs, and if we ever get a truly universal healthcare plan, we're going to have to make some tough decisions on healthcare. Spending tens of thousands of dollars to "treat" patients with late stage cancer doesn't generally make sense. Keeping them as pain free and comfortable as possible will be the goal.

I know if my loved one were dying, I'd want to do everything possible to keep them alive, but it just doesn't make sense most of the time.

first diagnosed. If you have no insurance at all, and not a lot of money in the bank, you can't even begin treatment. That's what I would be faced with if I got a cancer diagnosis. That's not a "refusal"; that's immoral and unfair.

One of my best friends, when I was a teacher, found out that the "cold" she'd had for a month was actually lung cancer. They started chemo, since there was no real primary tumor to cut out, and during the second round of chemo, when she was handling it pretty well and looking really great for going through chemo, she had her first stroke. The third stroke killed her, and I miss her still.

The insurance company could've said that lung cancer has sucky odds and therefore not to even start chemo, but no one could've known with any certainty that she would've had the strokes. The kind of lung cancer she had is extremely difficult to beat, but as a young mom with two kids, would it have been the right decision not to treat in the first place?

However, I know that resources are finite, and that decisions will be made to limit treatment worth tens of thousands of dollars or more to prolong life for a few more weeks. At some point, doctors realize they are not attempting to save a life but prolong a life. That's my main point.

It's not done fairly, though, and is purely based on ability to pay.

My husband's an internist, and he's often the one who has to sit down with the family and explain when it's time to let a loved one go. It's a tough decision on his end--when is too soon to give up, and when is suffering being prolonged. Not easy to answer at all. He's had patients with families who gave up on treatment earlier than he would've and then lost the patient, and he's had families who keep telling him to do a full code on someone's who's pretty much gone already. The reality is, with the malpractice climate that we have, doctors and hospitals have to listen to the families, even when it goes against best medical advice either way.

but some folks here act like a single payer program will be able to pay for everything we want. It won't, but it will be much better than the system we have now.

It would be a fairer system, though, I think. In covering everyone for preventative care (cheaper to do but many insurance plans don't based on the odds that you won't still be on their plan when you get sick), basic care, and the really scary stuff, we'd all be better off.

sorry but the excuse being offered that people shouldn't be treated for cancer because it prolongs the inevitable is just a thing of the past

one of these had breast cancer, she has since married and had a child and had an entire life and is still alive and is still working

another of these had stomach cancer, w. little hope of survival in those days (the 80s) -- he, yes, since married, had a child, and had an entire life, and is still alive and is still working

the cruelty is that the science was paid for by all of our tax dollars but only the wealthy benefit, in both of these cases, the cancer victim was well-to-do

i should not have to die because i wasn't born a millionaire's daughter

I'm a cancer survivor as well! I can assure you that I believe in vigorous treatment if there is a chance that the cancer will be cured or put into remission for - hopefully - a long time!

And I'm sorry, but what I'm talking about is "not a thing of the past." Look to countries that have universal health care and you won't find them spending obscene amounts of money prolonging a life for a few weeks. They just don't have the money to do that.

One day during a chat, he asked me how my business was going. I said it was fine; same as usual. Then he said that he's seen a big drop in appointments from some patients and thought that it was because they were having financial trouble.

He was very worried about these people who were missing check-ups, medicine, treatments etc.

He's such a great guy that - I swear - he'd treat these people for free if it was possible.

When I found out about my kidney tumor, I didn't know where else to turn, so I called her at home, and she had me come in to her office for free, sat down with me and cried with me and helped me know what was ahead of me and what to prepare for.

A good oncologist is worth her weight in gold, frankly.

After my wife's cancer diagnosis her doctor told her she should go through a chemo and radiation therapy program. She had a double mastectomy and her margins were clean. She refused. She said she would rather die than spend her last days suffering thru those treatments and the maintenance drugs for years afterwards that are normally prescribed. She tried the maintenance drugs for 6 weeks before giving them up. A single mother she met online on a cancer forum was in much greater need of them, so she sent them (a six week supply)to her. The lady did not have the money to buy her own. It probably wasn't legal, but reason outweighed legality in this case.

That was six years ago. She is healthy as a mule, no signs of cancer, and is enjoying life to it's fullest! I'm not saying everyone should do this. Some people need this stuff to live. But, doctors have a tendency to cover their asses with treatments that are totally unnecessary just so they won't get sued for not prescribing them. And, that isn't right either!

We have insurance and the means to provide her any treatment she needed. It wasn't about money, it was about quality of life.
It was a gamble on her part, but I respected her wishes.

Very little is written about it, but more is starting to come out. I don't think it's intentional on the part of doctors--first, it's their training that makes them want to treat/fix everything; and yes, there is the CYA aspect. A lot of DCIS could go untreated and people would be fine; and the chemo and hormone receptor drugs can really muck up your life without that much more of an appreciable benefit. Every case is different and of course there is a percentage where all of this works and is warranted, but our society's immediate conclusion that all cancer diagnoses (even the most early ones) should be treated in these aggressive ways is f-d up and causing a lot more suffering than it's alleviating. And I too speak from personal experience.

My margins were clean, so my oncologist and I decided I would only do radiation, and I'm cancer free. And although I'm a candidate for hormone receptor drugs, I opted out. I'm being watched very carefully, so at this point, I feel like my chances of catching another cancer early would be very good. I'll live with that little extra risk.

early and only found one lymph node involved. However, they wanted to do radiation, chemotherapy and a maintenance drug for 5 years. When we pressed the doctors further, we found out the chemo and the maintenance drug would only decrease her chances of the cancer returning by something like 2% more than radiation alone. For all the side affects and stress the chemo and drugs would cause for a 75 year old woman, it just wasn't worth it to her. And I think she made the right choice. She's 79 and cancer free.

