Two years after undergoing a double mastectomy and chemotherapy so severe she was hospitalized in intensive care for several weeks, breast cancer survivor Denise Hicks should be following what her doctors call "the plan."

"I should be taking medication, I should be having tests and lab work," says the 51-year-old Californian. "But my choice is to pay virtually every cent I have to do that or be able to pay for my rent, food and gas."

Hicks has health insurance but already reached her coverage limits. So the CT scan that her oncologist "strongly advised" months ago to check a possible recurrence remains undone. "It would cost me $4,700 out of pocket—money I just can't afford." She's also skipping recommended medications. "One drug would cost me $167 a month and another is $200 a month," she says.

"So what am I doing? Well, I may soon be moving in with my 83-year-old mother, who lives in a trailer. But for now, I pray a lot," Hicks says.

Two million in limbo … and counting

Hick's disquieting predicament is not unique. At least 2 million Americans—roughly one in six cancer survivors—decide to forgo at least some of their recommended follow-up medical care because of the cost, according to recent research.

Like Hicks, who works as an emergency room nurse, "the vast majority of these cancer survivors have health insurance," says Kathryn Weaver of Wake Forest University Baptist Medical Center, who led the study. "But they still [may] have difficulties with high deductibles, copayments and other out-of-pocket costs."

Her findings, published in the medical journal Cancer, come after analyzing annual government surveys of more than 30,000 households from 2003 to 2006.

And those surveys were taken before the recent economic downturn and continued high unemployment.

These days, even more cancer survivors are believed to be skimping on, delaying or totally avoiding medical care because of money concerns.

Cancer has always been devastating to mind, body and finances. "But we're hearing more and more of these stories than we used to," says Anna McCourt, a supervisor at the National Cancer Information Center, a round-the-clock call center operated by the American Cancer Society (phone: 1-800-227-2345).

"People say they must choose between getting care or meeting daily living expenses—putting food on the table and paying their mortgages and utility bills," she says. "Because of out-of-pocket costs, they're avoiding tests they know they need, they're taking half doses of medication to make it last longer. But if you freeze because you can't afford heat this winter, cancer medication isn't going to be that helpful anyway."

Workplace woes

Although cancer survivors of all ages are doing without care because of costs, research indicates that those hardest hit are the men and women who were diagnosed before they are eligible for Medicare at age 65—and typically depend on employer health insurance. Blame it on a perfect storm of problems related to the workplace:

Increased cost, reduced benefits. "To keep rising premiums affordable, more employers are shifting costs to employees, resulting in a loss of benefits," explains Erin Moaratty of the Patient Advocate Foundation, which assists cancer patients and others facing medical debt crisis and other issues. "So if your $20 copay becomes a $40 copay and you need to see a doctor three times a week, it starts adding up—on top of your other expenses." Last year, the foundation saw a 15 percent increase in requests for help over 2008, "and more than 80 percent [of callers] were fully insured," says Moaratty.





Job loss. "A major issue is that many cancer survivors that were two-income households are now one-income households because of layoffs," adds McCourt. With fewer paychecks, cancer care takes a backseat.



