Breast cancer patients tend to live longer than people with other types of cancer. Obviously, that’s a blessing. But it also means that the costs of continuing care add up in a big way. For women 65 and older, data from the National Cancer Institute suggests that initial treatments cost an average of $23,078, while continued care comes out to around $2,207 per patient*. Around 42.3% of women who develop breast cancer will be diagnosed over the age of 65, but an average is still just a generalization, one that hides vast disparities in cost, and quality, of care.
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After a cancer diagnosis, most patients are left with the acute understanding that they’re now fighting for their lives. But many are also fighting a second battle, one waged not against quickly metastasizing tumors, but insurance companies and banks. It’s a struggle to keep families afloat, and while the common idea that husbands often leave their wives after a breast cancer diagnosis may be more myth than reality, the strain of endless appointments and grueling therapies isn’t.
In 2006, the American public paid out $104.1 billion to cover cancer care, the National Cancer Institute reports. Breast cancer treatments accounted for the most of any malignancy, at $13.9 billion. But what about real patients? How much does treating breast cancer cost individuals?
No one really knows. Nailing down the true costs of cancer, which vary widely depending on a patient’s location and insurance options, is surprisingly difficult. Even experts like Jessica Morton, a director at Susan G. Komen, throw up their hands when asked to estimate the costs. “We try to pin down numbers like average cost, but it’s super hard,” Morton told USA Today in 2015. How do you know what treatment costs? “You don’t.” That uncertainty can have a big impact on patients and families.
Part of the problem is that breast cancer can be treated in numerous ways. Most patients undergo some sort of surgery, either lumpectomy or mastectomy. Including reconstructive surgeries, these procedures can range anywhere from $15,000 to $50,000, depending on where they’re performed and how. After that, nothing is certain. Radiation therapy and chemo are common, but chemo drugs come at radically different prices, from around $7,000 to $40,000 per treatment. Ongoing surveillance is another concern, and complimentary therapies like acupuncture, which many women find beneficial, all come at a price.
There’s one fact, however, that no one would question. It pays to be insured. That’s not entirely surprising, but we’re willing to bet that you’ll be shocked to know how big a difference insurance can make.
People without insurance pay around twice as much for their cancer-related doctor’s appointments, and as much as 43 times more for chemotherapy drugs, than patients on Medicare or with private insurance plans. As just one example, take carboplatin, a chemo agent used for everything from breast to germ cell tumors. Government data analyzed by researchers at the University of North Carolina, Chapel Hill shows that Medicare patients paid only $26 for an infusion of carboplatin in 2012. Uninsured patients had to fork over more than $1,120 for the same treatment.
Those prices are only going to rise, at least for patients considering newer cancer therapies, many of which could promise significant benefits. Newly-released chemo drugs are “just getting more expensive over time,” says Stacie Dusetzina, PHD, an assistant professor at UNC’s Eshelman School of Pharmacy. In her review of 32 new oral anticancer drugs, Dusetzina found that products released in 2014 were, on average, six times more expensive than products released in 2000. The average cancer drug that went on the market in 2000 cost patients and health insurers a combined $1,869. In 2014, that average had skyrocketed to $11,325.
Even the prices of older drugs are climbing quickly. Between 2001 and 2014, the cost of leukemia drug imatinib jumped more than 7%, from $3,346 to $8,479. But there’s an even bigger problem, Dusetzina thinks. In the wake of Obamacare, private insurance companies have restructured many of their plans, opting for higher deductibles and co-pays. That shifts the burden of paying for treatment, and specifically paying for drugs, onto patients.
Financial costs are one thing, but what about the less-tangible consequences of a breast cancer diagnosis?
In their 1998 study, “Marital Stability After Breast Cancer,” researchers in Quebec note an oddly prevalent belief: that, once a woman is diagnosed with breast cancer, her husband will quickly desert her, either through trial separation or divorce. But is it true? Are men more likely to leave a marriage after their spouse has been diagnosed with cancer, and specifically with breast cancer?
It’s not true in Quebec, at least that’s what the study’s authors found after following the marriages of around 200 women who had been recently diagnosed with non-metastatic breast cancer, along with a slightly larger, but socioeconomically equivalent, group of cancer-free married women.
The women were interviewed at 3-month, 12-month and 18-month intervals after diagnosis. Using the results of a pre-existing study, the researchers were also able to estimate divorce rates from 3 to 8 years after diagnosis, but there really wasn’t much of a difference between the patients with breast cancer and the cancer-free patients. In both groups, the proportion of women who reported separations, divorces or “low marital satisfaction” was roughly equivalent.
Their other results follow closely along with common sense. Women who reported being dissatisfied in their marriages early-on were more likely to divorce later, whether or not they had been diagnosed with breast cancer. But women in happy relationships didn’t get divorced, and for women who reported high marital satisfaction, with or without cancer, their relationships remained strong. Their conclusion was simple and clear: cancer doesn’t end marriages. Unhappy relationships do.
Ellen Baker calls her own divorce “collateral damage” in her fight against breast cancer. Speaking with DailyFinance in 2011, Baker says her husband of 22 years walked out after her last treatment, after months of chemotherapy, a mastectomy and reconstructive surgery. All told, she estimates having paid around $20,000, about 20% of her treatments’ initial $100,000 price-tag. But along with the loss of her husband’s emotional support, Baker lost his $300,000 salary as well.
The banks repossessed her cars, and it was only reaching out personally to state officials that saved her house from foreclosure. At the time of publication, she was still pushing off two more reconstructive surgeries, procedures the insurance company had agreed to cover, but not until she shelled out $12,000 to $20,000 up-front.
But Baker stayed positive, telling DailyFinance’s Sheryl Nance-Nash, “What doesn’t kill you makes you stronger. Every day is a gift. I’m starting my life over at 59.”
Severe illnesses do, however, put stress on relationships, and while some of that stress is certainly financial, the effects can be less tangible. But that doesn’t mean any less damaging.
Michael J. Glantz, a doctor at the University of Utah, says most studies put the rate of divorce after a major diagnosis around 11%. In his own review of marital stability, which included 515 brain cancer and multiple sclerosis patients, Glantz found a very similar divorce rate of 11.6%. But what surprised him, along with his co-authors, was the role a patient’s gender played in the likelihood of divorce.
In fact, gender was the strongest predictor of whether or not a patient would eventually get divorced. After being diagnosed with a serious medical condition, women were more than six times as likely to eventually divorce than men. Six times. And after divorce, those women were more likely to undergo hospitalization and less likely to complete their radiation treatments, a common therapy used to kill brain cancer cells. That’s true even for previously-happy marriages, according to a write-up of Glantz’ study in the New York Times. In marriages that were perfectly happy prior to a diagnosis, men are still more likely to leave than women. Women, on the other hand, are less likely to push for a divorce after a spouse’s diagnosis, even in marriages that are unhappy.
*In 2010 US dollars, adjusted for patient deductibles and coinsurance.