Molly MacDonald
In the spring of 2005, I was launching a new career as a sales consultant for a startup graphics company and wanted to cross off a few essential things on my to-do list, including getting my annual mammogram and physical, before I started my new job. Although I was surprised when I got a call from my gynecologist saying that the mammogram showed “spots” in the milk ducts of my right breast and that I would need to come back to the office for a tissue biopsy, I wasn’t overly concerned. There was no history of breast cancer in my family, and my doctor assured me that the spots were most likely benign calcifications.
Soon after the biopsy, I headed to the airport for a Friday morning flight to New York to make a sales presentation to a potential client. While waiting to board the plane, by happenstance, I struck up a conversation with an oncologist specializing in breast cancer who was on her way to San Francisco for a conference. I remember thinking this is a foreshadowing of what is to come, and I needed to prepare myself for a cancer diagnosis.
Ironically, the call from my gynecologist came later that afternoon, as I was on my way home to Michigan, asking that I come to see her on Monday morning to discuss the results of the test.
Knowing there was no way I could wait 3 days to get the news, I insisted she tell me over the phone. Even though I had braced myself to hear the words “You have breast cancer,” they were still shocking to hear. I tried to concentrate on her encouraging words that the cancer was early-stage ductal carcinoma in situ and highly treatable, but I was already worrying about how the diagnosis would affect my life and my career.
Overcoming Cancer-Related Financial Toxicity
After meeting with a surgical oncologist and being presented with two viable treatment options, mastectomy and immediate breast reconstruction or lumpectomy plus radiation therapy, since the cancer was confined to the milk ducts, I opted for the less radical of the two. Still, there were treatment complications. Because the surgery did not get clean tissue margins, I needed additional surgery, which delayed the start of radiotherapy for 6 weeks.
While undergoing 2 months of daily doses of radiation therapy, I began to identify what is now commonly referred to as cancer-related financial toxicity. In addition to my own economic woes now that cancer had interrupted my consulting business, jeopardizing my financial security, as I talked with other patients waiting for treatment, I began to realize the enormous stress they were under worrying about diminishing savings to supplement lost wages and whether they would have jobs to return to after cancer. (According to one study, between 20% and 30% of women diagnosed with breast cancer will lose their jobs, with poor women four times more likely to become jobless after a cancer diagnosis than their wealthier peers.1)
Creating Social Change
Listening to these patients heightened my own economic anxiety. Although I had health-care coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), the monthly cost of insurance was $1,300. Even with income from my freelance business and my husband’s business, with five children to support, the cost of cancer care was putting us financially underwater and on the brink of losing our home to foreclosure. The possibility that we could join the ranks of the homeless was so real, I had to tap into a fund I was to inherit from my very ill mother for relief. The money was enough to secure our housing for 6 months and gave me enough time to put into action an idea that had been brewing since soon after my cancer diagnosis.
I’m one of the lucky ones. I have not only survived cancer, I have survived near financial ruin. And in the process, I have found a fulfilling vocation.— Molly MacDonald
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While talking with those other patients undergoing radiotherapy, I had had an epiphany. Instead of focusing on my own problems and how to solve them, my thinking started to shift to what I could do to help fellow cancer survivors in financial distress. A few months later, I launched The Pink Fund (www.pinkfund.org/about), a nonprofit organization that provides a $3,000 grant to patients with breast cancer undergoing active treatment to cover their nonmedical cost-of-living expenses.
Since its inception in 2006, The Pink Fund has awarded over $3.8 million to 2,400 women and men with breast cancer to help with the cost of everyday necessities, including housing, transportation, utilities, and health insurance. The money is paid directly to patients’ creditors.
Surviving Cancer and Near Financial Ruin
I took on this challenge because I saw firsthand how a breast cancer diagnosis—or any cancer diagnosis—has the potential to suddenly plunge a financially stable person into poverty and even premature death. Studies have shown that patients with cancer are nearly three times more likely to file for bankruptcy than their healthier counterparts,2 which puts them at a higher risk for early death.3 No one should have to face such dire consequences because he or she has cancer.
I know there are calls from ASCO and other medical societies to encourage oncologist-patient conversations at the time of treatment planning regarding cancer care costs, but I think it is unreasonable to expect oncologists to have the time and knowledge about the exact cost of every treatment option to initiate such discussions. I do believe, however, that every physician practice and hospital should have financial navigators available to help patients discern what their health insurance covers and what their out-of-pocket expenses are likely to be and how to find financial assistance to help defray those expenses if necessary.
I’m one of the lucky ones. I have not only survived cancer, I have survived near financial ruin. And in the process, I have found a fulfilling vocation. I’m grateful that The Pink Fund is making a contribution to the financial welfare of patients with cancer, but as cancer treatments become more advanced and expensive, we will need national solutions to prevent more patients from slipping into poverty—and worse, early death. ■
Ms. MacDonald lives in Beverly Hills, Michigan. She is Founder and President of The Pink Fund and the 2019–2020 recipient of the AARP Purpose Prize, which recognizes people using their life experience to create social change.
REFERENCES
1. Blinder V, Eberle C, Patil S, et al: Women with breast cancer who work for accommodating employers more likely to retain jobs after treatment. Health Aff (Millwood) 36:274-281, 2017.
2. Ramsey S, Blough D, Kirchhoff A, et al: Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 32:1143-1152, 2013.
3. Ramsey SD, Bansal A, Fedorenko CR, et al: Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980-986, 2016.
Editor’s Note: Columns in The Patient’s Corner are based solely on information The ASCO Post received from patients and should be considered anecdotal.
