RAPID CITY, SD — Jeni Rae Peters made promises to herself as she lay awake at night after being diagnosed with breast cancer two years ago.
“My kids had lost so much,” said Peters, a single mother and mental health counselor. She had just adopted two daughters and welcomed four other children. “I swore I wouldn’t force them to have yet another parent.”
Multiple surgeries, radiation and chemotherapy have controlled the cancer. But, despite having insurance, Peters ended up with more than $30,000 in debt, threats from debt collectors and more anxious nights thinking about her children. “Do I take them out of daycare? Do I stop their schooling and tutoring? Am I not helping them with college? Peters wondered. “My doctor saved my life, but my medical bills are stealing my children’s lives.”
Cancer kills approximately 600,000 people in the United States each year, making it one of the leading causes of death. Many more survive, thanks to breakthroughs in drugs and therapies.
But the high costs of modern care have left millions of people with a devastating financial burden. It forces patients and their families to make heartbreaking sacrifices even as they face serious illness, according to a KHN-NPR investigation into the sprawling medical debt problem in the United States. The project shows that few suffer more than people with cancer.
According to a survey conducted by KFF for this project, about two-thirds of adults with health care debt who have had cancer themselves or in their family have reduced their spending on food, clothing or other basic household items. . About 1 in 4 have declared bankruptcy or lost their home due to eviction or foreclosure.
Other research shows that patients from minority communities are more likely to experience financial hardship from cancer than white patients, reinforcing the racial disparities that cloud America’s healthcare system.
“It’s crippling,” said Dr. Veena Shankaran, a University of Washington oncologist who has studied the financial impact of cancer. “Even if a person survives cancer, they often cannot pay their debt.”
Shankaran found that cancer patients were 71% more likely than unaffected Americans to have bills on collection, face tax liens and mortgage foreclosure, or experience other financial setbacks. By analyzing bankruptcy records and cancer registries in Washington state, Shankaran and other researchers also found that cancer patients were 2.5 times more likely to file for bankruptcy than those who were not. not achieved.
And those who went bankrupt were more likely to die than cancer patients who didn’t.
Oncologists have a name for it: “financial toxicity,” a term that echoes refractory vomiting, life-threatening infections, and other harmful effects of chemotherapy.
“It’s hard,” Shankaran said, “to think about what the system is doing to patients.”
Cancer diagnosis upsets family
In the three-bedroom house in Rapid City that Peters shares with her children, most of the time she doesn’t have time to dwell on these worries. There are ice skating lessons and driving tests and countless meals to prepare. Teenagers come and go, chatting about homework, tattoos, and driving.
The little ones gather around a small kitchen table under a wall adorned with seven old telephones. (As Peters says, red is a hotline to Santa Claus, green goes to the Grinch, and a space shuttle-shaped phone connects to astronauts orbiting Earth.)
Peters, 44, happily presides over the chaos, directing his children with sarcastic remarks and expressions of love. She proudly watches one teenage girl help another with math in the living room. Later, she dances with a 5-year-old at Queen under a disco ball in the lobby.
Peters, who sports tattoos and earlier this year dyed her hair purple, never planned on having a family. In her late thirties, she wanted to do more for her adopted community, so she took in foster children, many of whom come from the nearby Pine Ridge Indian Reservation. A girl was homeless.
“Foster children are amazing humans,” she said. “And I can help raise these little people to be healthy and safe.”
In the spring of 2020, the secure world Peters had carefully nurtured was shattered. As the covid pandemic spread across the country, she was diagnosed with stage 2 breast cancer.
Within weeks, she had an intravenous port inserted into her chest. Surgeons removed both her breasts and then her ovaries after tests showed she was also at risk of developing ovarian cancer.
It was scary, says Peters. But she rallied her children. “We talked a lot about how they had all lost siblings, parents or other loved ones,” she said. “All I had to do was lose my boobs.”
Far more difficult, she said, were the endless and confusing medical bills.
There were bills from the anesthesiologists who attended his surgeries, at the hospital and at a surgery center. In total, Peters estimates that his medical debts now exceed $30,000.
High costs, despite insurance
Debts of this size are not unusual. Nationally, about 1 in 5 indebted adults who have had cancer or have a sick family member say they owe $10,000 or more, according to the KFF poll. People with cancer are also more likely than others with health care debt to owe large amounts and to say they never expect to pay them back.
This debt has been fueled in part by the advent of life-saving therapies that also come with exorbitant price tags. The National Cancer Institute has calculated that the average cost of medical care and medication exceeds $42,000 in the year following a cancer diagnosis. Some treatments can exceed $1 million.
Usually most costs are covered. But patients increasingly have to pay big bills because of annual deductibles and cost-sharing from other health plans.
Peters has had seven surgeries since 2020. Throughout that time, she had health insurance through her employers. Peters said she knew she had to keep working or she would lose her coverage and face even bigger bills. Like most plans, however, hers required her to pay thousands of dollars out of pocket every year.
Within weeks of his diagnosis, the bills poured in. Then the collectors started calling. A call came as Peters lay in the recovery room after her double mastectomy. “I was a little delirious and thought it was my kids,” she said. “It was someone asking me to pay a medical bill.”
Before falling ill, Peters was earning around $60,000 a year. It was enough to support her children, she said, supplemented by an allowance she receives for foster care.
The family budget was always tight. Now, she says, they live on the edge. “I keep praying there’s a shoe fairy,” she joked about the demands of so many feet growing in her home.
Peters took on extra work to pay some bills. Five days a week, she works consecutive shifts at both a mental health crisis center and a teen counseling clinic. Last year, three east coast friends paid off some of the debt.
She said she might drop car insurance for her teenage daughter, who just got her license. Canceling ice skating for another girl would bring in an extra $60 a month. But Peters is reluctant. “Do you know what it’s like to be an adopted child and get a gold medal in ice skating?
Many cancer patients face difficult choices.
About 4 in 10 people with debt have withdrawn money from a retirement, college or other long-term savings account, according to the KFF poll; about 3 in 10 have moved in with family or friends or made some other change in their living situation.
Dr. Kashyap Patel, chief executive of Carolina Blood and Cancer Care Associates, said the practice in South Carolina has found patients who turn to food banks and other charities for help. A patient lived in his car. Patel estimated that half of patients need financial help.
As Peters put away bags of groceries in her kitchen, she admitted she didn’t know what would happen to her family. Like many patients, she worries about how she will pay for tests and follow-up care if the cancer comes back.
She is always going through collection notices in the mail and answering calls from collection agents.
She asked one of them if he had children. “He told me that I had chosen to have surgery,” Peters recalled. “And I said, ‘Yeah, I guess I chose not to be dead. “”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues.