The financial hardship cancer patients endure is seldom talked about and seldom seen, suggests George F Winter.
It’s bad enough receiving a diagnosis of cancer, but the financial pressure on patients undergoing systemic anti-cancer therapy in Ireland is often heavy but seldom publicised.
A recent report in the Irish Journal of Medical Science reveals that the total additional cost of a complete course of cancer therapy ranges from €21.60 to €7,089.84, with a median total cost of €1,138 per patient.
The survey of 151 patients (age range 20 to 79 years; 90 female) attending Dublin’s Beaumont Cancer Centre revealed that the greatest median monthly costs were €400 for hair accessories — although most men spent nothing on these products; transport (€65); and complementary therapies (€55).
Lead author of the study Dr Dearbhaile Collins of Beaumont Hospital’s Cancer Clinical Trials and Research Unit told the Irish Examiner that she and consultant oncologist Dr Oscar Breathnach devised the original idea from concerns they had over the growing burden these indirect costs were having upon their patients.
“Beaumont Cancer Centre is one of Ireland’s major cancer centres and a national specialist referral centre for neuro-oncology, upper and lower gastrointestinal cancer, renal cancers and lymphoma-leukaemia. Patients travel from all over Ireland for treatment, often struggling financially with the transport, accommodation and food costs associated with being away from home. Support structures are under-resourced, in high demand and unable to fulfil their good intentions,” she said.
The survey also uncovered vulnerable groups at particular risk of increased financial hardship. For example, the median monthly expenditure for those living more than 25km away was €2,015, compared to €1,078 for those living less than 25km away. Significantly, 74% of the patients were not working, with 9% self-employed, 50% of whom continued working during treatment.
Dr Collins said: “We would like to highlight to the public the types of hidden costs involved during chemotherapy. These include the dearth of available financial support to this vulnerable population from hospitals and the Government, and the importance of patients being aware of these indirect, unexpected and unpredictable costs at an early stage in their cancer care to help with budgeting and planning for the future.”
Head of Services and Advocacy at the Irish Cancer Society (ICS), Donal Buggy told the Irish Examiner that many cancer patients and their families face a financial crisis while they are undergoing treatment: “In 2015, the Irish Cancer Society launched its Real Cost of Cancer report which revealed that the average extra spend per month amongst cancer patients surveyed, even those with a medical card or private health insurance, was €862. Those who cannot work, work less or lose income as a result of having cancer face an income drop averaging €1,400 a month, or €16,750 per year.’
Buggy also pointed out that those who are self-employed, young, without private health insurance, not eligible for a medical card or don’t have savings are left in the vulnerable position of being unable to manage basic expenses such as heating and travel to hospital for treatment.
“No cancer patient,” he added, “is spared the financial panic and distress caused by this disease, despite the range of individual circumstances. Cancer is a financial catastrophe for many families.”
In its pre-budget submission to Government, launched on October 4, the ICS called for prescription charges to be abolished; the amount patients have to pay for medicine before they are reimbursed under the Drugs Payment Scheme to be lowered from €144 to €85; and the inpatient charge of €75 to be abolished. “This,” said Buggy, “would save cancer patients with medical cards up to €300 a year and those without medical cards, up to €1,450 per year.”
In 2013, Macmillan Cancer Support published the results of a UK survey which revealed 83% of people are on average £570 a month worse off as a result of a cancer diagnosis.
In the context of the considerable financial hardship that cancer patients have to endure, it is noteworthy that the Department of Health declined to comment on the Collins report, referring me to the HSE, whose complete response is: “The HSE recognises that there are added costs and difficulties when someone is given a cancer diagnosis.
“The National Cancer Control Programme funds the Irish Cancer Society to provide the Travel to Care Programme which provides assistance in helping patients with the cost of travel.”
Providing “assistance in helping patients with the cost of travel” will only go part way to addressing the suggestion by Collins and colleagues that “additional government, hospital or charitable subsidies to the more common sources of expenditure, such as travel and parking, would be welcomed in the future.”
Cancer cost from a patient perspective
“Even though it is a terminal illness, there is no financial aid and it puts a lot of financial pressure on a family.” This stark statement came from one of 501 patients who participated in a multi-centre quality of life study of those living with metastatic breast cancer in Ireland.
Metastatic breast cancer occurs when breast cancer cells spread from the primary breast tumour to other parts of the body. Breast cancer is the second leading cause of cancer death among women in Ireland, and one-fifth of patients diagnosed with breast cancer in Ireland will develop metastatic disease.
The study was conducted by palliative medicine specialist Jodie Battley and consultant medical oncologist Seamus O’Reilly of Cork University Hospital in conjunction with Cancer Trials Ireland. They found that:
30% of respondents had experienced financial distress following their breast cancer diagnosis.
5% had to change homes as a result of their diagnosis. At diagnosis, one-third were sole or primary wage earners, and 34% had to stop work as a direct result of their diagnosis.
Almost 20% of patients rated financial distress as their most significant unmet need. For example, one stated that “Most stress is financial, with medication of €144 each month on a part-time salary. Have to use savings to pay for medicine/ food.”
And another observed her “Biggest distress is money! If I go for illness benefit, I’ll have no money to live. Refused health insurance because of cancer.” One patient felt that all cancer patients should automatically be given a medical card: “Cost is high and patients should not be stressed about that sort of thing.”
A second patient said “people are not aware what is available to them in terms of financial support and treatments”. Another admitted to an “inability to sort out my financial problems. No one will employ someone with stage four cancer so financial future is bleak.”
The study results, highlighting the often dire financial straits that many cancer patients have to navigate, were presented to an international audience of over 3,000 cancer specialists who attended the World Cancer Congress in Paris from October 31 to November 3, 2016.
The congress motto was ‘Mobilising Action, Inspiring Change’. It is one that could be usefully adopted by politicians, many of whose constituents struggle with financial hardship following a cancer diagnosis.
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