As a general matter, advanced breast cancer is treatable even though it is not curable. More and more women are living longer and longer after a diagnosis. In fact, for many women, breast cancer is like a chronic condition such as diabetes.

When the early confusion that usually accompanies a diagnosis starts to clear, you will find your world has shifted into a new normal. Just about every aspect of your life will be affected. We help you learn what you need to know to survive and even thrive after a breast cancer diagnosis.

Our discussion is divided into eight categories: Day To Day Living, Emotional Well Being, Finances, Government Benefits, Insurance, Medical Care, Planning Ahead, and Work Issues. We recommend that you skim the content in each category to get an overview, then return to each subject as it works for you. Each subject starts with a summary. 

Underlying all discussions is "The Basics" - which is where we suggest you start. Since so much emotion comes with the word "advanced" or "metastasis" in addition the words "breast cancer," consider reading the tips in "Emotional Well Being" in addition to any other subjects you may be interested in at the moment. 

NOTE:

• Information can help you feel in control. On the other hand, getting ahead of your self can be overwhelming. For instance, there is no need to read about being "in treatment" or "post treatment" now. 
• If information is overwhelming for you, take breaks as needed. Alternatively, ask someone close to you to read the information and tell you what you need to know as you need to know it.
• You can personalize the information to your diagnosis, economic and social situation by getting a Personal Survival Guide.
• If your diagnosis is of a condition which is so advanced that you may be facing end of life issues, read Nearing End of Life.

For information, see:

• The Basics
• Finances
• Managing Your Medical Care
• Emotional Well Being
• Insurance
• Government Benefits
  
• Work Issues
• Planning Ahead
• Day To Day Living

Experience has shown that the best way to proceed after a diagnosis is:

• Take some time to breathe and to let your emotions settle. You received a brutal shock. As a general matter, you do not have to take immediate action so there is no reason to rush into a hasty decision. The calmer you can be when making major decisions, the more likely you will make effective decisions. On the other hand, do not procrastinate. Move forward with deliberate speed.
• Commit yourself to doing everything you can to control and even beat your disease.
• Adopt a reasonably optimistic attitude (we call it a "positive attitude"). People do best who expect the best. For instance, think: "I'm going to get the health care I need." A person with a positive attitude understands that when the glass is half full and half empty, it's up to you to try to keep the focus on the half full side. See: A Positive Attitude (And How To Keep It)
  • Do not beat yourself up if you have days when you can't do anything. 
  • If fear threatens to take over, use it as a trigger to take a moment and center yourself to the here and now.
• Choose your cancer doctor (oncologist) with care. Once you decide which doctor will treat your breast cancer, trust him or her. (If it doesn't work out, you can switch doctors if necessary).
• Learn how to maximize your limited time with a doctor. Part of this process is learning about breast cancer and the words you are likely to hear.
• Share your feelings with the people close to you. Consider seeking a breast cancer buddy.
• Start reaching out for support even if you are used to going it alone. It will make it easier to go through the decision making process and the seemingly endless waiting.
• Select a person to act as a patient advocate to go with you to doctor appointments, at least until a treatment decision is made. The person can to help ask questions, help remember what the doctor said, and review the meeting with you afterward. Experience indicates that this is particularly important for the initial meeting with the surgical oncologist.(If you don't have a person to act as patient advocate, Professional Advocates are available.)
• Start thinking about the food you eat, exercise, proper rest and stress reduction as part of your treatment. Such a lifestyle is generally referred to as a "cancer prevention dieet and lifestyle."
• Break things into doable steps. Then deal with each step one at a time.
• Do not make any major financial or other decisions you do not have to make right now.

Each of these subjects is discussed in the other sections of this document where you will find more information.

When you have contact with an insurer, employer or government agency:

For more information about each of the following subjects, see the documents in "To Learn More."

If you have health insurance

Even with health insurance, your recent diagnosis can play havoc with your finances. It is important to get control of your finances now or as soon as you can focus.  

Over 50% of the personal bankruptcies in this country involve health care costs. Over 75% of those people have health insurance. While this may sound scary, think of it as a call to action. Do not let general fear about money drain your energy. Push the thought aside with action.

If you do not have health insurance (uninsured)

Start thinking about how to pay for your medical care. While medical care can be costly, all medical bills are negotiable.

Free or low cost care is available.

Check to see if you do, or could, qualify for Medicaid (Medi-cal in California).

Do what you can to get health insurance. 

General finances

Keep up your finance basics. Pay your rent or mortgage and minimums on your credit card. After a diagnosis, credit can be critical to helping you through. This is not a time to negatively impact your credit rating if you can avoid it.

