Navigating The Legal Maze of Cancer

There are over 12 million cancer survivors in the United States.  As cancer treatments have improved, increased attention is being paid to the field of cancer survivorship.  What do survivors need? How can we support them?

A 2005 report by the Institute of Medicine, “From Cancer Patient to Cancer Survivor: Lost in Transition,” recognized that employment, insurance, and financial issues should be addressed in order to improve the quality of life of cancer survivors.   

When people hear the dreaded words, “you have cancer,” the last thing, if at all, people think about are the legal issues that they may face because of their diagnosis.   

Many of those people are unaware of their rights and the resources available to assist them through the vast maze of legal, employment, and insurance systems.  And most of those individuals are completely unaware of the financial impact that cancer may have on their lives.

Take Paul, for instance.  Paul is 35 and has been working his way up the ranks at ABC Company for ten years, since graduating from business school at the top of his class.  He was married three years ago, had his first child two years ago, and bought his first home last year. 

Paul has just learned, after an annual visit to the doctor, that he has a thyroid cancer.

Paul’s diagnosis sends him reeling down a path in a maze of cancer-related legal issues.  As the maze twists and turns, Paul knows that he can’t take a wrong turn, or he may lose his job, his insurance, or even his home.  Overwhelmed by decisions that need to be made and deadlines that need to be met, Paul now has to inch his way down the road in front of him, trying to figure out  . . .

·         Can he continue working through treatment, or if he will need to take time off work? 

·         Can he get a reasonable accommodation to help him continue to work through his treatment? 

·         If he takes time off, does he have to disclose his diagnosis to his employer?  

·         What are his company policies? 

·         Will his job be protected?

·         Will any period of leave be paid or unpaid?

·         If he does take time off or loses his job, can he keep his health or life insurance coverage? 

·         If he does lose his health insurance coverage through his employer, what are his other options for health insurance coverage now that he has a pre-existing medical condition?

·         Does he qualify for state or federal disability insurance benefits to maintain his income? 

·         How will he be able to pay his bills or take care of his family? 

·         What if he becomes unable to make health care or financial decisions for himself?

The list of questions goes on and on.  At each turn in the maze another question/issue/potential problem arises for Paul and he isn’t sure where to turn for help. 

Fortunately for Paul, and the millions of other cancer survivors like him, there are organizations and agencies stationed out there in the maze that can help him find his way. 

Nonprofit organizations such as the Cancer Legal Resource Center (CLRC) (www.cancerlegalresourcecenter.org) can help people understand their options and rights.  The CLRC provides a national Telephone Assistance Line (866-843-2572) where people can get free information and resources to address their cancer-related legal issues, including navigating the legal issues in the workplace.

Cancer and Careers (www.cancerandcareers.org) is another nonprofit organization that specifically focuses on the practical issues related to work and cancer, including disclosure, balancing cancer and careers while working through treatment, and free online job search tools and career coaching for those seeking employment.

In order to help people figure out what health insurance options are available to them based on their specific situation, the U.S. Department of Health & Human Services has created a new online portal, www.Healthcare.gov.  This website was created under the Patient Protection and Affordable Care Act (health care reform) and provides information about specific health insurance options as well as information about recent health care reforms.

Cancer can be a life-altering experience.  But arming oneself with information about legal rights and options can help slay any dragons that may be hiding in the maze of cancer-related legal issues. 

Joanna L. Morales, Esq. has served the cancer community as a cancer rights attorney, advocate, speaker, and author for over 18 years.  She is currently Principal at North Star Alliances, a nonprofit and business consulting firm.  She was formerly the Director of the Cancer Legal Resource Center and an Adjunct Professor at Loyola Law School, teaching cancer rights law.  She can be followed on Twitter @CancerRights.

Cancer Connect Episode 6

Cancer Connect reunites with Julie Grimm after the ONS Conference in New Orleans. Julie tells us WHY it is so important to have a planner when first diagnosed and HOW her planner will not only keep you organized, but act as your comfort blanket and friend during this uncertain time.

Julie Grimm is a breast cancer and brain tumor survivor and knows first hand the feelings and emotional state the flood a patient's mind and body when newly diagnosed. Inspirational and motivational, Julie is a great person with an amazing product!

Milk and Cancer

Dear Dr. Bone,

Is it true that there is a difference in the risk for cancer if you drink whole milk instead of skim or 2%? My friends and I were discussing it at lunch. I thought the benefits of lower fat were all related to heart disease, but they say that whole milk also contributes to cancer. Who is right?

D.L.

Dear D.L.

The relationship between milk and cancer is complex. Countries whose inhabitants do not consume much milk seem to have lower incidences of certain cancers. For example, in Japan and Mongolia there is less breast cancer than in the United States. One of the reasons posited for this phenomenon is the presence of hormones in milk. In order for cows to produce more milk they are kept pregnant for prolonged periods of time. Milk from pregnant cows naturally has a higher estrogen content. Farmers also inject the cows with hormones. One in particular, recombinant Bovine Growth Hormone (rBGH), results in milk that contains higher amounts of Insulin-like Growth Factor, known as IGF-1. IGF-1 can be absorbed from the milk and stimulate cancer cells. Since hormones in milk are fat soluble, it would seem safer to drink low fat milk. On the other hand, conjugated linoleic acid, a natural anti-cancer molecule, is found at its highest concentration in whole milk as is calcium, a necessary building block for our bones.

