The issue: Cancer patients canface crippling financial hardship, forcing some into bankruptcy. Solutions: All provinces should cover the cost of expensive out-of-hospital cancer drugs; government benefit programs should better respond to cancer patients’ needs.
Monica Pope probably didn’t need to be told the breast cancer that doctors diagnosed in 2014 was aggressive: one day she suddenly saw the tumour pressing up from under her skin.
What followed was the full traumatic panoply of cancer treatment, including three surgeries, chemotherapy and radiation.
But that was not all. Complications from surgery mean Pope, 51, has been unable to work at her technical sales job the past 34 months and now must find a new occupation. Even when her workplace disability finally kicked in after 19 weeks, it paid the single woman $23,000 less than her annual salary.
Add in expenses like drugs and hospital parking, and last year Pope felt forced to take drastic action. In a country that prides itself on looking after the sick, no matter their ability to pay, she declared personal bankruptcy because of cancer.
“People will deal with different stresses, they will have financial stress or problems with health,” says the southern Ontario resident. “When you throw everything together all at once, there comes a point where you say ‘I just can’t do it any more.’ You need to be able to breathe.”
Ending up in bankruptcy because of disease sounds like a quintessentially American problem, and it is undoubtedly more common in the US
Yet interviews with patients, and a growing body of research confirm that having cancer in Canada is not just a life-threatening burden, but often a financial disaster, too.
Prolonged loss of income and cancer-related costs –from drugs to travel expenses –can combine to have a devastatingeffect on patients already in the health struggle of their lives.
About one in six bankruptcies that trustee Hoyes Michalos handles involve health problems, many cancer-related, said co-owner Doug Hoyes.
“It’s a huge issue,” says Gabriel Miller of the Canadian Cancer Society. “For middle-class Canadians and working-class Canadians, a cancer diagnosis is like standing on thin ice, and you only hope you can get back to work and cover your bills before you go under.”
To keep from sinking, some patients drain retirement savings, re-mortgage homes or end up on welfare.
Making the ordeal more challenging is a historic shift to people undergoing cancer drug treatment at home rather than in hospital. For more than half the country, that means patients themselves have to pay the often sky-high price of medications.
Patients and their advocates also complain that federal and provincial income replacement programs are woefully inadequate for people faced with months or years off work because of disease.
The system was designed in a different era, when being diagnosed with cancer inevitably meant a drastically curtailed life expectancy; now many patients can live long lives after treatment, often returning to work, notes Miller.
“Those (government) benefits just expire too soon for a lot of people,” he said.
The situation can be even more precarious for self-employed Canadians — people like Lawrence.
He was already feeling the pinch after being off work as a Toronto real estate agent because of a perforated ulcer. Then the 56-year-old was rocked by a stomach-cancer diagnosis in December 2015, leading to surgery that removed 60 per cent of his stomach and his gall bladder. “I was gutted,” he says.
So were his finances. Lawrence thought the disability insurance he had been paying into for decades would fill the gap, but the insurance company refused to honour his policy, pointing to an alleged pre-existing condition.
Earlier this year, he, too, filed for personal bankruptcy.
“It’s something I’m not proud of, something I never thought I’d do. I’ve always been a proud, stand-up individual,” says Lawrence, who asked that his last name not be published. “But I had no alternative … You’re not bringing in income, bills are mounting, (creditors) are not compassionate and understanding. They want their money.”
He and other Canadians do, of course, receive actual oncology treatment, mostly without charge. Beyond that, cancer patients are largely on their own.
Two of every five end up off work for at least six months, according to a 2012 survey by the Canadian Partnership Against Cancer.Even 60 per cent of their caregivers either have to cut work hours or quit outright, estimated a Lung Cancer Canada survey.
Overall, a 2010 McMaster University study estimated that Canadian patients’ families see incomes plummet 26 per cent – $3 billion in wages lost every year because someone got cancer.
Perhaps the most unfortunate among them are parents of sick children, who must be at the patient’s side throughout treatment, and lose an average of $26,000, according to another McMaster study.
They include Vancouver’s Patrick Sullivan. When his son, Finn, a twin, was diagnosed with a rare muscle cancer in early 2007, the 21-month-old was prescribed a special type of radiation treatment available only in the United States.
The BC government covered the cost of the therapy, but the family had to travel to Boston and stay there for two months on theirown dime. Tragically, the treatment failed to halt Finn’s malignancy, and he died several months later.
Patrick and his wife are both lawyers, and his partners paid him an advance during those months off work. Relatives also raised money to help with expenses.
Yet, at the end of the day, as they mourned the loss of a son, the couple still had to take out a second mortgage on their home to cover the bills.
“The reality is that everything catches up to you,” says Sullivan.