Breast Cancer Survival Guide, Part 2

The Cost of Cancer Care

Call it the breast cancer paradox. Remarkable strides have been made against the disease, with new therapies that hike survival rates and lengthen the lives of even women with advanced disease. But these potent treatments aren't cheap, and thousands struggle mightily to pay for them. They spend down their savings, may go into debt, and end up deferring or even skipping needed care, which can shorten their lives. It's not a situation in which hardworking middle-class families expect to find themselves. But it can happen surprisingly easily.

Nearly 1 million Americans file for bankruptcy every year because of medical bills, which contribute to more than half the bankruptcies in the United States each year, a 2005 Harvard University study showed. These people are hardly deadbeats: Most are homeowners who had been to college and held responsible jobs. Even more surprisingly, more than three-quarters of those bankrupted by illness had health insurance, researchers found. Those who were stricken with cancer were hardest hit: Their out-of-pocket spending averaged a whopping $35,878.

Part of the problem is that many of today's health insurance policies, with high deductibles, copays, exclusions, and loopholes, offer scant protection during a serious illness. Even policies with yearly out-of-pocket maximums that seem comprehensive may hit you with additional payments if the company won't pay more than "usual and customary" fees and your doctor charges more, or if it excludes certain types of treatment altogether. Adding to the misery, illness often forces breadwinners to take time off from work, because they're sick themselves or they have to care for an ailing family member, precipitating a downward financial spiral.

"Middle-class people fall through the cracks with a catastrophic illness," says study coauthor Steffie Woolhandler, MD, an associate professor of medicine at Harvard Medical School. "Typically, families lose the paycheck and then the job-based health insurance benefits. Or they have insurance but are bankrupted by uncovered expenses."

Cancer care has become so expensive (see "What Insurance Pays -- and Doesn't Pay") that more than 20 percent of cancer survivors under the age of 65 (thus usually ineligible for Medicare) delay or miss treatments or don't fill a prescription because of cost, notes a 2006 study from the Centers for Disease Control and Prevention.

Fortunately, help defraying costs is available even for middle-class women who never thought they'd need assistance. "The good news is that there are resources," says Cheryl Perkins, MD, a breast cancer survivor and senior clinical adviser to Susan G. Komen for the Cure in Dallas. But as survivor Anne Cortes found, "Programs I looked into were all closed for breast cancer patients because the high level of demand depleted the funding".