What happens after someone survives a life-threatening disease such as cancer? Are they able to return to their previous life or prior employment? What are the long-term implications and costs of their treatment? Are they financially secure as they age? This editorial will explore the financial challenges of cancer survivors by beginning with Margaret's story.
Margaret was 52 years old when she was diagnosed with ovarian cancer 5 years ago. She underwent surgery, intensive chemotherapy, and radiation. Unable to work during treatment, Margaret was on disability and sold her home to pay her medical bills. Even though she is cancer free, she requires imaging follow up and clinical management by her oncology team and other specialists. To date, she experiences chronic issues from her treatment that have prevented her from returning to employment, contributing to the hardship in making ends meet. Cancer survivors, like Margaret, experience a disproportionate financial burden that stems from the cost of medical treatment and unemployment.
Everyone diagnosed with cancer hopes for a cure, but what is the cost of cancer treatment? Is it worth withdrawing from your retirement, taking a loan, or selling your house? What are the ethical implications of leveraging your financial stability for your health? As physicians, advance practice providers, and nurses, we focus our care on the cure of the disease, and yet we frequently neglect the consequences of the care we provide. How much do we truly care about our patients? If our commitment is to treat patients holistically, financial toxicity is a critical issue to address, especially if it impacts our patients' health and medical compliance (Chan et al., 2019).
On average, cancer treatment can cost approximately $10,000 per month and last from several months to years (National Cancer Institute, 2019a). Furthermore, even after treatment, cancer survivors must proceed regularly with active surveillance to screen for the recurrence of cancer. Consequently, they experience chronic issues, such as persistent fatigue; cognitive problems; lingering pain from surgeries; the risk of infection after transplant; and potential neuropathy, cardiomyopathy, and endocrinopathy from cancer treatments (Armenian et al., 2016; Cavaletti et al., 2019; Harrington et al., 2010; Jensen et al., 2018). These are only a few chronic conditions cancer survivors experience on a daily basis that can affect their mental, physical, and emotional well-being. Often, they see other specialists to manage these chronic comorbidities, adding to the unpaid bills waiting for them at home.
Every patient diagnosed with cancer wants the chance to live; however, many struggle to balance compliance with care and risk of debt. Margaret is not alone. In 2016, approximately 37% of cancer survivors had gone into debt (Banegas et al., 2016). To make matters worse, one of three cancer survivors is unemployed (de Boer et al., 2009), making the financial burden even more significant for these individuals. Remarkably, the unemployment rate among cancer survivors in the United States is 1.5 times higher than their European counterparts (de Boer et al., 2009). In addition, the cost of cancer care in the United States can be twice as much in comparison to other nations with similar survival outcomes (Yezefski et al., 2018).
With these facts in mind, is our health care truly for everyone, or is it only for those who can afford it? What does that say about our society when we cannot successfully integrate cancer survivors back into the workforce? How does financial burden affect the care of those who are most vulnerable, those who have limited income prior to their cancer diagnosis? How does the future look for aging cancer survivors? Is homelessness a battle they will have to endure 5, 10, or 15 years down the road?
The cost of health care and unemployment place a significant financial burden on cancer survivors as they continue to age and live in our society. Nurses alone cannot solve this crisis. Fixing the cost of medical treatment requires collaboration among health care professionals, patients, community leaders, health insurers, and government officials to reform the affordability of our health care. However, this financial burden cannot be effectively eliminated unless the unemployment disparity is addressed simultaneously. Cancer survivors should be (re)integrated into society. Rehabilitation and return to work programs are critical in successfully assimilating cancer survivors back into the workforce and providing job security as they age with the general population (Sheppard et al., 2020). Just as each of us is a valued member of our community, cancer survivors are as well. There are an estimated 16.9 million cancer survivors in the United States, representing 5% of the population (National Cancer Institute, 2019b). This number is projected to increase to 26.1 million by 2040 (National Cancer Institute, 2019b). If one third of cancer survivors are unemployed or in debt, how does it affect the economy and the future of our nation?
There should not be a financial burden among cancer survivors. Care does not stop at cure. Our health care system must move past survivorship and toward bridging the gap, helping cancer survivors thrive and facilitate their integration back into society for the betterment of their health and our health as a nation. Cancer survivors are heroic and resilient individuals and are deserving of opportunities in our economy. As a society, we must do better in providing care without the consequences of financial toxicity and help cancer survivors, like Margaret, to age equally like the rest of the population, to not financially suffer because they were sick or because they are cancer survivors. As nurses, we must advocate for the affordability of health care, engage in conversations that affect our patients' outcomes, and lead the crucial paradigm shift of caring among our patients who survived cancer.
Karl Cristie F. Figuracion, MSN, ARNP, AOCNP
Alvord Brain Tumor Center University of
Department of Radiation Oncology
T32 Predoctoral Fellow
University of Washington School of Nursing
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