Guest Author - Colleen Moore, RN

Multiple studies have been conducted on patient outcomes related to the lack of heath insurance. It has been proven time and time again that those whom do not have adequate coverage suffer worse outcomes than those who have adequate coverage. This article will focus on Oncology patients, who do not have good healthcare coverage and their outcomes. Those without health insurance many times do not get recommended screening tests, so when they are finally diagnosed, their cancer is likely to have spread.

A diagnosis of cancer is difficult to handle in the best of circumstances. Cancer is a very frightening and stressful disease. The treatment options and the risk of mortality add to this distress. Patients without adequate health insurance, who have been diagnosed with cancer, have an increased rate of depression, stress and mortality.

The people who fall into this category are not the very poor, as may be thought, but many times are the middle class, who do not qualify for Federal assistance because of their income but cannot afford the outrageous costs of health insurance. Many, private insurance do not cover the high cost of many chemotherapy agents, so patients are forced to accept a second line of treatment versus the first line medications.

Diagnostic tests to detect cancer are very expensive and not readily accessible to patients without healthcare coverage leading to a later diagnosis. The more advance the disease is the poorer the patient’s outcome.

Cancer is contributed to some of the highest healthcare costs, from diagnosis to treatment. Because uninsured patients are do not usually receive recommended cancer screenings, they are more likely to have a cancer diagnosis at a later stage, when they are less curable. Thus, their survival rate is much lower than those with a good insurance plan.

The costs of chemotherapy agents are exorbitant. One treatment can run as high as 50,000 to 75,000 dollars.

Surgical procedures can be devastating if the patient is uninsured.

A hospital stay for a surgical patient can be 20 to 30 thousand dollars depending on the procedure.

Medications to fight side effects to the chemotherapy and radiation are also very expensive. One Zofran pill costs 32 dollars, so although Zofran is the most effective antiemetic for chemotherapy, Zofran is the least likely to be prescribed to someone without adequate healthcare insurance.

Even when a patient can afford the treatment, follow up screening and tests can be very expensive. One CT-Scan is thousands of dollars, oncology patients are required to have these test on a regular basis to monitor the effects of the treatment. Progress is not known if Ct-Scans, MRI’s and lab tests cannot be preformed.

Although we live in the United States, it is estimated that 47 million people are uninsured. This means 1 in 10 people do not have any type of health insurance. This is in a country where healthcare expenses are double what they are in other countries and the best healthcare systems are available.

American’s should have the better coverage than any other country in the world. But still it is estimated that 20,000 of the 560,000 people diagnosed with cancer yearly, have little or no health insurance.

Most cancer patients feel overwhelmed by depression and stress. Many times cancer patients have body image changes associated with the disease. Stress is the physical and emotional response which is not uncommon to the oncology patient.

Many patients experience feelings of guilt about the disease, possible preventative measures and possible outcomes. This can be exacerbated by the lack of health insurance. Patients do not want to burden their families financially and may opt not to get the proper treatment.

An oncology nurse, will witness a patient who decides not to accept treatment because of the financial devastation it will cause their family. The nurse has the responsibility to respect the decision of the patient but to also educate the patient on available options.

Guilt is carried forward by the survivors of those who opted not to receive treatment. The family must be treated as a whole in this equation. Everyone must be a part of the decision, as difficult as that may be. The nurse is responsible to facilitate the process.

The American Cancer Society is in the forefront of this fight. Their web-site is full of information for the public to participate in healthcare reform on a state and federal level. As a responsible citizen everyone should go to the Cancer Action Network, http://www.acscan.org/site/PageNavigator/Access_to_Care_Action_Landing to see what they can do to make a difference.

This is a community and country wide problem, which has a good chance of affecting you or someone you love.