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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

A new diagnosis of cancer is generally accompanied by a high degree of stress and anxiety and a roller coaster of emotions. In addition to dealing with the possibility of death, there is a lot to learn, many things to consider and questions waiting for answers. Experience has shown that it helps to do the following: 

  • Take some time to breathe and to let your emotions settle.
  • Start working on your mental attitude.
    • Keep in mind that at least one person survives every disease. Experience shows that it helps to think of yourself as that person.
    • Commit yourself to doing everything you can to overcome your disease.
    • People do best who expect the best (even though the first few months will likely be difficult). Don't beat yourself up if you become so overwhelmed that 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 be here now.
  • Break things into doable steps. Then deal with each step one at a time.
  • Do not make any major decisions that you don't have to make right now.
  • Aim to be an informed medical consumer instead of just a "patient."
  • Decide who to tell and what to tell them.  You can always tell people later. On the other hand, once you tell a person, you cannot "untell."

Following is a list of suggested steps. As you read the list, please keep in mind that there is more information about each step in the other sections of this article.  If you are not up to doing these steps yourself, ask a trusted friend or family member to help. 

The steps to consider are:

  • Contact the doctor who diagnosed you or the doctor's nurse or office manager. Ask the following:
    • To repeat the diagnosis.
    • What the next step should be. If the next step is to see a different doctor, what specialty? For example, a person diagnosed with cancer is generally referred to an oncologist - a specialist in cancer. If the doctor recommended a particular doctor, ask why that particular doctor or doctors?
    • How much time you have before it is advisable to start treatment.
    • What would speed up the time table so you know if something happens that you have to move more quickly.
    • How to decrease or eliminate pain and any other symptoms you are experiencing.
  • Focus on getting the medical care you need. 
    • Things don't just happen in our medical system. You or a caregiver/patient advocate need to take an active role in making things happen. 
    • A patient navigator can help guide you through the medical system.
    • Ask what you should be doing about your diet and exercise to mazimize your body's ability to heal and withstand treatment side effects. This is known as prehabilitation (or "Prehab" for short.) Prehab is like dressing in armor for the mind and the body - armor that prepares both mind and body for the battle ahead.
  • If you work: 
    • Be cautious telling about your diagnosis right away. You can always tell your boss or co-workers later. On the other hand, once you tell, you can't untell.There is no obligation to tell unless your condition is somehow unsafe for the people around you.
    • Consider taking some time off to focus on your condition.
  • Start looking at your insurance and financial situation to determine how you will pay for medical care. Medical care can be costly even if you have health insurance. Free or low cost care is available if you do not have health insurance.
  • Keep up your finance basics. 
    • Pay your rent or mortgage and minimums on your credit card. Timely payments are reflected in your credit score. Credit can be important to help pay medical bills.
    • Pay your health insurance premium. on time so you do not lose coverage. 
    • Medical bills
      • Start keeping track of all medical services you receive and expenses you pay.
      • Do not pay a medical bill just because you receive one. Always check for errors.
    • Do not go on a spending spree. You may need the money later.
  • Start thinking about family and friends as part of your health care team. Keep in mind that a diagnosis also affects them. If you have underage children, tell them about your diagnosis in an age appropriate manner.
  • Learn to purchase, use, store and dispose of drugs wisely. If needed, assistance paying for drugs, or even free drugs, may be available.
  • Keep in mind that drugs and treatments do not work in a vacuum. Start to think of the food you eat, the exercise you get, your rest/sleep, and even proper care of your mouth as steps you can take to make treatments and drugs most effective. (If you have dental problems, schedule a check up.)
  • Share your emotions. Watch for depression. Consider seeking counseling.
  • Speak with other people who are going through what you are.
  • Last, but not least, remember that you are a person living with cancer, not a cancerous person. A diagnosis does not define a person.

NOTE:

  • It may help to take a few moments to set your own order of priority so you are not overwhelmed trying to think of everything at once. To help set the order that works best for you, consider using Survivorship A to Z's Prioritizer which allows you to reorder priorities with the push of a button.
  • Pain does not have to be part of a health condition. If you have pain, speak with your doctor about alternatives for getting rid of it, or at least decreasing how much it hurts. There are even doctors who specialize in treating pain and reducing symptoms. These doctors are known as Palliative Care Specialists. You can receive palliative care at the same time as you work to cure your condition. (For information about pain and how to deal with it, click here.)
  • Side effects from your health condition, drugs and/or treatments can be controlled or possibly even eliminated. To learn about various side effects and how to deal with them, click here.
  • If you are want to have children in the future, ask if a treatment could affect your ability to have them. If so, consider freezing eggs or banking sperm before the start of treatment..
  • Information can help you feel in control.  When you start treatment, read In Treatment.
  • If you could become unable to work, learn about your rights at work and about government and/or private disability income to which you may be entitled (as well as how to apply for it).
  • Home health care is available for many situations that used to require hospitalization.
  • If your diagnosis is of a condition which is so advanced that you may be facing end of life, read Nearing End of Life.

