Bad for business

For an entrepreneur like Dalton, cancer is bad for business. Because her immune system was weakened from her treatments, her doctor insisted she stay out of the gym for her safety. She was able to do some virtual coaching sessions, but her revenues fell by approximately 60%.

Maintaining the business while funding cancer costs could be a "deal killer," according to Kerry Rupp, an investor in women-led companies as general partner at True Wealth Ventures and board chair of Texas 4000 for Cancer.

"It's hard to imagine how a woman entrepreneur facing a cancer diagnosis might even continue forward with an early stage business," Rupp wrote in an email exchange. Start-ups demand the founder's time, energy, and, in many cases, their cash. According to Rupp, many entrepreneurs — especially in early stage or smaller companies — opt for bare minimum health insurance to conserve cash just like Dalton did.

Costs can impact care

Financial constraints matter in cancer treatment, according to Dr. T. Salewa Oseni, assistant professor of surgery at Harvard Medical School and breast surgical oncologist at Massachusetts General Hospital.

Women who work in hourly jobs may struggle to get time off for treatments, and even if they can, they often have to forgo wages for those hours. On top of lost income, women may struggle to afford the indirect costs of cancer, such as transportation to get to treatments.

Even for Oseni's patients who work full-time, the financial implications of lost work can be the deciding factor in their treatment preferences. "It's not just, 'Do I want to keep my breast or not?' but, 'How fast can I go back to work?'"

Some, Oseni said, let assumptions about insurance coverage — such as for reconstruction surgery after a mastectomy — determine their choices.

"I realized that some women would just start … shaking their head 'No,' and it wasn't because they didn't want [the treatment]," Oseni said. They just assumed they couldn't afford it.

Verini encourages healthcare providers to openly discuss costs.

"Ongoing, inclusive dialogue with the patient will allow for increased open communication of needs and decreased feelings of shame, embarrassment or fear patients may feel surrounding topics of affording lifesaving treatment," Verini said.

Our survey showed that, while only 54% of respondents discussed costs with their healthcare providers, 70% of those who did found lower-cost options, highlighting the importance of communicating about the costs of care.

Women were more likely to research costs and seek help with bills than men, but also were more likely to feel stress about costs. Few respondents spoke with a social worker, which may represent missed opportunities.

"Presenting social worker involvement as a valid option would assist patients on dealing with the financial impact of cancer," Verini said.

Oseni and her colleagues increasingly invite such cost conversations. Without knowing a patient's financial concerns, doctors recommend the treatment approach they think is best clinically without regard for cost. If they understand that costs may create obstacles, they can often find alternatives.

Oseni urges patients to speak up. If you don't feel comfortable talking to your doctor about cost, Oseni says, find another doctor.

This resource was created with support from Amgen and Daiichi Sankyo.