In my interview with Lisa VanHoose last week, we discussed disparities in oncology patient populations. We touched on financial toxicity, but Lisa really got me thinking about how it affects our patients. Interestingly, this past week I saw an tweet about parking costs & oncology centers (tweet here; article here). This all really got me thinking: are we missing some VITAL info from our patients?
Consider this patient: My patient has metastatic breast cancer, obesity, & a few other comorbidities. She is on disability due to her ongoing cancer treatments & inability to work regularly with her multiple medical appointments. She presented with RUE lymphedema, pain, & weakness. Her biggest complaints include grasping, opening items, & chopping her veggies. Okay, seems straightforward enough; however, we began a conversation about her desire to eat more healthily & lose weight. Things became much more clear.
Due to her pain, weakness, & swelling, she is unable to chop celery when cooking for herself. Thus, she has to buy pre-chopped celery, which is more expensive than typical stalk celery. Due to the additional expenses & increased difficulty of chopping her veggies, she has to navigate trying to eat well, preparing her own food, on a very limited budget. Below I’ve broken down this case example by the numbers:
| Stalk Celery | Chopped Celery | ||||
| Cost per buy: | $1.32 (16 ounces) | $3.79 (7 ounces) | |||
| Cost per ounce: | $0.08 | $0.54 |
So that’s a pretty significant difference in cost per ounce. But what does that translate to over the course of a year? (For this patient example, I’m doing my math based on her buying celery once every 2 weeks.)
| Stalk Celery | Chopped Celery | ||
| Cost per buy (every 2 weeks) | $1.32 | $3.79 | |
| Monthly cost (2 buys) | $2.64 | $7.58 | |
| Yearly cost (26 buys) | $34.32 | $98.54 |
For us who have a steady source of income, this can be hard to conceptualize. Let’s dive deeper: A typical American will spend 11% of their monthly budget on food (whether that’s groceries or eating out). We know that people living with cancer are not “average,” but for our purposes, let’s use 11% of monthly budget for food.
Disability income per month tends to range from $800-1800 per month in the US. If we use the higher end ($1800), 11% of my patient’s monthly budget is $198 for food. This doesn’t leave much room for luxuries, like pre-chopped celery.
But it’s not just celery. If she can’t cut celery, she may not be able to cut onions, broccoli, carrots, beets, peppers, or a myriad of other healthy foods that she wants to eat. So this problem of not being able to chop celery becomes very problematic & EXPENSIVE. Before you know it, our patients are spending 3-4x as much on groceries, or worse: relying on take-out for its convenience.
This is a deep issue & not one we are going to fix today. But with baby steps, we can do our part to help our patients achieve their goals. How you can do that is this: have the conversation. Ask about finances. Talk to your patients about what may be sabotaging their success. If you don’t, you are actively working against your plan of care & potentially sabotaging your patient’s success.