The popular book called The China Study looks into the relationship between diet and cancer. I have many friends who became vegan after reading it because they were convinced that dairy consumption can be dangerous, not just for cancer, but for heart disease and other ailments too. A moderate by nature, I suggest that each person find their comfort level after assessing the data. It is unlikely that an occasional glass of milk or ice cream will cause cancer, but dietary modifications along with exercise, decreasing alcohol consumption, and controlling stress, should results in a longer, healthier life.

~ Dr. Bone

Chicken Nuggets

Dear Dr. Bone,

My mother hates it when I eat McDonald’s food. She says that the chicken nuggets are loaded with chemicals. Would I be more likely to get cancer from eating too many chicken nuggets? If so, what kind of cancer?

Junk Food Junkie 

Dear Junk Food Junkie,

Hard question to answer. I won’t single out one fast food chain. Most chicken nuggets bought at a fast food restaurant are made with combinations of chicken meat and what are called by-products. These are other parts of the chicken including the tendons that attach muscles to bones. They grind the meat into a paste and add food starch, dextrose, and other flavorings. There is no documented evidence that the contents of nuggets cause cancer and it is highly unlikely that eating nuggets now and again will cause cancer. However, a diet rich in vegetables and fruits will help to prevent cancer. So, if you are going to eat chicken nuggets and fries, you’d be smart to order the apple slices or carrot sticks to go along with them!!!

Dr. Bone

Juicing and Cancer

Dear Dr. Bone,

I just read an article about the power of juicing and a raw diet to prevent cancer. What do you think?

Health Nut

Dear Health Nut,

I am so happy that bring up prevention as a topic. Cetainly we wouldn’t need to work so hard on treating cancer if we could prevent it in the first place! I may sound like a broken record, but cancer is not just one disease. If it were, then we could probably come up with the right way to prevent it. Instead, there are so many reasons people get cancer, that no one behavior will guarantee that you won’t get cancer. Eating organic, or raw, or juicing is a healthy thing to do because you get the recommended daily intake of various fruits and vegetables. Whether those choices really prevent cancer has not been proven. My personal opinion is that moderation and personal happiness is the key. That would translate to some raw, some cooked. Juicing, but not necessarily every day. Red meat on occasion, but not as a staple.  I applaud people who take an interest in their food choices because they usually exercise and maintain their weight as well – both of which seem to be correlated with a lower risk of many diseases including cancer.

Dr. Bone

Convincing A Friend To Quit Smoking

Dear D. Bone,

I know this is not exactly a question about cancer, but I thought you might help. My sister died of lung cancer after smoking for 40 years. My nephew is now a grown man with children. He smokes like a chimney! He watched his mother die but won’t quit. Is there anything that can be done to convince him that he needs to stop smoking now?

Frustrated

Dear Frustrated,

It is hard to believe that someone who has watched a loved one die of a smoking related cancer still smokes themselves. Remember, smoking is an addiction, and a lesson learned from Alcoholics Anonymous is that you cannot change a person who is addicted. They must want to change themselves. All you can do is love and support them. His own family can make rules that he cannot smoke inside the house because of the risk of exposure to second-hand smoke, but more aggressive intervention will probably not work. Until he is ready to quit smoking, any nagging, warning, prodding, or begging is in vain. I suggest that you simply make him aware that you are available if that time should arrive. Then, there are medications, support groups, hypnotism, laser, acupuncture, etc. to make it easier.

By the way, for those of you inclined to quit smoking, there is an urban legend that for each year you quit smoking, your risk of lung cancer goes down. Unfortunately, former smokers make up a considerable portion of lung cancer patients. The risk remains high for a very long time. Please, please use that as motivation to quit NOW.

Dr. Bone

Elective Second Mastectomy

Dear Dr. Bone,

I just celebrated 5 years out from my breast cancer. I had a mastectomy and implant reconstruction with a matching augmentation implant to the other side for symmetry. This week I had a suspicious mammogram on my remaining real breast. I am a wreck waiting for the biopsy. I don’t think I can go through it all again. Do you think the surgeon would be wiling to remove my breast regardless of the biopsy result? I think it will be the only way I will sleep peacefully.

Anxiously waiting,
Jupiter

Dear Anxious,

If only I had a penny for every patient in your shoes...Your situation is not unusual. There is no question that the prospect of having another cancer is almost unthinkable. The good news is that statistically it should not be a cancer. My advice is to take it one day at a time and not try to predict your reaction ahead of time. If you wish to have a mastectomy regardless of the biopsy results, you should discuss it with the surgeon. As I have mentioned many times, I have never heard a woman regret that she had bilateral mastectomies, only that she didn’t! If your insurance company does not feel that it is a procedure they want to pay for, you will need to address that issue. The cost-benefit analysis would seem to fall in favor of the surgery over years of imaging with follow-up extra views, sonograms, MRIs, and even biopsies. Should you get a second cancer, it would then be very costly for your insurer to pay for surgery, radiation therapy and/or chemotherapy. Having said all that, it can be tough to convince some insurance companies that they should pay for the prophylactic surgery.

Good luck.
Dr. Bone