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6. Practical Issues: Work,
Insurance, Finances

The practical issues MBC patients and their families face are monumental. Surveys reveal that
financial hardship is a fact of life for many families, driven by inability to work, for both patient
and family caregiver; travel expenses; and high out-of-pocket co-payment and treatment
costs [58, 59, 61] .
The practical issues
MBC patients and Merely having health insurance may fail to insulate patients from the financial impact of
their families face expensive and ongoing treatments [91] . In patients with early stage breast cancer, compliance
are monumental. with treatment decreases as the amount of co-payment increases, suggesting that patients
may be forced to choose between treatment and other expenses [92] . As the cost of new
treatments escalates to levels far exceeding the annual income of most families, it’s easy to
imagine patients having to make difficult choices, especially during the 2-year lapse between
Social Security Disability determination and Medicare coverage, when many families’ savings
are depleted [93] . High rates of bankruptcy have been documented, particularly among MBC
patients under 65 years of age, in a population-based study [94] .

Despite the The majority of MBC patients are in the workforce at the time of diagnosis. Within the first year
challenges they of treatment, at least half have quit or lost their jobs, which often results in greater financial
face, most people problems and a lower standard of living than before diagnosis [57, 61, 95] . Most patients report
with MBC and being unaware of available resources that help address financial need. For example, one
their families quarter of the MBC patients completing an online survey in the US were not aware that MBC
demonstrate
considerable patients with a certain amount of work history qualify for Social Security Disability benefits.
resilience, Although few of the more advantaged patients who completed the surveys had to forgo
adaptation, and treatment because of financial circumstances, many missed vacations, celebrations, and
courage as they social events and depleted their savings [58, 95] .
continue to live with
the disease. Other practical needs that MBC patients report as problematic include accessing
transportation to health care facilities; managing the home, child care, and shopping; getting
help with applications for disability or insurance benefits; obtaining medical referrals; and
finding help with work-related issues, such as Americans with Disabilities Act protections and
[3]
medical leave .

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