Financial Worries Top Psychosocial Concern of Cancer Patients

Elsevier Global Medical News. 2011 Feb 28, B Bates
ANAHEIM, CALIF. (EGMN) -Highlighting shifting priorities after the recession, nearly half of all recent psychosocial consultations with patients at a leading cancer center involved financial worries, rather than adjustment issues or other pressing mental health concerns.
Among 313 single-episode encounters at the Cleveland Clinic’s Taussig Cancer Institute during one month in late summer 2010, 49% focused on financial issues, according to a study presented at the annual conference of the American Psychosocial Oncology Society.
These included a lack of adequate health insurance, inability to afford medications, housing crises, and/or difficulties in meeting basic financial obligations during cancer treatment, reported Christa Poole, a social worker at the institute.
“This study was a result of the [social work] team noticing a trend in increased consultation requests and interventions related to financial need,” Ms. Poole said in an interview.
Among patients’ presenting concerns were losses of benefits from layoffs, high COBRA premiums, and housing foreclosures, with these challenges often taking precedence over the more existential struggles faced by patients facing life-altering or life-threatening cancer diagnoses.
In the study, mental health distress – including coping challenges, adjustment to the diagnosis or treatment, and acute risk assessment for suicidality – constituted 37% of social work consultations, followed by other issues, including coordination of family meetings to discuss goals of care or decision making (5%), and domestic or family violence (2%).
The institute’s five social workers are now very often placed in a position of having to focus immediate attention on patients’ basic needs, while staying attuned to their depression, anxiety, grief, and changes in life roles and self-image, according to Ms. Poole.
“Cancer care, in most cases, cannot wait. These financial worries cause significant distress and when not addressed, may cause barriers to quality care,” she said.
At times, money woes are now directly impinging on medical care, she added, affecting choices patients and families make about cancer treatment regimens or symptom management. “Unfortunately, some patients choose care or treatment that will avoid debt or hardship for their loved ones,” even when those choices may affect their survival or comfort, said Ms. Poole.
“We don’t want to see patients in situations where they are choosing between paying an electric bill and paying for a drug to control nausea, when we know that patients need both.”
Financial burdens influence adherence as well, she noted: “When patients can’t afford gas or copays, they often cancel or ‘no-show’ for appointments.”
The “devastation of financial recession” has not only jolted the priorities of cancer patients, but also has taxed the institutional and external philanthropic assistance programs that once addressed such needs, said Ms. Poole.
“Resources are continuing to dwindle. Programs are simply running out of funding and are much less able to extend financial assistance,” she said. “This issue deserves continued attention and investigation, as the problem may worsen. How will hospital policies and programs respond to absorbing unpaid medical debt?”
Ms. Poole said her department continues to track trends in consultation, “as the full impact of the economic crisis continues to unfold in health care.”
Investigators reported no relevant financial disclosures.

Health Care Reform Murders Family, Blows Up Orphanage, Supports Terrorists!

Socialized medicine! Death panels! Government-funded abortions! In case the “Tea Baggers” have you truly frightened, this should comfort you: A Guide for Those Traumatized by Right-Wing Fear-Mongering Lies about Health Care Reform.

Although the so-called HealthCare Reform bill was watered down to the point of toothlessness, and the Seig Heil Uber-Right ended up getting almost everything they wanted, in the true spirit of crybabies everywhere, the TBs have taken public rhetoric to a new low. Honestly, I hadn’t thought that was possible, but those ever classy “Tea Baggers” have again demonstrated their debating skills and righteousness by shouting “f*ggot!” and “n*gger!” and even spitting at House members who dared to defy god hisself by voting for that pathetic, tepid health care reform bill. This should erase any doubts about their intelligence.

Since they’ve provided a real insight into their motives and intentions, I think it only fair that the TBers be correctly addressed on the floor from now on. Instead of “We recognize the kind gentleman from Skankville…,” let’s switch to “We recognize the lying, hypocritical, scumbag…” No more “Gentlewoman from Stupidland.” She will henceforth be “The shrieking, spitting hysteric.” Yes, I’m actually looking forward to their next strategy: accusing us of name-calling and ad hominem attacks. In anticipation, I offer this reply, which even they should understand: “Neener, neener, neener!”

Buckle Up for The Medicare Labrynth

I’ve spent the last two days on the phone with the friendly folks at Medicare. Seems I’ve been on disability long enough that I’m eligible and — unless you tell them, “no thanks,” — they sign you up automatically.

So I spent a half day wading through Part A, Part B, and the exceptionally confusing Part C, and a day and a half on Part D, which is prescription drug coverage. It has got to be the greatest shame ever foisted on the American public, and I defy any Congresspig to explain it to their grandchildren. Of course, they couldn’t. How on earth did this debacle, this tragedy, this bloody abortion of a prescription drug plan ever get passed? It boggles the mind.

There are prescription-drug-only plans and prescription-drugs-plus plans (which may include vision or other coverages.) After providing a list of my daily meds, the Medicare Rep told me about what the computer says is the best plan for me. But one drug was in dispute: I said there was no generic equivalent, the computer insisted there was. Many phone calls later, I prove I am correct, but the computer won’t let the agent (a different one, of course) override the generic option. Of course, there has to be a way, I insist ten times. After the eleventh plea, Ms. Helpful finally talks to a supervisor and finds there is, indeed, a way to do so. And the chip on her shoulder grows exponentially.

Now I have a new price for the recommended plan but, she explains, it’s only good until I hit the infamous “donut hole.” (I won’t even try to explain this to you, even though I finally understand it, although I still don’t understand whether the criteria for reaching it is based on what I’ve spent or what Medicare has spent.) But yesterday, I say, I was told this plan has no donut hole. Every plan has a donut hole, Ms. Helpful insists, and not five minutes later, she’s trying to explain a different plan which has no donut hole. I just don’t have the stomach to point it out.

After getting off the phone and doing lots of calculations based on information that may or may not be correct, it appears that my DieSuckah Health Insurance policy is actually very close to my true cost of Medicare. And at least I’ve met my deductible for the year, and at this point I know what is and isn’t covered — including that disputed prescription which I take daily, which doesn’t have a generic, and which, until I hit the deductible, costs me $500/month.

(This is true now, but I will be getting my annual premium increase in April, which has been running close to 20% per year, in which case, Medicare probably will be the better option. But — get this — if you don’t sign up as soon as you become eligible, the Part D premium goes up every month. Sooo… it’s impossible to know which will be the better value in 60 days.)

I’ve wasted two days of my life just sorting it out and coming to this conclusion, although as I said, I don’t have much faith that I’m basing my calculations on correct data. Oh, boy. Who would have thought — it seems our friends in the federal government may have provided me a raison d’etre after all.

My new goal is not only to campaign for health care reform, but to strip our Congresspigs of their gluttonous plan, which includes donations to their election campaigns, luxury travel, and complete health, vision, dental, botox, shoe shines, massages and prescription coverage for themselves and their families, staff, neighbors and acquaintances, for their whole lives and at least one afterlife. It doesn’t seem fair, does it?