Cancer Costs Destroy Finances: 'It Broke Me'

"Gwendolyn Jackson was financially sound before her cervical cancer diagnosis -- she was gainfully employed, insured and secure in a home of her own.

But now, the 53-year-old has tens of thousands of dollars of medical debt. Chemotherapy drained her energy, and she suffered other health problems, including a stroke. She lost her housing-coordinator job because of the physical toll. An eviction notice showed up on Jackson's door, and her truck was repossessed.

"One morning, I woke up and I was a top case manager," said Jackson, who lives in Houston. "Then I was losing everything."

The economic burden of a cancer diagnosis is getting strikingly worse in the U.S., as drug and medical costs soar and more patients live longer. About 55% of cancer drugs introduced between 2019 and 2023 cost at least $200,000 a year, according to Iqvia's Institute for Human Data Science. And a rising number of patients are working-age, a group more likely to report financial hardship after diagnosis compared with older adults.

Nearly 60% of working-age cancer survivors report facing some financial difficulty. Many patients struggle to afford care and end up taking on debt, with some getting payday loans or running up credit cards. Cancer alone accounts for some 40% of medical campaigns seeking help on GoFundMe, research shows.

"Cutting back on meds. Cutting back on doctor visits. Losing your home. Cutting back on food -- these are not things that we want to believe happen to people with cancer in this country," said Dr. Reshma Jagsi, a radiation oncologist at Emory University School of Medicine and the Winship Cancer Institute.

Among common diseases, cancer creates a uniquely difficult financial strain known as financial toxicity. Treatments with expensive medicines start immediately and come with a string of nonmedical costs. Chemotherapy and other treatments can leave patients too weak to work for weeks or months. This can result in a twofold blow, with patients losing income and their employer-sponsored health insurance.

"It can cause this wealth shock that can ripple on," said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York, whose husband died of cancer more than a decade ago. Debt collectors still call her about his unpaid bills.

The problem starts with costs for medical care and cancer drugs that have either risen above the rate of inflation or have high starting prices. Common cancer drugs have list prices that go well into the six figures: Imbruvica, which treats leukemia, has a list price of more than $213,000 for a full year. The average Medicare patient taking it paid $5,247 out-of-pocket in 2022, federal data show. 

AbbVie, one of the drug's co-marketers, declined to comment.

Tagrisso, a top-selling lung cancer drug, has a list price of about $208,000 a year. 

Its maker, AstraZeneca, said the cost to an individual patient is rarely the list price, and the cost would vary based on a patient's insurance coverage. The company said it has patient-assistance programs, and it is committed to pricing responsibly and making its medicines affordable to patients.

Many insurers have shifted rising healthcare costs to patients. Some employer-backed plans require patients to pay a percentage of a drug's cost, which can add up to thousands of dollars. One report found a 15% increase in out-of-pocket costs for privately insured, working-age cancer patients from 2009 to 2016. Patients also foot the bill for transportation, lodging, child care and parking.

The added costs are only part of the toll, with people's livelihoods also put at risk. Many patients have to take time off -- or actually stop working -- after a cancer diagnosis. Patients who get chemotherapy are more likely to stop working within four years than those who don't.

The burden often affects entire families, with relatives pitching in financially or caring for their sick loved ones.

Erica Olenski scaled back her working hours considerably when doctors diagnosed her infant son, August, with brain cancer in 2019. For four months, Olenski drove back and forth from McKinney, Texas, to August's hospital in Dallas. August spent at least one week each month in the hospital for treatment, more if he had a fever.

August then suffered a stroke that paralyzed his vocal chords and required more procedures. Olenski took work calls from emergency departments and hospital rooms. Medicaid covered the medical bills, but the family still had to make ends meet on her reduced income.

"It was the transport, gas, tolls, food at the hospital because you can't buy groceries like you would at home," Olenski said.

Toward the end of August's treatment in 2020, Olenski divorced her husband and lost some $20,000 to the proceedings. Life eventually stabilized. But a legal battle with Olenski's ex-husband forced her to liquidate most of her 401(k) to cover her bills, and the cancer re-emerged around August's brain stem in 2023 and later at the base of his spine.

Olenski then turned to credit cards, using them for her mortgage, car payment and other necessities. Soon, she realized she wouldn't be able to cover the minimum payments. In April, she filed for bankruptcy, with more than $100,000 in debt.

"I can only feel proud of myself for weathering the storm as long as I did," she said.

People with cancer are at higher risk of ending up late on credit-card payments, mortgage payments, and experiencing other financial challenges than noncancer patients, according to research co-written by Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Center in Seattle.

Other research shows that patients with more out-of-pocket costs are more likely to delay starting their medications or stop taking them. Ramsey and his co-authors also found that cancer patients who file for bankruptcy had an 80% higher risk of dying than cancer patients who didn't file.

"There actually was a pretty big detriment for survival," he said.

Jackson's life shrank after her cervical cancer diagnosis, from daily jogs and happy-hour drinks to a string of doctors' appointments. When she lost her job in 2022, her 83-year-old mother paid some $800 monthly for her health insurance until it became too big of a strain. Jackson then bought a cheaper insurance plan, but bills for scans, chemotherapy and physical therapy were incessant.

Jackson maxed out her credit cards. Friends and family sent her money via Cash App as she waited to get on long-term disability. After Jackson lost her rental townhouse and her car, she moved in with her daughter, sharing a room with her grandson. She couldn't afford to buy toothpaste or toilet paper.

"It broke me," Jackson said.

Jackson's 31-year-old daughter, Darian Butler, picked up a second job. "I feel like her life has been robbed from her," Jackson said.

The mounting hardships have inspired advocates and doctors to find patchwork solutions, but there are still major gaps in the safety net.

More cancer centers are offering assistance for patients with financial problems, and nonprofits help patients pay for food, travel and other needs. But their funding is limited, and many people don't know how to find these resources.

Jackson initially sought help from various groups, but her income was too high at the time. She later tried getting a remote job but wasn't able to keep up.

Now on disability, Jackson helps pay for groceries, gas and sometimes utilities, plus her medication. A letter came in the mail this month, saying she would be enrolled in Medicare soon. But she has about $38,000 in medical debt that she can't make payments on after her monthly expenses.

Debt collectors will "call and send letters," she said. "But I can't pay what I don't have."" [1]

How the cancer shows up unexpectedly is well described in "Master and Margarita".  One of the devil's group members with proven supernatural abilities tells a person: "You will die of liver cancer soon".  The person runs to the best oncologist in the city and says: "This is what I was explained by a very good specialist." The best oncologist in the city finds nothing. The person dies soon from liver cancer.

 

1. Cancer Costs Destroy Finances: 'It Broke Me'. Abbott, Brianna; Loftus, Peter.  Wall Street Journal, Eastern edition; New York, N.Y.. 29 May 2024: A.1.