Disclosures: Petrelli reports no relevant financial disclosures.
July 30, 2021
3 min read
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Delaware, a state of firsts, sets new example with cancer treatment program

Disclosures: Petrelli reports no relevant financial disclosures.
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Delaware was named after the Delaware River, which in turn derived its name from Thomas West, Lord De La Warr, the English governor of Virginia who first explored the Delaware Bay in 1611.

Delaware also is known as the First State because on Dec. 7, 1787, it became the first of the 13 original colonies to ratify the U.S. Constitution. On that date, “Delaware Day,” 30 representatives gathered at the Golden Fleece Tavern in Dover and ratified the new Constitution. In the process, Delaware ruined the plans of the state that gave it birth, Pennsylvania, which is nicknamed the Keystone State because it was the middle colony of the original 13.

Smoking cigarette and ashtray
Delaware was one of the first states to use funding from the tobacco settlement for health care.

Delaware’s quickness in signing blocked Pennsylvania’s attempt to be the first to ratify in the hope of securing the seat of the national government in Pennsylvania. Instead, the nation's capital is located in a strategic swamp between Maryland and Virginia.

In more recent times, Delaware was one of the first states to use funding from the tobacco settlement for health care, especially for cancer treatment. The Master Settlement Agreement involved lawsuits that sought billions of dollars in costs associated with treating smoking-related illnesses. The attorneys general of 46 states, the District of Columbia and five U.S. territories signed the agreement with the four largest tobacco companies in 1998.

From No. 1 to No. 16

In the late 1990s, Delaware was the No. 1 state in our country for cancer mortality. Fortunately, being first in cancer mortality is not the reason for Delaware’s nickname. Today, I am happy to say we are now No. 16, and no longer on one top 10 list you don’t want to be on.

Nicholas J. Petrelli, MD, FACS
Nicholas J. Petrelli

Delaware’s disappearance from the top 10 cancer mortality list occurred in less than a decade. There are many factors that have led — and continue to lead — to this success. One of them is the establishment of the Delaware Cancer Treatment Program (DCTP).

The DCTP, a program of the Delaware Health and Social Services Division of Public Health, was created to provide medical insurance coverage to uninsured Delawareans for the treatment of cancer. To be eligible for funding, the applicant must have a household income less than 650% of the federal poverty level.

A Delaware resident is defined as someone who lives in Delaware with the intention of staying and has a job or is seeking employment. Importantly, undocumented immigrants also are eligible for the program.

Benefits are paid at rates equivalent to Medicaid on a fee-for-service basis. If a Medicaid rate does not exist for the service provided, the DCTP will determine a fair rate. Eligibility requirements include having been diagnosed with cancer on or after July 1, 2004, and having no comprehensive health insurance.

The DCTP went into effect in 2004 and continues to be funded today. Initially, the DCTP supported cancer treatment for 1 year. Now, as cancer has become a chronic disease, the DCTP supports 2 years of therapy. Plus, the program is available not only to patients with cancer who have no comprehensive health insurance, but also to those whose maximum out-of-pocket expenses exceed 15% of their income.

No sign of stopping

As cancer is one of most expensive diseases to treat, many patients in Delaware and elsewhere unfortunately need to choose between their health and their financial security. Several wonderful organizations, such as American Cancer Society, provide financial help to patients with cancer. Still, there are many patients who can’t afford to pay for their treatment or don’t have access to financial assistance.

Since 2004, the DCTP has been helping to lessen the financial burden of patients with cancer in Delaware. There is no hint of the program stopping.

That the DCTP may be one of the first programs enacted under the Master Settlement Agreement is not important. What is important is that it continues to give patients with cancer 2 years of cancer care, helping with their copays, and has been a major contributing factor to the state’s continued decrease in cancer mortality. It’s the closest to universal cancer care we have anywhere.

It’s no secret that the cost of cancer drugs is skyrocketing, with prices for many cancer therapies climbing to hundreds of thousands of dollars for a single year of treatment.

A cancer diagnosis puts every patient in an exceptional situation. Financial burden should not be one of them, especially in our country.

For more information:

Nicholas J. Petrelli, MD, FACS, can be reached at npetrelli@christianacare.org.