Marginalized Cancer Patients: Burdens in Treatment

Authored By: Jizelle Dumayas Art By: Vanessa Chen Hsieh Melissa Taylor, a wife and mother of two children, lost her job due to crippling medical costs for routine procedures essential for monitoring and slowing her cancer’s progression. Facing the mental and emotional toll of dealing with cancer, Melissa’s life was falling apart. To add to this burden, the very healthcare system sworn to protect the health and safety of patients was failing her, refusing any form of care until she paid hundreds to even thousands of dollars out of pocket [1]. This intertwining of payment with care is disconcerting as it demonstrates that when immediate medical attention is needed, money is a key determinant in being ‘worthy of receiving care.’

What if you were faced with an impossible choice– survival coming at the cost of your job, your home, and food security? An individual’s economic status can make a stark difference when it comes to their survival in the face of cancer. Marginalized groups, specifically individuals from low-income households, face disparities that result in an excessive burden during cancer treatment and even care after remission.

According to Minas et al., socioeconomic status is a key determinant in cancer mortality [2]. Individuals who have neither the funds nor the resources for early cancer detection are faced with the scenario of receiving treatment at late, even terminal stages. Minas et al. highlight a dysfunctional healthcare system in which patients with private health insurance have greater benefits and prioritization than patients with Medicaid. These obstacles raise the question: is the mortality rate of cancer patients proportional to their socioeconomic status? In a world where money equates to power, opportunity, and prosperity, cancer patients are faced with the reality of having to make decisions not only about their health, but also the financial costs needed to receive care.

Even in the face of debilitating disease, healthcare access and treatment options are framed as a “luxury” due to their lack of affordability. The U.S. healthcare system has become a “conglomerate of monopolies” in which “... merged hospitals and powerful health systems have raised the price, lowered the quality and decreased the convenience of American medicine” [3]. This system scrutinizes priority of care even to cancer patients and stands as a healthcare injustice that violates basic human rights. The American Cancer Society provides statistical data supporting that income and social status are correlated to the hardship that patients and their families face over the course of treatment and even after being cured. Of the individuals with limited incomes, 63.6% reported worrying about paying for future medical bills in case they get sick or get into an accident, 22.2% reported delaying medical care due to cost in the past 12 months, and 36.1% experienced some level of food insecurity in the past 12 months [1]. This highlights the burden that cancer patients with low or limited income face. In addition to emotional distress, low-income cancer patients report having trouble covering essential costs outside of cancer treatment, like food, housing, etc. By receiving care, limited-income patients are often forced into the difficult decision of seeking care or paying for necessary expenses beyond their health.

Furthermore, patients with Medicaid go through a separate process, which delays urgent and critical treatments for cancer (i.e., getting approval to see different specialists, or undergo radiation/chemotherapy). Differences in treatment availability reveal a corrupt flaw of the health care system, in which even in the case of life and death, monetary gain is prioritized over the needs of patients. Studies that evaluated the associations between coverage disruptions and prevention or screening found that “between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis.” A common theme across these studies was the fact that “Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment” [4]. Putting these numbers into perspective, compared to those privately insured, Medicaid cancer patients were “2.2-2.5 times more likely…” to be diagnosed at late stages [5]. These numbers underscore a deep-rooted institutional issue that disserves socioeconomically disadvantaged individuals.

These ‘coverage disruptions’ push critical cancer treatments weeks and even months back. The reason for this delayed response is partly due to a process called prior authorization (PA). PA is not limited to patients on Medicaid, but since Medicaid covers a significant portion of medical costs, PA is strictly enforced “...to limit services in an effort to prevent unnecessary utilization and ensure quality of care” [6]. A study involving 178 cancer patients who had medical services regulated and distributed through prior authorization demonstrated a delay in their treatment process of at least 2 weeks or more [7].

Recently various states throughout the U.S. have worked to expand Medicaid coverage. Part of this expansion includes lowering the standards for Medicaid eligibility [5]. Although these improvements will make it easier to obtain Medicaid coverage, it is important to continuously focus on the populations susceptible to healthcare inequity.

Works Cited

1. The costs of cancer for people with limited incomes. American Cancer Society Cancer Action Network. (2025, February 19). https://www.fightcancer.org/policy-resources/costs-cancer-people-limited-incomes-0

2. Minas, T. Z., Kiely, M., Ajao, A., & Ambs, S. (2020). An overview of cancer health disparities: New approaches and insights and why they matter. Carcinogenesis, 42(1), 2–13. https://doi.org/10.1093/carcin/bgaa121

3. Pearl, R. (2023, January 16). U.S. Healthcare: A Conglomerate Of Monopolies. Forbes. https://www.forbes.com/sites/robertpearl/2023/01/16/us-healthcare-a-conglomerate-of-monopolies/

4. Yabroff, K. R., Reeder-Hayes, K., Zhao, J., Halpern, M. T., Lopez, A. M., Bernal-Mizrachi, L., Collier, A. B., Neuner, J., Phillips, J., Blackstock, W., & Patel, M. (2020). Health insurance coverage disruptions and cancer care and outcomes: Systematic Review of Published Research. JNCI: Journal of the National Cancer Institute, 112(7), 671–687. https://doi.org/10.1093/jnci/djaa048

5. Yabroff, K. R., Han, X., Nogueira, L., & Jemal, A. (2019). Medicaid Insurance Coverage Disruptions and Stage of Disease at Diagnosis Among Adolescent and Young Adult Cancer Patients. JNCI: Journal of the National Cancer Institute, 111(11), 1111–1113. https://doi.org/10.1093/jnci/djz046

6. Medicaid and CHIP Payment and Access Commission. (2024, August). Prior Authorization in Medicaid. MACPAC - Advising Congress on Medicaid and CHIP Policy. https://www.macpac.gov/wp-content/uploads/2024/08/Prior-Authorization-in-Medicaid.pdf

7. Chino, F., Baez, A., Elkins, I. B., Aviki, E. M., Ghazal, L. V., & Thom, B. (2023). The Patient Experience of Prior Authorization for Cancer Care. JAMA Network Open, 6(10). https://doi.org/10.1001/jamanetworkopen.2023.38182