Along with care, cancer patients must juggle finances

not prepared for the cost of cancer, let alone the care.”

Cancer has long been expensive to treat, but several factors have made the financial sting more intense, prompting more patients to delay treatment or cut back on their medications. Insurers are tightening prescription drug coverage and raising patient costs, such as deduct- ibles, as treatment prices soar. That means patients may have to pay several thousand dollars a year for a drug like the leukemia treatment Gleevec — a pill taken daily, sometimes for life.

The Affordable Care

Act sets limits on how much people have to spend on care each year. But cancer treatments often extend beyond a year, and those limits don’t apply to care outside the network of doctors and hospitals that some insurers offer.

Patient costs also can rise because newer cancer treatments are more tolerable, so people can stay on them longer, said Dr. Yousuf Zafar, a Duke Cancer Institute oncologist who studies financial distress.

A few years ago, Zafar and colleagues surveyed 300 adult, insured patients at the cancer institute. Nearly 40 percent report- ed a higher-than-expected financial burden, while 16 percent dealt with “overwhelming financial distress.”

More than a quarter said they didn’t take their medicines as prescribed. That meant skipping doses, taking smaller amounts or not filling prescriptions because of the cost. Other research has found that cancer patients are more than twice as likely as those without the disease to declare bankruptcy.

More than 1.7 million new cancer cases will be diagnosed this year, according to the American Cancer Society. Who winds up in financial trouble will depend on the patient’s income, savings and insurance coverage.

It’s not just the treatments that cause financial strain. Patients or parents of children with cancer often miss work or take on unexpected costs while traveling for care.

Shauna McLaughlin left her job as a dialysis technician the day her daughter, Madison, was diagnosed with leukemia. Doctors told the single mom that her 18-monthold would be hospitalized at least a month.

McLaughlin fell behind on bills and eventually ran out of propane to heat her home in Massachusetts.

“You’re learning about cancer and ... (chemotherapy) and all the side effects,” McLaughlin said. “People don’t understand that your whole life is falling apart around you as you’re trying to worry about those other things.”

McLaughlin, whose daughter has been cancerfree since December 2016, regrets brushing off a social worker’s offer to help. She eventually turned to the nonprofit Family Reach for assis- tance with several bills.

Doctors say patients should meet shortly after diagnosis with someone who can guide them on financial matters.

“A lot of times people don’t realize there are resources available until they’ve already gone broke,” said Dr. Veena Shankaran of the Fred Hutchinson Cancer Research Center in Seattle.

Patients and doctors need to keep talking throughout treatment. Eventually, that may include discussing whether an expensive drug that improves a patient’s quality of life is worth the cost, said Dr. Ali Thaver of the University of Chicago Medical Center.

“There’s no black-andwhite solution … and that’s hard, but just because it’s hard doesn’t mean it shouldn’t be done,” Thaver said.

Most hospitals and cancer centers offer help for patients facing financial challenges, and many are bolstering the assistance. That might include a counselor who finds drug coupons and connects patients with charities, or a financial planner.

Dan Sherman, a Grand Rapids, Michigan-based consultant, has helped launch some 35 patient navigation programs in U.S. hospitals in the past six years to help people deal with problems like high deductibles or find better insurance coverage based on their prescriptions and medical needs.

Sherman noticed last year that one of his patients had surgery scheduled for Dec. 29. He arranged for it to be delayed a few days until after the patient’s coverage reset. That saved her from having to pay a $5,000 deductible for the surgery and then face a fresh deductible in the new year.

Rizo would have welcomed more help. She didn’t know disability pay would amount to only 40 percent of her income when she went on leave from her job. She didn’t realize she’d have an insurance coverage gap before qualifying for Medicaid.

Now, she says, she’s basically starting over.

“It was something that was out of my control, and I didn’t know how to fix it,” she said.

Ross D. Franklin / Associated Press Josephine Rizo had no financial counseling when she began cancer treatment. “It was something that was out of my control, and I didn’t know how to fix it,” she says of the financial havoc.