Let your emotions settle. A cancer diagnosis is usually not an emergency.

Although it may seem like it, the world hasn't ended. You are here today. The phrase, "Take one day at a time," has practically become a cliche because it works.

Don't be surprised if you experience a rush of emotions. You may feel confused, shocked, angry, depressed, scared, guilty, or a host of other emotions. Actually, you may experience several emotions at the same time. On the other hand, you may feel numb. There are techniques which can help you cope with emotions that appear. They are described in the articles listed in To Learn More.

The calmer you can be when making major decisions, the more likely you will make effective decisions. Making careful, well-thought-out choices about inerventions and treatments is one of the most important things you can do during the initial weeks post-diagnosis. 

NOTE: Don't be surprised if you have difficulty absorbing information. Take the time you need. It can help to tell a trusted person what you think you've learned. Telling will help pin point the gaps. It's perfectly reasonable to return to the source of information and ask that it be explained again, or in a different way.

Contact the doctor who diagnosed you or the doctor's nurse or office manager. Ask for a repeat of the basics, including how long you have to make a decision..

Ask your doctor to repeat the important parts of what he or she told you when you were given your diagnosis. Studies indicate that patients do not hear much of what is said after bad news is delivered. In one study, more than half of the provided information was forgotten. For example, consider asking the following questions:

  • What is the exact diagnosis?   
  • What is the next step you should take? If the next recommended step is to see a different doctor, what specialty? A person diagnosed with cancer is generally referred to a doctor who specializes in cancer. Such a doctor is known as an "oncologist" (on-col-o-gist).
  • How much time you have before it is advisable to take the next medical step? Generally decisions do not have to be made immediately. Knowing how much time you have provides a time frame for finding the best specialist for you.
  • What would speed up the time table so you know if something happens that you have to move more quickly?
  • If your symptoms get worse, or you experience new symptoms, what would indicate that you should call the doctor or go to an Emergency Room?
  • How to decrease or eliminate symptoms you are experiencing? 

NOTE: You don't have to live with pain, or other difficult side effects of your condition, drugs or treatment. There are remedies available. Talk with your doctor.

Take time choosing a cancer doctor - generally a specialist called an Oncologist.

Although it may go without saying that you should choose the best doctor available to treat your cancer, many people make the choice by the seat of their pants, often on the belief that a choice has to be made right away. In fact, there is generally time to gather facts and make a reasoned decision. Your primary doctor can tell you whether a choice of cancer doctor is urgent or not.

It is preferable to find a doctor who is a board certified cancer specialist and who has a good deal of experience with your particular cancer and stage. For some types of cancers, another specialist may be just as good as a cancer specialist. For example, for certain female cancers, a gynecologist with experience with the particular type of cancer can provide the care you need.

Interview several doctors until you find the one that is best suited to your needs. This may be a doctor who is top in the field rather than one with a good bedside manner. For additional information on choosing a cancer specialist and for an interactive chart that helps you make the choice, please see "To Learn More."

NOTE: If you haven't already, this is a time to learn how to maximize your time with a doctor.

Focus on getting the medical care you need. A patient navigator can help. Postpone major non-medical decisions until after treatment ends if possible.

It is preferable to be treated by a doctor who specializes in your health condition. Think about what is important to you in determining the ideal doctor to provide medical care about your diagnosis

  • The more experienced a doctor is in your particular situation, the better.
  • Interview several specialists and pick the best one for you.

Learn how to maximize your limited time with a doctor.  

  • Check to see if your mobile phone includes recording, If not, consider buying an inexpensive recorder so you can record your sessions and replay them later when you can listen without distractions.
  • Locate a person to go with you to important doctor visits to help ask questions and listen. (Such a person is known as a patient advocate.) Sometimes emotions can impair your ability to hear everything that is said.
  • Buy a fax machine or other inexpensive mechanism which allows you to receive and send reports.
  • Start keeping a symptoms diary.
  • Write down a list of all your medications, including over the counter medications --and keep it up to date. (We provide an easy chart that allows you to store your list and print it whenever you need it. To see it, click here.).

