American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Financial Health

He was intelligent, well dressed, and he had a family that he shared with me across his I-phone screen shortly after I explained that his prostate biopsy results confirmed his diagnosis of prostate cancer. His pathology returned as adenocarcinoma Gleason 4+4= 8 which was low volume but aggressive.

As a Urologist treating prostate cancer in a rural community this post biopsy discussion has become a common occurrence. Most patients are initially surprised by the confirmation of disease and when the biopsy results are low grade non-aggressive prostate cancer, I spend most of the consultation explaining that prostate cancer is extremely common and if surveilled or treated will not ultimately limit the patient’s life expectancy. I couldn’t recommend surveillance in his case and he would need additional testing.

When he returned after his MRI of the pelvis and bone scan there was no evidence of metastasis. After he visited the radiation oncologist he returned to my office. We reviewed the risks of surgery, his option for radiation as a primary treatment, what he should expect, and the need to convalesce post-surgery.

He laughed and said, “I’m sure I’ll be up and back to work way before that.” To which I replied sternly, “No, you will need time to heal. There are no exceptions.”

I joked with him that I would be counting on his wife to make sure of this. He glanced at his wife who was dabbing a slow stream of tears from her cheeks and he attempted to smile in her direction. I reached out to her and grasped her hand as I have so many times before and he consented to a Robotic Prostatectomy. Over the next few weeks he proceeded to cancel and reschedule the surgery four times. When I received the notification that his surgery had been reschedule again, I requested that he return for another visit. When he finally returned to my office I was professional but swift. I started out with a brief synopsis of his medical history and ended with an emphasis on the word aggressive.

“I just couldn’t do this month,” he spit back at me without an explanation nor an apology. His wife glanced down at the floor. Clearly, the rapport we had established eroded during the stint between visits. Nonplussed and bothered by his lack of concern I explained that I was worried, and he did have options. If he no longer wished to proceed with surgery the option for radiation was still available. When he still had no response, I asked him if he wanted to go for a second opinion. I used words like urgent and phrases like window of opportunity hoping to reconnect with him. After some time, he broke

“Listen, doc, I don’t care about my life just give me a few more months and I will let you remove anything that you want.” He leaned toward his wife for support and she reciprocated by pressing her palm onto his arm. I took a moment to adjust to the new tone of the room. He was not afraid of the surgery and he understood the risks. He needed to work, and he did not want to tell me or anyone that he was in danger of losing his home.

How had I missed this? This family did not appear to be in need, his children were in college, and this patient was employed. I had no reason to inquire about his financial health and I was not sure if he would qualify for assistance. What I did know was if he didn’t act soon his treatment options would change.

I went to our cancer liaison and was relieved to find out that he did meet the requirement for assistance of the Ascension Health Hospital System and the American Cancer Society. We were able to cover his mortgage payment and cover his living expenses during his convalescence period. In the end, he did well after surgery. I wish I could say that this experience was unique but the number of patients that are unable to take time off to care for themselves increases each day. I am sure that many people choose to delay or forgo treatment completely because of similar issues. Taking the time to access a patient’s financial health and advocate for assistance can have a tremendous impact on their care and possibly save their life.