Everyone knows that money doesn’t buy happiness. But can it buy life? A new study out of the University of Washington Medical Center suggests that prostate cancer patients in extreme financial distress are more likely to die than those who are not. This doesn’t mean that having money can buy life, but hardship is a thief that can tragically rob people of life.
The research team chose bankruptcy as their measure of “severe financial distress.” They combed through 231,596 records of persons diagnosed with any cancer in the western Washington region between 1995-2009 to identify persons who declared bankruptcy since their diagnosis. They found 4,728 patients who met their criteria. On average, those who were forced to declare bankruptcy were 1.79 times as likely to die. Three cancers had the highest risk: prostate, colorectal, and thyroid. The authors wrote, “Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate [lessen] this risk.”[i]
Economic differences correlate with lifespan differences. In comparing two Virginia counties on either end of the state, reporter Annie Lowrey noted that the “haves” of Fairfax Country, to the east, enjoy a higher average income compared with “havenots” in McDowell to the west. “Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq.”[ii] There are countless examples in which better financial means corresponds with living longer.
For untold numbers of cancer patients, their disease impacts their wallets. Especially for those who need interventions, drugs, rehab services, etc., the lack of adequate medical insurance, or no coverage at all, bills can mount up to the point where filing for bankruptcy may be the only alternative when faced with the choice between buying groceries or sending in a small payment. Certainly, financial deprivation on top of the physical and psychological stress of dealing with cancer has a cumulative negative impact on life expectancy.
Wiser minds than I will find good strategies to solve the problem of cancer patients who can’t afford their care. At our Center, where we offer a treatment that is not yet assigned a reimbursement code and therefore not covered by Medicare or private insurance, we do what we can to accommodate a patient’s circumstances – and we work with those who launch an appeals process with their insurers. Some are more successful than others, but even small victories set precedents that help change the system. Also, our groundbreaking imaging services allow us to detect and characterize prostate cancer very early when economically efficient clinical choices like Active Surveillance and focal therapy are possible. Both have been shown to save significant medical costs over the short and long term.
Despite the hard fact of cancer’s potential drain of personal resources, we hope that the challenges posed by medical care variance based on economics will lead to the creation of an equitable healthcare system.
[i] Ramsey SD, Bansal A, Federenko C, Blough DK et al. Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. J Clin Oncol. 2016 Mar 20;34(9):980-6.
[ii] Lowrey, A. “Income Gap, Meet the Longevity Gap.” NY Times, Mar. 15, 2014. http://www.nytimes.com/2014/03/16/business/income-gap-meet-the-longevity-gap.html