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A new study delivers the dark financial reality of cancer.
17 October, 2018
Photo: Ken Treloar / Unsplash
- 62 percent of cancer patients report being in debt due to their treatment.
- 55 percent accrue at least $10,000 in debt, while 3 percent file for bankruptcy.
- Cancer costs exceed $80 billion in America each year.
<p>Rebecca Meyer was diagnosed with glioblastoma when she was 5 years old. She fought bravely for 10 months before dying on her 6th birthday. The <a href="https://www.cancertodaymag.org/Pages/Winter2017-2018/The-Cost-of-Treatment.aspx" target="_blank">total cost</a> of of her treatments during that time? $1,691,627.45. </p><p>Cancer is costly, emotionally and socially. But it's especially pricey in terms of money. The stress of being unable to pay for treatment doesn't help your immune system while going through chemotherapy or radiation. It's impossible to relieve yourself of tension when your medical costs are bankrupting you and your family. </p><p>This is more common than you might imagine. A new <a href="https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext" target="_blank">study</a>, published this month in <em>The American Journal of Medicine</em>, discovered that 42 percent of patients deplete their life savings during the first two years of treatment. There's good reason the term "financial toxicity" is in the name of this report. </p><p>Of the 9.5 million cancer diagnoses studied between 2000–2012, researchers discovered that 42.4 percent of patients (median age 68.6±9.4 years) spent all of their money, averaging $92,098. This follows <a href="https://www.forbes.com/sites/zackfriedman/2018/05/24/money-retirement-student-loans/#2305db851059" target="_blank">disturbing news</a> from earlier this year that 40 percent of Americans can't afford to pay $400 in case of an emergency. The math is not adding up.</p>
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="9336557d30cca31fc8d52007513ed625"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/OJ1qWTkt38k?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Financial toxicity led Fumiko Chino to co-write a <a href="https://jamanetwork.com/journals/jamaoncology/article-abstract/2648318" target="_blank">research letter</a> in <em>JAMA Oncology</em> last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino <a href="https://www.npr.org/sections/health-shots/2017/08/10/542589232/widowed-early-a-cancer-doctor-writes-about-the-harm-of-medical-debt" target="_blank">drained her savings</a> to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt.</p><p>In her study of 300 cancer patients, Chino and team discovered that over one-third of them had to pay more than expected for their care, which put a strain on their decision-making process. </p><p style="margin-left: 20px;">Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision making.</p><p>A 2016 <a href="https://academic.oup.com/jnci/article/109/2/djw205/2905657" target="_blank">systematic review</a> of 45 studies, published in <em>Journal of the National Cancer Institute</em>, found that up to 62 percent of patients report being in debt due to treatment. Another <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0830" target="_blank">study</a> of over 4,700 patients from that year discovered that 55 percent accrued at least $10,000 in debt, while 3 percent filed for bankruptcy. </p><p>Cancer costs exceed $80 billion in America each year. Over half of all cancer patients "experienced house repossession, bankruptcy, loss of independence, and relationship breakdowns." Up to 85 percent of patients have to stop working for up to six months, putting further strain on their finances.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xODczMjY2Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MDk2ODc5OH0.eoaVD59i_qnTDkhzBdopDlSHLPMP-MgjPepdIpLOukQ/img.jpg?width=980" id="57691" class="rm-shortcode" data-rm-shortcode-id="b8bc8841dd4d2843d2b0d5d4c3d268e2" data-rm-shortcode-name="rebelmouse-image" />
On October 16, cancer patients in New Zealand petitioned Parliament for treatment funding. Photo by Hagen Hopkins/Getty Images<p>The financial toxicity study above comes to possibly the only conclusion imaginable:<br></p><p style="margin-left: 20px;">As large financial burdens have been found to adversely affect access to care and outcomes, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance.</p><p>Health care <a href="https://www.mcclatchydc.com/news/policy/health-care/article219852215.html" target="_blank">remains</a> one of the most important issues in this election cycle — it <em>always</em> seems to be an issue, sadly. Seventy-two percent of <a href="http://mediaproject.wesleyan.edu/releases/issues-100418/" target="_blank">all political ads</a> that ran in Washington during September mentioned health care in some capacity, while 50 percent of national ads run by Democrats have used this talking point (compared to 28 percent of national Republican campaigns). We need to figure this out. </p><p>As a cancer survivor, I deeply empathize with this problem. There is no easy answer, as cancer treatment is expensive. Funding is needed to keep researchers searching for cures and better treatments. Hospitals need to stay in business, and cancer happens to be one of the more expensive widespread diseases to treat. </p><p>But we've also set up our society in such a way that these high costs are passed on to those who can afford it least. This study is just one example of a culture that continues to divide its wealth to such extremes. That might not be the country we wanted, but it's what we've got. Where we go from here is up to us, and a sizable piece of this puzzle will be put into place on November 6.</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>.</em></p>
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Take one long stroll, four times a week.
