Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The financial hole for patients begins on the first day of diagnosis

Wendy A. Rhoades, MD
Physician
February 26, 2020
210 Shares
Share
Tweet
Share

I pushed open the door with a huge smile on my face while my eyes searched the room for the chubby toddler that was my patient. One sweep across the roomful of siblings, and my eyes stopped on the child crinkling the paper on the examination table. I could see the long, smooth scar poking out from beneath the hemline of her skirt.

She smiled and waved at me with a skinny, little arm. It had only been three months since I had seen her — not nearly enough time to lose all that toddler chubbiness. My mind rewound instantly; I had reviewed her scans the day before finding no signs of tumor recurrence.

I began to chat with her mother and father about her health and did a complete review of symptoms. I was searching for a sign — any sign that would tell me that I had missed a relapse to explain the obvious weight loss. Childhood cancer relapses can sometimes unexpectedly sneak up like that, and I was inwardly panicking that this was the case.

After a complete review of symptoms and full physical exam, I was reassured that I had not missed anything. I paused and opened up her growth chart. There it was: the little, black dot staring back at me. It had plummeted off of a previously solid trajectory of expected weight gain for a child her age that we had maintained through months of grueling chemotherapy and surgery.

I treaded lightly and asked about how the family was doing since their daughter’s therapy had ended several months earlier. The mother reported that life was busy. The kids performed well in school, the father continued to make strides working at a plant, and she remained active in their church while raising the kids.

I began to discuss my patient’s diet and suggested ways to add healthy fats to meals. I paused when the mother’s breath caught a hitch at the mention of cheeses, avocado, and butter. I asked if she had concerns about those types of foods. She sighed and said, “Well, I can’t afford to buy those types of things and just let them go to waste if she won’t eat them. It has been a little tight since all of this happened.”

My heart broke as I realized that the weight loss was, in fact, a sequela of childhood cancer. It was the downstream effect of the financial hardship that many of my families face. Money was tight; thus food was scarce.

Unfortunately, their story is not unique. Sometimes it’s the teenagers that tell me there is no food in the house. I hear about cars that get repossessed, and I have difficulty connecting with families by telephone because their service was discontinued due to non-payment. For every obvious sign of financial toxicity I do see like these, I know there are four more that I don’t see. I am certain that every single one of my families feels the financial impact of childhood cancer on top of the already enormous emotional impact.

Even after the passage of the Affordable Care Act, two-thirds of bankruptcy filings cite medical bills as the major contributing factor that led to the filing. This is unsurprising in light of the Financial Security Index survey by Bankrate that reported that only 40 percent of Americans would cover an unexpected cost of $1,000 from savings and the remaining 60 percent would utilize other methods such as a credit card or personal loan to cover such a cost.

Unique to childhood cancer are the logistics of caring for a seriously ill minor. A child or teenager with cancer generally cannot attend school for at least the first six months of treatment, but often this period can be much longer. It is also not safe for them to stay alone even if they are older adolescents during treatment due to the rapidity in which life-threatening emergencies can arise. Therefore, at least one person in the family must stay with them at all times, and often that means one parent must give up a job or take unpaid leave. This loss of income combined with the out-of-pocket expenses of co-insurance, deductibles, medications not covered by insurance, and extra incidentals such as gas, parking fees, and food while traveling to appointments are often too much for the average household to absorb.

Sadly, the financial hole that begins on the first day of diagnosis may last for several years and often throughout the patient’s lifetime. Surveys show that 60 to 90 percent of childhood cancer survivors develop one or more chronic health conditions related to their treatment, and 20 to 80 percent experience severe or life-threatening complications during adulthood.

Through no fault of their own, these patients and their families may struggle indefinitely from a single diagnosis.

Wendy A. Rhoades is a pediatric hematology-oncology physician who blogs at Beyond the Coat.

Image credit: Shutterstock.com

Prev

Your audience deserves the best: Consider Physician Speaking by KevinMD to highlight your event

February 26, 2020 Kevin 0
…
Next

How to find your squad in residency

February 26, 2020 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Your audience deserves the best: Consider Physician Speaking by KevinMD to highlight your event
Next Post >
How to find your squad in residency

More by Wendy A. Rhoades, MD

  • 10 things a pediatric oncologist wants you to know

    Wendy A. Rhoades, MD

Related Posts

  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • Retrospective refusal of payment based upon final diagnosis compromises patients’ welfare

    David Hoke, MD, MBE, Kenneth V. Iserson, MD, MBA, and Jesse Basford, MD
  • You are abandoning your patients if you are not active on social media

    Pat Rich
  • Match Day: Leaving behind my polished applicant identity and becoming a physician trainee

    Simone Phillips
  • Is physician shadowing immoral?

    David Penner

More in Physician

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution
  • Pitolisant Safe and Effective in Children With Narcolepsy

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...