If you are going into a hospital, look for one that has a good track record with the procedure you need as well as a low rate of infection. If your surgeon doesn't operate in the preferred hospital, consider getting another qualified surgeon. Learn how to maximize your time in a hospital while doing your part to minimize the possibility of medical error 

Start learning what you need to know about your health condition and what normally happens.

  • When you do research, always consider the reliability of the information as well as whether the information provider has a self interest.
  • Keep in mind that statistics only refer to groups of individuals historically and do not tell what will happen to you or any other individual. 
  • What happens to you will be unique to your specific set of circumstances. 
  • Even if the odds are a million to one, learn to approach your situation as if you are the one. 
  • Keep track of all questions that come up from your research, so you can ask your doctor about them.
  • If research tends to increase your stress levels, ask a family member or friend to do it and to tell you what you need to know.

Decide who you want to make medical decisions if the medical path isn't totally clear. You? The doctor? A family member or friend?

  • Medical decisions may not be as clear cut as you would like. There may be different medical treatments available. There may be gray areas. Medicine is a combination of science and art.
  • There is a growing body of evidence that patients who participate in the decision making process do better than people who don't.
  • If you have a family member or friend go with you to appointments with doctors, you will have someone you trust to with whom to discuss your options and needs.
  • Understand that decisions and recommendations may change as facts change.

Think about so called "alternative" therapies such as massage, visualization, psychological therapy, and aromatherapy as complementary to Western style medicine instead of "either/or."

When a treatment is suggested:

  • Ask:
    • Why the doctor recommends the particular treatment, and not the alternatives.
    • Whether there are any studies concerning the effectiveness of the recommended treatment. 
  • Get a second opinion.This practice has become so standard that doctors are not offended when patients ask for second opinions. Insurance companies generally pay for second and even third opinions. 
    • Ideally a second opinion should come from a doctor experienced with your condition who is not in any way related to the doctor who gave you the first opinion.
    • If you have difficulty getting the appointment with another doctor, ask your doctor's office to help.
    • If the two opinions differ, continue to get opinions and do research until you are comfortable making a decision. On the other hand, don't let a search for certainty provide a reason to put off making a difficult decision.

NOTE:

  • Expect to hear lots of advice and stories from friends. Keep in mind that this information is "anecdotal," rather than scientifically generated. It is frequently irrelevant to your own experience. If you don't want to hear what friends have to say, or want to limit the amount or kind of information they give you, let them know.
  • 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.

Learn the basics about your cancer.

There is a medical learning curve required to be an informed consumer. This doesn't mean that you need to learn enough to become a doctor. You only need enough information to be able to have a precise discussion with your medical team and to be able to make informed decisions. 

The kind of cancer you have is stated on a a pathology (path-AWL-uh-gee) report. Pathology reports have to be written in language a layperson can understand. If you have a tumor, the report also states whether the tumor is likely to grow quickly or slowly. The pathology report uses a system of numbers and letters to show how serious your cancer is and to decide your 'cancer stage.' Sometimes cancer cells break away from a tumor and spread to other parts of the body through the lymphatic system or bloodstream. The cells can settle in other places in the body and form new tumors. This is called metastasis (meh-TAS-tuh-sis). Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started.

Information about each type of cancer is available from the American Cancer Society: www.cancer.org offsite link. Click on "Learn About Cancer." Then click on the type of cancer.

You can also do research on your own. If you search the internet:

  • Check the reliability of the site.
  • Expect to be anxious and possibly depressed. Much of the information you'll read about is likely to be about the worst cases. Keep in mind that these articles do not describe what will happen to you.You are an individual and your situation is unique.

Keep in mind that: 
  • Statistics only refer to groups of individuals historically and do not tell what will happen to you or any other individual. 
  • By its nature, research literature will always be behind the current state of treatment. 
  • What happens to you will be unique to your specific set of circumstances. 
  • Even if the odds are a million to one, learn to approach your situation as if you are the one.     
Keep track of all questions that come up from your research, so you can ask your doctor about them. 

If research tends to increase your stress levels, ask a family member or friend to do it and to tell you what you need to know. Alternatively, you can hire a medical research service to do the work for you for a fee. The services will take the details of your situation, search the literature, and prepare a report for you. 

 

 

Decide whether you or someone else will be the decision maker about your health care. Learn how to maximize time with a doctor.

Medical decisions may not be as clear cut as you would like. There may be different medical treatments available. There may be gray areas. Medicine is a combination of science and art. 

There is no right or wrong when it comes to who makes the decisions. The key is what works for you. It is worth keeping in mind that there is a growing body of evidence that patients who participate in the decision making process do better than people who don't. The great majority of "how to" books and articles by long term survivors talk about the importance of being pro-active and understanding that it is your job to make the health care system work for you.

By and large, cancer doctors today understand that their role is to present information and advice. It is the patient's role to make the decision. 

Still, it is your body and your decision who you want to make medical decisions. If you don't want to make the decisions, you can ask the doctor to. Or you can appoint a person to make medical decisions for you. In legal language, such a person is called a "Health Care Power of Attorney" or "Proxy."

NOTE: You can continue to have control over medical decisions even if you become unable to communicate through legal documents known together as "Advance Directives." A Living Will is the advance directive we hear about most often.

Before deciding on a treatment, consider getting a second opinion. Understand the pros and cons of each possibility.

Second Opinions

It never hurts to get a second opinion, particularly if you have a rare condition or an unusual situation. Treatment is not generally one size fits all. Second opinions have become so standard that doctors are not offended when patients ask for second opinions. (If a doctor objects to your getting a second opinion, it is a valid reason to change doctors). 
 
Insurance companies generally pay for second and even third opinions. Check with your insurer before getting the opinion so you will know how much the opinion will cost. If you have to pay, you can negotiate the fee and a payment schedule.) 

Ideally the second opinion will come from a doctor experienced with your condition who is not in any way related to the doctor who gave you the first opinion. 

If you have difficulty getting the appointment with another doctor, ask your doctor's office to help. 

If the two opinions differ, don't accept the second opinion just because it is the last one you received. Perhaps the two doctors can come up with a joint recommendation if they talk. Otherwise, continue to get opinions and do research until you are comfortable making a decision.

Don't let a search for certainty provide a reason for stalling making a decision. 

To learn more about second opinions, including how to find a specialist, see the document in "To Learn More." 

 
Informed Consent

To be an educated consumer, you need to know what treatments are available and the advantages and disadvantages of each. Your doctor will describe the various treatments available and make a recommendation. (If you were diagnosed with an advance stage of cancer, or your situation is unusual, you may want to do additional research. See our information about this situation.)

Once you have the information you need, It is then up to you to decide which treatment to take depending on your particular values and goals. It is your body. The final decision is yours. For example, if you are in a critical period at work, you may want a treatment which interferes with your work ability the least.

The American Cancer Society describes the various treatments available at: www.cancer.org/doctoot/ETO/ETO_1.asp offsite link. The various types of chemotherapy, with a description of the therapy and side effects, is located at: http://www.cancer.org/docroot/CDG/cdg_0.asp offsite link. Survivorship A to Z provides information about how to deal with each side effect. (Please see our general article about Side Effects and click on the one(s) in which you are interested.)

Treatment decision tools for each type of cancer are available through the American Cancer Society at www.cancer.org/doctoot/ETO/ETO_1_1a.asp offsite link

Survivorship A to Z provides a tool that helps you to compare treatments side by side so that you can evaluate which works best for your lifestyle and values. Please see the link in "To Learn More."

If there are no standard treatments available for your situation, consider joining a clinical trial. There may also be protocols to explore in foreign, developed countries. Watch out for fraudulent treatments. (Please see "To Learn More.")

NOTE: If you want to share what you learn about your cancer and treatment(s) with family and friends, consider using the American Cancer Society Circle of Sharing offsite link

Think of non-traditional treatments as complementary or in addition to - not instead of what your doctor has to offer.

So called "alternative" or "complementary" treatments should only be considered in addition to medical treatments. 

For information about each therapy and what medical evidence indicates with respect to cancer, see American Cancer Society Complete Guide To Complementary & Alternative Cancer Therapies $24.95 including shipping.

Discuss any complementary treatments you are considering with your doctor before starting them.

NOTE: If existing treatments are not adequate, cutting edge treatments are available through clinical trials. There may also be treatments in use in other countries that may be of interest.

Decide who to tell about your condition, when, and how much to tell.

Whether to tell people about your condition, when to tell them, and what to tell, depends on the situation and why you are thinking of disclosing the information. The decision is a purely personal one. There is no right and wrong.

In general, there are four situations which give rise to this question. What you decide to do may vary in each situation.  The four situations are:

  • Family, Friends and Acquaintances
  • Children
  • The professionals in your life
  • Work

In each situation, consider:

  • The pros and cons of telling.
  • Preparing before you tell.

There are two givens:

  • Keeping a secret is stressful. The greater the secret, the greater the stress.
  • There is no going back once you tell. As they say: "The cat's out of the bag."

All the literature suggests telling children who live with you. They'll know something is wrong and assume it's their fault.

We strongly encourage telling unless there is an overriding reason not to. Stress hurts the immune system. The immune system is needed to help your body function at its best disease fighting capacity.


Think of family and friends as part of your health care team. Ask them for help when you need it. Your health needs should come first, but also consider theirs. If you have underage children, tell them about your diagnosis in an age appropriate manner.

Your team

Start thinking about the appropriate people around you as part of your team, just as doctors and other professionals are part of your team. Each member can provide his or her knowledge, advice and support. 

Who is actually involved with you and your health care, and to what degree, is up to you. You don't have to accept help just because it is offered.

Likewise, you can set limits on peoples' participation in your experience. For example, only spend time with people who are positive and supportive.

Expect that people will let you know when they hear stories about other people with your type of cancer or who have undergone the treatment you decide to take. This information can be overwhelming and not helpful. Feel free to let people know what you do or do not want them to pass on to you. Check any information you do learn with your doctor.

Ask for the help you need

Don't wait to ask for help until the burden gets too great or you reach a breaking point. You don't need to be Superman or Wonder Woman and try to deal with everything you did before your diagnosis as well as everything that comes along with a diagnosis. There will be times when you will need help either doing everyday tasks such as grocery shopping, child care, or matters directly related to your health such as bathing, accompanying you to doctor appointments or acting as a patient advocate if you enter a hospital.

Make a list of your chores and responsibilities that you can't handle right now. Divide them up among your team.

Consider a tip from Jeannette, a cancer survivor: she appointed a friend to coordinate her family and friends for her. It took away the burden. It was also helpful to her team members because they could more easily say "no" when they had to.

If you need Medicaid (Medi-cal in California) and have too many assets, consider entering into a caregiver contract with a family member or friend. Such a contract is a legal way of reducing your assets. We have an article concerning Caregiver Contracts noted in "To Learn More." 

Ask someone to go with you to important meetings

It is helpful to have a family member or friend attend all important meetings with doctors. Until treatment starts, that is basically every meeting. Such a person can help in a batch of ways, including helping ask questions, help you to recall what was said, and to help relieve anxiety.  We also recommend that you take  digital or tape recorder to each session, but you'll learn about tips like that in our content about maximizing your time with a doctor. See "To Learn More."

Think about their needs as well as your own.

A diagnosis affects everyone around you. Your needs come first, but theirs should not be ignored.

Just as you need to share your emotions, they should keep talking with one another. Talking keeps mole hill size difficulties from erupting in to mountain size problems.

Relax family rules to fit the situation

For example, meals could be eaten on paper plates with throw away plastic utensils. Chores that don't need to be done right away can be postponed.

Tell your children

If you have children, tell them about your diagnosis. Tell each child in a manner that is appropriate for his or her age. Children will know something is happening and will likely assume it is their fault if they are not told.

Non-medical professionals in your life

Tell your insurance broker, lawyer, accountant and other non-medical professionals in your life about your diagnosis. They may have suggestions about how it affects specific situations you face and how to best deal with them.

If you work, whether you are an employee, business owner, or self employed, be cautious telling about your diagnosis right away. There is no legal obligation to tell. Consider taking some time to focus on your condition first.

You don't have to make a decision right now about whether or not to disclose your health condition to your employer or co-workers. For now, just tell the supervisor or person in HR who needs to know what they need to know to let you have the time you need.

If you need to disclose your condition, talk with a supervisor in human resources. Remind him or her that you expect this information to remain confidential -- at least until you have a chance to decide who you want to tell and when.

Keep in mind that what you tell co-workers is not confidential information.

Look for an advisor at work who has been with the company long enough to know the way people with your diagnosis are treated. She or he can help guide you through the potential minefield. An advisor should be someone you trust not to disclose what you tell.

If you need a change because of your health condition or treatment to enable you to do your job, read our article on accommodations to learn how to get what you need.

Share your emotions. Watch for depression. Consider seeking counseling. Keep busy while waiting for test results. You may also want to consider getting a pet if you don't have one (yes, a pet).

Let the people closest to you know when you are experiencing stress and fear. Talking helps. As we've already seen, your emotions may be all over the place due to the stress of dealing with the issues at hand as well as the unknown. 

Do what you can to relieve the stress. For example:

  • Define your fears. If you define your fears specifically, you can come up with solutions to each of them so that so you don't feel so powerless and overwhelmed by them.
  • Eat foods that are comfort food for you, even if they're not the healthiest.
  • Start doing things to make you feel in control or that help you feel centered. For instance, think of a small project you can start and finish quickly.

Waiting for test results can be agonizing. There are time tested ideas that can help you get through this period. For instance, keep busy. Take advantage of your support systems. If you need help sleeping, get it. Use relaxation techniques. Exercise.

If you get stuck in a down mode:

  • Talk with your doctor. He or she may prescribe anti-depressant or anti-anxiety medications. AND
  • Consider seeking professional counseling. Counseling is for anyone who wants to sort out what they're feeling. Counseling is usually done in person. If that is not possible, you can arrange for therapy on the telephone, or even on line. If your insurance doesn't pay for counseling, many therapists work on a sliding scale and charge according to your means. 

Last, but not least, consider getting a pet. Pets are not a substitute for communicating with other people in a similar situation, support groups or therapists. However, they are good for emotional health and have been shown to increase longevity. The pet doesn't have to be a dog or a cat, and it doesn't have to be an attention requiring puppy or kitten. If you have a landlord who prohibits pets, you may be able to have one as an accommodation under the Americans With Disabilities Act. Survivorship A to Z provides advice about how to live with a pet including how not to get any kind of infection from them. Please see "To Learn More."

Start looking at your insurance and financial situation to determine how you will pay for medical care. Even with health insurance, medical care can be costly. Free or low cost care is available if you are uninsured or underinsured.

If you have health insurance:

  • Do whatever is necessary to keep it. Health insurance is vitally important.
  • Learn what your health insurance does and does not cover, whether you are restricted to a group of doctors or hospitals or have a broader choice, and what needs prior approval, if anything.
  • Learn how to maximize use of your health insurance.
  • Keep in mind: if you don't get what you want from your insurer you should look for a source of influence that can help. (For example, the person in HR who negotiated the company's contract, or a caring case manager at the insurer). If that doesn't work: appeal - and appeal again. Be persistent. If appeals don't work, think about pressure you can apply on the insurer - such as through the state Insurance Commission or through the press. (We tell you how to frame your story to get press attention in the document listed in "To Learn More.")

If you don't have health insurance, there are still ways to access health care. Keep in mind that all medical bills are negotiable. 

If you have too many assets or income to qualify for Medicaid (Medi-cal in California), it may still be possible to qualify.

If you have to pay for your care, consider traveling outside the U.S. for good quality care at a lower price. This is known as "Medical Tourism."

NOTE:

  • Experience indicates that people who take the attitude "I'm going to die, so I'm going to blow through all my money now", generally live to regret it. Even with the most dire diagnosis, someone survives.
  • If finances of any type are an issue, Survivorship A to Z provides financial planning information that will help you maximize your resources. We also have tips for dealing with a financial crunch. 
     

Attend to your financial basics. Pay your rent or mortgage and minimums on your credit card. Start keeping track of all medical services you receive and expenses you pay. Don't pay a medical bill just because you receive one.

Whether you pay your rent, mortgage and credit cards on time affects your credit rating. In turn, your credit rating will determine how much money you can borrow and at what price if you need money. You may need money to pay for your medical expenses or to keep your lifestyle. Credit rating also impacts areas of life such as automobile insurance premiums. Do what you can to protect and improve it.

Don't let any insurance policy lapse for non-payment. The last thing you need at this point is a large economic loss that could have been insured against.

When you keep track of medical expenses, include the cost of getting to and from doctors. Medical expenses may be deductible for tax purposes.

Also keep track of the medical services you receive.

  • If you pay the bills, you'll want to know what services were received.
  • If an insurer pays the bills, it's important to keep track so the insurer doesn't pay for services not received.
  • Medical bills may be deductible from your Adjusted Gross Income for income tax purposes. They may be deductible for a family member or friend who pays them for you.

Don't pay a medical bill just because you receive it. Many health care providers send insureds bills even if the amount is covered by insurance. Check the bill to be sure:

  • That the service was received AND
  • That you owe it instead of the insurance company. 
  • If you owe a bill, you can likely negotiate the amount due.

Tell your personal lawyer, accountant and financial adviser about your illness. The more they know about you, the more they can help.

Financial assistance may be available if needed.

A variety of government and private programs provide financial assistance. Resources for practical needs are also available. For more information, see National Cancer Institute's Financial Assistance And Other Resources For People With Cancer offsite link.

Assistance with drugs may be available. 

Also, learn how to save money when purchasing drugs. For instance, tell your doctor that finances are a problem and ask for the drug that accomplishes the purpose with the least cost. The doctor may prescribe an older, less expensive version of the drug that does the same thing as the newer, more expensive one. There are also less costly generic versions of many drugs. Generics contain the same ingredients but doesn't have a brand name. When thinking about cost, include the cost of tests that may be required with a particular drug.

Learn to be wise about purchasing, living with, storing and disposing of drugs. Free drugs may be available.

Before agreeing to take any drug, consider the pros and cons, as well as the alternatives. Keep in mind that all drugs have risks.  The longer a drug has been on the market, the more that is known about its effect (both good and bad).

Even if you have health insurance, it is in your interest to purchase drugs for the least price. Also consider other factors such as convenience and what happens if you need an emergency supply.

Drugs which are prescribed for purposes other than those which have been approved by the FDA are known as being used for "off label" use. If an insurer refuses to pay, appeal with your doctor's help.

Take each drug as directed, when you are supposed to, and for as long as you are supposed to.

For drugs that you take on a long term basis, talk to your doctor about finding out if a lesser dose will accomplish the purpose.

Learn how to safely store drugs, and to dispose of unused drugs.

Drugs and treatments do not work in a vacuum. Start to think of the food you eat, the exercise you get, rest/sleep and even proper care of your mouth as steps you can take to make treatments and drugs most effective.

Proper food, exercise and rest can help get your body into its best fighting condition. Dental health also counts. (Mounting evidence indicates that poor oral care can worsen serious medical problems).

This may be a time when you want to reach for what you think of as your comfort foods - the foods that make you feel better when you're down. If that's what you need to help get you through this period, then go for it. Once you've made a decision about which treatment  to take, keep your comfort foods for once in a while (say once a week). The goal is to eliminate unhealthy foods, or keep them to a bare minimum.

Remember, having a pet of any kind can help with both emotional and physical health.

Speak with other people who are going through what you are.

You are not alone. Experience shows that there is nothing quite like speaking with another person who is going through the same thing that you are. In addition to support, people who have been in your situation are a good source of practical information.  If there is no one nearby, you can make contact with people anywhere in the country over the internet or on the telephone.

Your local or national cancer organization can connect you with someone going through a similar situation or with someone who has been there either through a support group and/or with an individual (a "buddy".) You can make connections through your specialist, a social worker or your national or local disease specific nonprofit organization.

If you have underage children, tell them about your diagnosis in an age appropriate manner. Monitor their behavior. Arrange for their care in case something happens to you.

Tell your children

If you have children, tell them about your diagnosis. Tell each child in a manner that is appropriate for his or her age and personality. Children will know something is happening and will likely assume it is their fault if they are not told. How to tell children of different ages is described in the article noted in "To Learn More."

Monitor your children's behavior

It is likely that their reaction will show up in behavior instead of words or tears. Common reactions are described in the article in "To Learn More."

If your children are in school

Make your child's school aware of what is going on.

Ask to be contacted if your child's schoolwork begins to suffer or if there is a change in the child's behavior.

Arrange for their care.

It is never too soon to start arranging for a child's temporary care during your treatment. It also prudent to make contingency arrangements in case something happens to you and to the child's other parent.

Schedule a dental check up.

An infection in your mouth can lower your body's ability to fight your health condition.

Have your teeth cleaned and checked. This is a good time to eliminate cavities, abscesses or gum disease. If you have a problem with dentures, this is a good time to fix them.

If you are going to undergo chemotherapy, learn the steps to take to during chemo to minimize oral side effects from the treatment.

To Learn More

More Information

Oral Care

If you want to have children, take steps to preserve your ability prior to starting chemotherapy or radiation.

You may lose your ability to have children because of a chemotherapy treatment and/or radiation. Speak with your cancer doctor if this is of concern.

It is possible to protect your fertility prior to commencement of treatment.

To Learn More

IF YOUR DIAGNOSIS IS AN ADVANCED STAGE OF CANCER OR AN UNUSUAL OR A RARE CANCER


Advanced cancer is cancer that has grown beyond the organ where it first started. Sometimes cancer that has not spread is considered locally advanced if it is affecting a vital organ and cannot be removed.
If your diagnosis is an advanced stage of cancer or an unusual or a rare cancer:
  • Consider getting a second opinion about your diagnosis and proposed treatment from a National Cancer Institute (NCI) certified Comprehensive Cancer Center.
    • You can locate an NCI center at: https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=1,2 
    • If you can't travel to such a facility, you can have the necessary information sent by an overnight carrier or regular post. Free air transportation is available.  
    • Once you decide on a treatment, it can be administered by your cancer doctor close to home.
  • If there are no mainstream medical treatments available, find out what new treatments are being investigated in clinical trials.Clinical trials are cutting edge medicine. If there are no promising treatments in the United States, research whether there are useful treatments abroad. Learn how to spot a phony treatment. 
  • If you may need to stop work:
    • Learn about the disability income sources to which you may be entitled. Check benefits at work. Look at the requirements for obtaining Social Security Disability Insurance (SSDI). You paid premiums from withholding. See if you qualify for Supplemental Security Income (SSI).
    • If you are going to apply for Social Security Disability Insurance (SSDI): Only one third of applicants for SSDI are awarded an income. Survivorship A to Z provides easy-to-use information for applying as an educated consumer that makes it more likely to get a "yes."
    • Check your employer provided life insurance and retirement plans to be sure the beneficiaries are the people you want. 
    • If you have health insurance through work and will continue coverage through a COBRA type law, start thinking about how to pay for the premium.
  • Much of what used to be done in a hospital can now be done at home thanks to nurses and doctors (yes, doctors) who go to your home. You can hire home health aides through a service or on your own. An increasing amount of medical equipment is available for home use. Must of the cost of home care is covered by health insurance.
  • Get your legal affairs in order. (We call the subject "Planning Ahead"). Please do not assume from this recommendation that we are suggesting you are going to die sometime soon. What will happen depends on many factors, including the type of cancer, your physical condition and your access to quality cancer care. However, it is better to be safe than sorry. And what we are suggesting is what we suggest to everyone - including people with no health condition. Life is fragile. 

ONCE A TREATMENT DECISION IS MADE

Once a treatment decision is made, it is time to start thinking about the practical aspects of the treatment so that you do not have to catch up on things you could have taken care of when you were feeling better while at the same time dealing with the treatment.. For instance:
  • If you are going to have surgery:
    • Start by finding a board certified surgeon who is experienced in the surgery you need.
    • Learn how to choose a hospital, how to maximize your stay in a hospital and how to minimize risk of infection. One of the things that you will learn from out documents noted in "To Learn More" is that you should try to have a family member or friend be with you as much as possible to act as a patient advocate.  
    • Find out what you should and should not be doing prior to surgery.
  • If you are going to have chemotherapy or radiation:
    • Reduce anxiety by learning about your cancer and the treatment.
    • Express your feelings. Don't keep them bottled up.
    • Try to keep your vision on the half full side of the glass. Fear and anxiety can make it difficult. Keep in mind that at least one person survives every illness. There is no reason that person won't be you.
    • If you are going to undergo chemotherapy and are at risk for losing your hair, decide if you will want to wear a wig. If so, now is the time to get one to match your hair. Free and low cost wigs are available.
    • Think about how you are going to get to and from appointments. If needed, American Cancer Society can help arrange transportation. Call 800.ACS.2345
    • Learn about changes to start making in your diet to build your system with nutrients that the treatment may diminish. Perhaps you should also be taking a multi-vitamin and/or supplements.
    • Stock up on your comfort foods, including some in your freezer that you can defrost as needed. When you freeze foods for this period, make the portions smaller than usual for those occasions when you don't feel like eating a lot.
  • Think about who will take care of your children while you are in treatment and during any recovery period(s).
  • What changes will be needed at work to accommodate the treatment schedule. (If changes are needed, you can negotiate for them. Changes in this situation are known as an "accommodation.") 
  • How will bills be paid if you aren't feeling well enough to attend to them? This is not the time for your health insurance to be cancelled for lack of payment, or for your mortgage to go into default or to be behind in your rent if you can avoid it.  (Family members or friends can pay bills for you. If none are available, you can hire a professional.)