12 October, 2018
- Doctors in Shetland, Scotland can now give nature prescriptions to their patients.
- It's believed to be the first program of its kind in the U.K., and it comes with a year-long calendar of outdoor recommendations.
- The evidence for the benefits of nature on mental and physical health are numerous.
<p>Since October 5, doctors in Shetland, Scotland, have been authorized to <a href="https://www.theguardian.com/uk-news/2018/oct/05/scottish-gps-nhs-begin-prescribing-rambling-birdwatching" target="_blank">prescribe nature</a> to their patients. It's thought to be the first program of its kind in the U.K., and seeks to reduce blood pressure, anxiety, and increase happiness for those with diabetes, a mental illness, stress, heart disease, and more.<br></p><p>There is a <a href="https://www.healthyshetland.com/site/assets/files/1178/730-1309-17-18_nature_prescriptions_calendar_4sep.pdf" target="_blank">whole leaflet of nature prescription suggestions</a> that accompanies the program, filled with amusing, charming, sometimes seemingly off-kilter suggestions: in February, you can make a windsock from a hoop and material to "appreciate the speed of the wind"; in March, you can make beach art from natural materials or "borrow a dog and take it for a walk"; in April, you can "touch the sea" and "make a bug hotel"; in May, you can "bury your face in the grass"; in July, you can "pick two different kinds of grass and really look at them"; in August, you can summon a worm out of the ground without digging or using water; in September, you can help clean the beach and prepare a meal outdoors; in October, you can "appreciate a cloud"; you can "talk to a pony" in November, "feed the birds in your garden" in December, and do so much more. All on doctor's orders.<br><br>The evidence for the benefits of nature on mental and physical health are numerous. If you spend 90 minutes of your day outside in a wooded area, there will be a decrease of activity in the <a href="http://www.pnas.org/content/early/2015/06/23/1510459112" target="_blank">part of your brain typically associated with depression</a>. Spending time in nature not only <a href="https://www.ncbi.nlm.nih.gov/pubmed/26886475" target="_blank">reduces blood pressure</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987044/" target="_blank">anxiety</a>, and <a href="http://journals.sagepub.com/doi/abs/10.1177/0956797612464659" target="_blank">increases happiness</a>, but it <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.644.9399&rep=rep1&type=pdf" target="_blank">reduces aggression</a>, <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.1408215" target="_blank">ADHD symptoms</a>, <a href="https://linkinghub.elsevier.com/retrieve/pii/S0012369216347663" target="_blank">improves pain control</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20487629" target="_blank">the immune system</a>, and—<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744722/" target="_blank">per a summary of research regarding the health benefits of nature</a>—there's much more we don't know and are figuring out every day.</p><span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="08ed945f7ce82b0fde9293b532616fb9"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/V-KfLgd27pk?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
<p>In <em><a href="https://www.nytimes.com/2016/07/28/books/review-landmarks-robert-macfarlane-language-and-landscape.html" target="_blank">Landmarks</a></em>, the writer Robert Macfarlane bemoaned the disconnect between the landscape and the words used to describe and engage with that landscape, as well as all that disconnect implied. The book attempted to serve as something of a catch-all for words Macfarlane worried were being lost. There are Shetlandic words in the book, including <em>grumma</em> (mirage caused by mist or haze rising from the ground), <em>flaa</em> (hunk of turf, matted with roots of heather and grass, torn up by hand without a spade and used in thatching), <em>skumpi</em> (clumsy, lumpish peat; outermost peat in each row as the peats are cut out of the bank), <em>dub</em> (very deep bog or mire), <em>yarf</em> (swamp), <em>iset</em> (color of ice: isetgrey, isetblue), and others.</p><p>One could imagine that someone encouraged to spend more time in nature by their doctor won't just feel better—they might think about tearing a <em>flaa</em> out of some <em>skumpi</em> before turning around and heading back home. They'll spot some isetgrey ice. And, as they reconnect with nature, they will reconnect with the language <em>of</em> nature, a language that is frequently site-specific and carries with it a quiet institutional memory of its own, a memory worth recalling as the world faces development, urbanization, and climate change.</p><span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="961cb871008adceafa645e3fa6518e2f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/yhUCG-9s8kA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
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