Pay your health insurance premium on time. Arrange for someone to pay premiums for you or for automatic payment if you get sick or undergo a treatment and forget. An insurance company would like nothing better than to cancel your insurance for nonpayment.

Start keeping track of all medical services you receive and expenses you pay. Don't pay a medical bill just because you receive one. First make sure that you are supposed to pay it, and that the bill is correct.

Cash can be king. Keep as much of it as you can. Put off discretionary purchases for now. Use credit instead of cash when possible.  If you are considering purchasing an expensive item such as a car, see if you can get credit life insurance on the balance. Generally this kind of insurance does not request medical information. It will pay off the debt in the event of your death.

Start accepting the credit card offers you get in the mail. They can provide cash if you need it.

If money is an issue

Some financial assistance is available if needed for women with breast cancer.

Only pay creditors the minimum while you lean more about your situation. If necessary, you can negotiate with creditors about paying off debt over time, and/or reducing the amount of the debt. There are non-profit services available to help if you need it (but watch for the non-profit organizations that do not work in your interest). Bankruptcy is also an option. Over 60% of the personal bankruptcies in the U.S. are people with medical debt.

If you have more income than outgo

Unless you have it already, start working toward a goal of a cash fund (an Emergency+Fund) equal to 3 to 6 months of monthly expenses. This is the amount of money generally recommended to have on hand in case of periods of no income or unexpected expense. It doesn’t mean you have to put this much money away today. However, now is the time to start. (If you work in a specialized area where there are very few jobs, aim for 12 months of expenses in your fund.)

Put as much money as you can spare into your retirement accounts. Saving tax dollars is the same as earning extra money. You can usually withdraw money or borrow it if necessary. If you become disabled, withdrawals are usually without penalty. Plus, money in a retirement account is protected from creditors. If you have a choice of accounts:

• First priority is to fund accounts in which your employer matches your contribution. The value of your contribution is increased as soon as you put it into the account.
• Then consider:
  • Which accounts are easier to withdraw money from or borrow against in case of unexpected expense. Pay particular attention to when you can do these things as well as the costs you’ll pay, such as penalties.
  • Which accounts are earning you the most money.
• If you need help with this decision, speak with a financial planner, your accountant or attorney.

 If you still have money left, open new accounts to the maximum permitted by the tax laws.  

Postpone big decisions to the extent you can
 
It is wise to postpone making big decisions that do not relate to your health care until you are calm emotionally and your thinking is clear. It is quite natural that your thinking is impacted by your diagnosis. 

You may not return to a more "normal" emotional state until after treatment ends. The treatment, or drugs you take during treatment, may have an affect on your thinking as well.

If you could become disabled

If you will be unable to work and your income will stop, think about how you will live. We discuss the subject, including how to deal with creditors, in In Treatment For Breast Cancer. For instance, you may be able to get cash from assets without selling them or even get cash from your life insurance policy.

Diagnosis To Treatment Decision

Treatment Decision To The Day Before Treatment Starts

More information about this subject is contained in the Main Article in "To Learn More."

Each of the following subjects is discussed in depth in Survivorship A to Z's insurance document. To avoid being overwhelmed, focus on the information you need to know now.

Health Insurance (including Medicare and Medicaid (Medi-Cal in California)

Health insurance cannot be cancelled because of your diagnosis.

Check your health insurance policy to find out:

• If you need pre-approval before you access medical care. If approval is needed:
  • For what? 
  • How do you get apprpoval?
• Whether your insurance covers the treatment you want. If so, are there conditions and/or restrictions?
• Whether it covers the person you want to provide the treatment.
• How much you will have to pay out of pocket.
• How to file claims. If it is your job to file claims, set up a system to keep track.

If your insurer says "no" to any medical care you believe is necessary, appeal - and keep appealing. Keeping at it pays off. Also:

• Look for a source of influence that can help. 
• Get professional help if necessary. 
• Keep in mind that there are usually procedures to fast track appeals if required by the medical situation.

Do everything you can to keep health insurance in force. If you don't have it, when things settle, start doing what you can to get it. People who have had any type of cancer are at risk of the cancer returning or of another cancer in the future.

If You Do Not Have Health Insurance

Check to see if you qualify for Medicaid, or could take steps to qualify for Medicaid. In most states, you can take actions to qualify for Medicaid and qualify the same day.

There are also techniques for accessing the health care system even if you are not insured (uninsured).

Both of these subjects are covered in the documents noted in "To Learn More."

