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Living with Breast Cancer: Practical and Financial Issues

Besides the emotional and physical effects, breast cancer often raises practical and financial concerns. While you are dealing with your breast cancer diagnosis and treatment, your normal activities will likely be disrupted and you may have to face new financial concerns.

Your experience with breast cancer may also lead you to think about your financial security and practical issues like health insurance, employment and daily commitments. You still have the same basic rights to employment, health care and financial security as any other Canadian resident. You have every reason to think about and plan for your future.

You may wish to ask friends and family members to help with the practical aspects of living with breast cancer. If you are your family's main caregiver, you may not be used to asking for help from others. Don't underestimate the willingness of the people around you to lend a hand.

The following information outlines some of the practical and financial issues you may face as you go through breast cancer treatment and beyond:

It may be helpful to review this information and make some advance arrangements, if possible, so that you are not trying to put things in place when you need the time and energy for your treatment. It may also be helpful to plan for the long term, when active breast cancer treatment ends.

Health Care Costs

Some medications and treatments for breast cancer may involve additional costs beyond those covered by your provincial or territorial health care plan. If you are eligible for extended coverage, such as health benefits from your employer or a partner’s employer, review your coverage and prepare any necessary paperwork.

If you do not have any benefits to cover the cost of drugs or other treatment expenses and are experiencing financial difficulties, you may wish to contact a social worker through the cancer centre where you are receiving treatment to review potential options for assistance.

Tax Deductions for Cancer Care Costs

You are entitled to income tax deductions for some of the expenses you will have during treatment. These include things like the cost of parking, travel, accommodation, meals and drugs. The expenses can be incurred by you or someone who comes with you to your appointments. Ask your health care team or a social worker at your cancer centre for information. You may also wish to contact the Canada Revenue Agency for details.

Ongoing Medical Expenses

Your ongoing cancer care may involve medical and drug costs that are not covered by your provincial or territorial health insurance plan. These may include prescriptions for pain relief, nausea, or other medications or creams for treating the effects of radiation therapyRadiation therapy:
(Sometimes called radiotherapy) A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.
.

You may be able to seek help for these costs from assistive device programs in your province or territory; private insurance through your employer or a partner’s employer; or federal programs. Speak to your health care team for information or a referral to a social worker for advice.

Prosthetics, Compression Garments, And Wigs

Some breast cancer treatments may cause both temporary and long-term changes in your body. You may want or need to use additional supports to help manage some of these changes, which can involve additional costs. These include items such as wigs or other head coverings to wear while you wait for your hair to grow back after chemotherapyChemotherapy:
A treatment method that uses medication to destroy cancer cells.
, compression sleeves to manage fluid build-up if you develop lymphedemaLymphedema:
A condition where lymph fluid (or tissue fluid) cannot easily get out of the arm and back into the circulation, resulting in swelling in part or all of the arm and hand. It can occur after breast cancer treatment following the surgical removal of lymph nodes from the underarm area or radiation treatment to this area.
, or a breast prosthesisProsthesis (breast):
An artificial breast form that looks like a breast and is worn either inside a bra or attached to the body with special adhesive.
or a post-mastectomyMastectomy:
Surgery to remove all or part of the breast and sometimes other tissue.
bra if you’ve had breast cancer surgery.

You may be able to seek help for the cost of prosthetics or compression garments from your provincial or territorial health insurance plan or assistive device program. Some private health insurance plans through your employer or a partner’s employer also cover these items if you have a doctor’s prescription.

Wigs and other head coverings are often not paid for by these plans and the cost can vary depending on the quality, size, length and other characteristics of the wig. Some cancer support organizations, such as the Canadian Cancer Society, help to provide financial assistance or access to these items at little or no cost. Speak to your health care team for information or a referral to a social worker for advice.

Employment

Lost Work Time and Income

The length of time you need to be off work will depend on your treatment plan. If you are being treated with surgery and/or radiation, the time you need off work may be short. If you are being treated with chemotherapy, this will take likely place over several months.

Common side effects prevent most people from working full-time during their cancer treatment. Speak to your health care team about how long your treatment will take and how you might feel during and after treatment.

You will also need to think about the physical and mental demands of your job. It may be possible for you to work part-time hours, change the hours you work or use flex time during your treatment. You may wish to speak with your employer about the options—and, if you have a benefit plan through your workplace, ask if there will be changes to it if your hours change.

If you are unable to work for an extended period and have coverage through employee benefits, review the terms for illness and disability benefits. In addition, the Canadian government offers financial assistance through the Employment Insurance program. Contact your local Employment and Social Development Canada office for details.

Returning To Employment

Issues to consider. You will want to think about the timing of your return to work (full-time or gradual) and the suitability and nature of your work, in terms of how you feel now. Consider the impact that any side effects you’re experiencing may have on your ability to work: physical side effects including limited mobility or fatigue; emotional side effects such as anxiety, fear or depression; and short-term cognitive (brain-related) side effects, such as lack of concentration or mental fatigue. You may find it helpful to seek support from your health care team, including getting a referral for counselling or occupational therapy to help you make the transition back to the workplace.

Self-employment. Self-employed workers face unique challenges during an illness like breast cancer. It is likely that your work has been disrupted, and you may have lost clients and contacts. You may also be facing financial challenges due to a loss of income and may have no private insurance to help you. Depending on your level of need, there are provincial/territorial programs that you may be eligible to access that can provide income and drug coverage. If you have paid into the Canada Pension Plan (CPP), you may also be eligible for the CPP disability benefit.

Dealing with co-workers’ reactions. People react differently to ill health. Some co-workers may fear that you are no longer healthy. Some may even worry that you are unable to do your share of the work. Keep in mind that some of your co-workers may not want to talk openly about your experience—or know how to ask you about it. Observe their reactions and use your judgment in responding. If you have a human resources staff person or department at your workplace, speak to them for support or suggestions on how to address your co-workers’ reactions.

Talking to your employer. If you have side effects that you think may affect your ability to do your job, you may wish to speak with your employer. The following tips may help:

  • Provide your employer with a note from your health care provider about your limitations and how long you may be affected by them

  • Work with your employer to set reasonable goals you know you can achieve

  • Explore your options: for example, a change in responsibilities, flexible hours or a gradual return to work

  • Find out about your company’s policies on sick leave, disability leave, flexible hours and work re-training options

Employment discrimination. Many employers are very supportive in accommodating employees who are facing a serious illness. Nevertheless, workplace issues are sometimes reported by women who return to work after their breast cancer treatment. These include demotion, denial of promotion, undesirable transfer, denial of benefits or hostility. These kinds of discrimination are often difficult to prove.

  • Seek support from your health care team. This may include referral for counselling to help you make the transition back to the workplace; referral to an occupational therapist to assess your work environment, your capabilities and the demands of your job; or a letter from your health care provider about your short-term and long-term health situation

  • Know your rights. Your employee rights are protected by provincial or territorial and federal laws. Find out about your employer’s procedures for settling employment issues

  • Keep written records of incidents at work. It can help to keep a written record of events as they happen. Also try to record positive comments as well as those you think are discriminatory

Finding a New Job

The same laws that protect Canadians against workplace discrimination also apply to the hiring of new employees.

  • On job applications and during interviews, employers may only ask job-related questions. They are not allowed to ask about medical history, but can ask for a medical certificate to prove your ability to perform the duties of the job

  • You may wish to provide your health care provider’s name as a reference or offer to provide a letter from them about your ability to work

  • Use your résumé to focus on your skills and experience. However, be prepared to explain any gaps in your employment history

 

Childcare and Housework

If you are responsible for childcare in your family, you may want to make other arrangements for times when you must attend treatment or are feeling unwell. How you are feeling during and after treatment may make it hard to keep up with household chores. Don’t put pressure on yourself to keep up with housework while you are undergoing breast cancer treatment. If this is important to you, however, you might want to arrange for help around the home.

Family, friends, and neighbours can be a big help with housework and childcare, and it may be more comforting for children to have a familiar face around.  Don’t be afraid to reach out for help. You may also have the option of paying for housekeeping and childcare services. In some areas, you may be able to access free home help, if you are eligible.

Obtaining Financial Assistance

 If your illness has resulted in loss of employment, and you have very little or no income and limited assets, you may be eligible for financial assistance through community resources or programs offered by your province, territory or the federal government. Speak to your health care provider about being referred to a social worker for advice about your options for financial assistance.

Life Insurance

In Canada, if you have had breast cancer, your pre-existing life insurance policy will be honoured for your lifetime if it is a whole-life policy and for the remaining amount of the term if it is a term (or temporary) policy.

Purchasing a new life insurance policy is a different matter. If you have been diagnosed with breast cancer, you will find that your eligibility for insurance policies (including life insurance or critical illness coverage) will be different from someone who has not had breast cancer.

You may find that you are offered a special class rate, often with an expensive monthly premium (payment) or that you are declined coverage. Find out if it would help your case if you provided more information.

To find the best package available, you may wish to work with an insurance broker. It will be important to make them fully aware of your health history, including your treatment for breast cancer.

Financial and Legal Planning

If you have a lawyer, financial advisor and/or tax accountant, you may wish to discuss the effects and implications of your illness on your finances and legal affairs. Other sources for advice on financial and legal issues may include friends and family with financial or legal expertise, or social workers at the hospital or cancer centre where you were treated.

If you are in debt and it is more than you can handle, speak directly to your creditors, mortgage holder or your landlord. You may also wish to ask a health care provider to refer you to a social worker for advice on your options and community resources available to you.

You will need to check with a lawyer if you write a will, make changes to your will or transfer any assets you may have. In addition to a will, there are other types of legal documents that you may want to consider having written up:

A living will is a legal document that outlines your wishes around the types of treatments and life-sustaining measures you want and don’t want to receive in case you are unable to let your health care team know yourself. Even if you have a living will, discussing your wishes with your family is important to ensure they are understood and respected.

A Power of Attorney (POA) is a legal document that appoints someone to make decisions on your behalf if you become unable to make those decisions yourself. A medical or health care power of attorney is different from one that makes decisions about your estate or finances. Choose someone you trust and discuss your wishes with them ahead of time so they can act in your best interest. Even if you have a living will, a medical power of attorney is still important since a living will can’t cover all possible medical situations.

In Canada, common-law and married same sex couples have the same legal rights as heterosexual couples. If you are unsure about your partner’s legal rights to making health care and financial decisions on your behalf, check with a lawyer.

When making practical and financial arrangements, speak to your health care team for a referral to supportive care services at your cancer centre and in your area.


Sources:

Canadian Cancer Society. Work and Finances. Accessed June 11, 2014

Canadian Cancer Society. Advance Directives. Accessed June 11, 2014.