If a particular treatment really won't up the odds on your survival rate, it makes a lot of sense to question or even refuse it.

They used to do radiation and chemo for kidney cancer (any and all of them), but more study found that it didn't do a damn thing for the odds, so now the standard is not to treat after removing the kidney unless and/or until it comes back, which it doesn't always do.

15 years and counting.

lots of symptoms of cancer could andd often are the result of non-cancerous conditions. We need single payer healthcare now.

refusing treatment is not much different from murder(or forced suicide in these cases), IMHO.

Doctor and patient had colon cancer. She was uninsured and died. He is alive, convinced she could be too.

From the Tribune
By Lindsey Tanner
Associated Press
Published April 4, 2007

Dr. Perry Klaassen lived to tell about his frightening ordeal with colon cancer.

His patient did not.

Same age, same state, same disease. Striking similarities, Klaassen thought when Shirley Searcy came to his clinic in Oklahoma City. It was July 2002, a year after his own diagnosis.

But there was one huge difference: Klaassen had health insurance, Searcy did not.

His treatment included surgery two days after diagnosis and costly new drugs. He is alive six years later despite disease that has now spread to his lungs, liver and pelvis.

"I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace," he wrote in a medical journal essay that contrasts his care with that of his uninsured patient.

The doctor didn't name Shirley Searcy in his March 14 article. After all he'd been through, he couldn't remember her name. But he dug for days through old medical files searching for her identity after he was interviewed by The Associated Press, hoping to shine a more powerful light on the plight of the uninsured.

The widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she couldn't pay the medical bills. Deeply religious, she put her faith in God, according to her family.

By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.

"She just really didn't feel like she wanted to endure what that would cost physically or financially," said her daughter-in-law, Karen Searcy.

Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.

Searcy's is a story that's far from unique. An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.

Klaassen's essay in the Journal of the American Medical Association illustrates the issue "close and personal," said the publication's editor, Dr. Catherine DeAngelis.

It underscores that insurance can be a life or death issue, said Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan policy research organization.

Klaassen, now 67, no longer sees patients but works part-time as medical director of an Oklahoma City group that recruits doctors to give free care to needy patients.

Always healthy and vigorous, his diagnosis in 2001 came as a shock.

Klaassen had a colonoscopy within two weeks after seeing his doctor for pain in his lower abdomen. When the specialist with the results asked, "Is your wife with you?" Klaassen wrote, "I knew immediately that I had colon cancer."

Surgery two days later showed the disease had spread outside the colon wall and to nearby lymph nodes. It was not as advanced as Searcy's, whose disease had spread to the liver.

Searcy married young and had her first child in her teens. Her mechanic husband died in a 1978 car crash, leaving her to raise the family alone. Social Security helped, but the Searcys never had anything extra, family members said.

"Life dealt her more I guess than some people have been dealt," Karen Searcy said.

She didn't work outside the home, didn't venture often beyond her 4 acres and the ranch house where she raised her children in Blanchard, about 30 miles from Oklahoma City. In her later years, reading stories to her dozens of grandchildren was a favorite pastime. She'd figured she'd live long enough to qualify for Medicare at age 65, family members said; she missed it by a year.

"She put off because of no health insurance, and she wanted to trust the Lord. She was hoping to be healed," said her daughter, Melba Spalding.

Klaassen knew immediately that it was colon cancer when she saw him. A colonoscopy weeks later confirmed the diagnosis and that it was incurable.

It was "heartbreaking to all of us," Spalding said. The family had always been close, and Searcy "was pretty well the hub of it," she said.

With insurance, Searcy would have sought treatment sooner, family members said.

"I believe with all my heart that if she had gone to a doctor early on, that she would still be living," Karen Searcy said.

Klaassen also thinks things would have turned out differently if she'd been insured.

"If she had survived at least a year more, she would have had new pills available to her," the same ones that have helped control his disease, Klaassen said.

"People say ... nobody ever dies because they don't have insurance, and I say, 'Yeah, they do.''

Copyright © 2007, Chicago Tribune

http://www.illinoiscovered.com/news/040407_trib.html

It's amazing the choices one must make in a "free market".

yes his family was bankrupted

but how can you sit back and die when you're 38?

esp. his cancer, it was hodgkin's disease -- in other words, treated, he has a normal life expectancy, but untreated he would have died in a year

Either way you choose you are screwed. I'm 31. I hope I don't have to.

Fortunately, I had an employer provided group plan which paid 100% hospitalization and 80/20% major medical. Had this not been the case, my only alternative would have been death, as I had no substantive assets to speak of.

there's no way to just "save up" and have that kind of money

These days, what middle-age or elderly American could afford that medical bill? What do you have left to live on, once the final bill is paid? How do you continue to pay for tests and follow-up treatment? Our health-care funding system is ripe for reform!

this number would scare the sh*t out of me.

One can divide the country into two groups of uninsured:
- those who don't need it...
- and those who do.

I do wonder what will happen when our country absorbs the cost of millions of people with extremely expensive pre-existing conditions. And whether, as in other countries with "socialized medicine", difficult decisions will have to be made.

Most insurance companies today have a pay-out cap for PPO coverage. And most of us think that $100,000/year is high enough... until we get cancer.

I'm not sure that enough is known about what kind of coverage will be "universally available", and whether it will have a cap of benefits. If the cap covers 95% of Americans... then 5% of us will still not be able to "afford" healthcare.

I don't think there's going to be a perfect solution.

n/t

:puke:

Hey, MORE TAX CUTS FOR THE RICH AND GREEDY BASTARDS, McSame's BASE!! :woohoo: :bounce:

Yes, I knew it was bad. But not that bad. Even my cat is outraged at those stats.