Disability Insurance

If there is a possibility your breast cancer will make you unable to work for a short period of time or permanently:

• Check to see if you have disability income coverage through your employer. If you do, what is the waiting period before you receive money, and then how much?
• If you have a private disability policy, check to see what is defined as a "disability."

Life Insurance

You can still get life insurance. Get as much life insurance as you can. In addition to providing coverage for dependents, life insurance can be a source of money if your life expectancy becomes short. For example:

• You can get insurance known as "guaranteed" life insurance which is sold with few if any questions.
• You may be able to get life insurance through your employer during an open enrollment period - or increase the death benefit for any life insurance you already have.   
• You may be able to get a death benefit on your credit cards. 

Other Insurance

This is no time for a major, unaffordable, loss.

Keep to date on premium payments for basic insurance such as Homeowners Insurance and Automobile insurance.  If you don't have either of these policies, this is a good time to get them. Survivorship A to Z provides unbiased information about what to look for in each of these basic policies (and how to file a claim if one happens.) See: To Learn More. 

NOTE: When you have contact with people at the insurance company: Be friendly. (We refer to it as making a friend.) Make notes.  Keep copies of all documents you send.

For more information about each of these subjects, see the documents in "To Learn More."

Health coverage

If you do not have health insurance, check to see if you qualify for a government health plan known as Medicaid (Medi-cal in California).

If you do not qualify because you have too much income or too many assets, you may be able to take steps to qualify for coverage immediately..

Income

If you become unable to work, you may be entitled to income from Social Security Disability Insurance (SSDI) and to Medicare 29 months after the onset of disability.

Also explore whether you are entitled to an income from Supplemental Security Income (SSI) or any state programs.

If your breast cancer is arguably work related

If your breast cancer is somehow work related, you may be entitled to Workers Compensation.

Food

If your income is low, or stops altogether, you may be entitled to food stamps.

Other benefits

There may be state and local benefits for which qualify, or could qualify.

NOTE: When you have contact with people in the government: Be friendly. (We refer to it as making a friend.) Make notes.  Keep copies of all documents you send.

The discussion about work issues is divided to suit your situation. Please click on the button that applies to you.

Looking For Work At Work
Small Business Owner Self Employed

For more information about each of these subjects, see the documents in "To Learn More."

It may be the last subject you want to think about right now, but your diagnosis is a reminder that every one of us should think through what could happen "just in case" - and then take the necessary steps.

We cover the subject in the document known as Planning Ahead. When things settle, we highly recommend reading the information gathered there.

For now, at least consider the following.

• Every treatment has risks. The risk that you will become unable to speak for yourself is likely minimal. However, the resulting impact on you and your finances could be huge. Consider what you would want to happen medically if you become unable to speak for yourself. Think about what you would not want to happen such as being kept alive for years on a machine. Then make sure what you desire happens by executing documents known as "Advance Healthcare Directives" (or more simply as "Advance Directives.")  Advance Directives are available for free for each state.
  
  • Executing an Advance Directive does not mean that it will be needed. These documents are merely a means for you to stay in control. Also, executing these documents can help ease the anxiety that accompanies an impending treatment.
  • One advance directive to consider is a Living Will. In general, a Living Will states what you do, and do not, want to happen. If Terry Schiavo had executed a LIving Will, there would not have been a court battle and wasted years hooked to a machine.
  • Another document to consider is a Health Care Power of Attorney. It appoints a person to act on your behalf (a "Proxy"). A Proxy can make a decision in the gray areas that frequently occur. A Proxy can also push for enforcement of your wishes. (f you appoint a Proxy, be sure to ask him or her to read Survivorship A to Z information about how to enforce an Advance Directive.)
  • NOTE: If you are going to check in to a hospital: Expect to be asked by the admissions person whether you have a Living Will and other advance directives. If you do not, you will be offered the forms the hospital uses. Even if you do have a Living Will, consider creating a duplicate on the hospital forms. In the event of an emergency, staff will know what to do if you use the hospital form. If you use your own form, staff may have to seek an opinion about the correct meaning of your document from the legal department which can slow things down considerably.
• What would happen to your children if you can't take care of them while you are still alive, or if you die.
• What would happen to your assets if you die. 
  • At the least, everyone needs to have a Will - no matter how little or much you own.
  • Check all documents with beneficiaries on them (such as brokerage accounts) to be sure: The beneficiary you want is listed. If there is more than one beneficiary, the split between them is clear.
  • Consider writing an Ethical Will - a document that passes on to your heirs such information as what you think they should know about how to live life and family history.

Advance directives are free. Wills are not expensive - and can be free.

More information about this subject is contained in the Main Article in "To Learn More."