Peter Cardy
As cancer care shifts out of hospital, more cancer patients risk poverty as the associated costs rise. Now is the time to tackle the financial distress of the disease, argues Peter Cardy

Peter Cardy
As cancer care shifts out of hospital, more cancer patients risk poverty as the associated costs rise. Now is the time to tackle the financial distress of the disease, argues Peter Cardy

At the Scotland Against Cancer conference last month, former chief medical officer Sir David Carter spoke of 'cancer poverty', neatly summing up the impact of cancer on personal finances that Macmillan has been trying to get the government to take seriously for over two years.

We have known the impact for almost a century: this charity started off giving small grants to cancer patients and families in financial distress. This year we will give over£8m to help with basics like heating and travel.

Cancer remains the most dreaded disease, and with justification. For most people the first shocked thoughts are about how long they have to live and how unpleasant the treatments are. Few immediately register that, although they have at least a 50 per cent chance of being alive in five years, they will lose a year or more of working and earning while their treatment proceeds. Almost a decade ago we set up the first of our network of cancer benefits advice services, modelled on a local service pioneered by Bradford Cancer Support, now backed by a national helpline.

The financial effect of cancer is shown in a recent UK-wide survey, which found that 91 per cent of patients' households suffer a loss of income or increased costs. And among patients under 55, seven out of 10 have an average fall in household income of 50 per cent. At the extremes some lose their homes or go bankrupt, with self-employed people especially vulnerable.

Shifting costs onto patients
The cancer plan aimed to increase survival, and it is succeeding. Advances in treatment and care mean that more people are living longer with cancer. Changes in the patterns of treatment to day cases and outpatients mean that more patients spend most of their disease trajectory trying to live a normal life away from hospitals.

However, the move from inpatient care also shifts payments onto the patient, especially in travel and parking costs. We found that on average, patients are paying£325 on travel and parking during treatment, though this ranges from zero to£10,000. This is at a time when personal finances are at their most vulnerable.

There seems little point in saving more lives only to condemn patients and carers to penury. Though talk of cancer becoming a chronic disease is still premature, the indications are that more cancers will be manageable at home in the near future. If that is to happen, the financial distress of cancer must also be tackled.

And it must be tackled too if other policies such as patient choice are not to be frustrated. Unless patients and their families can afford to travel to the chosen place for treatment, choice will simply further entrench inequalities and affect outcomes. The benefit system is administered by the Department for Work and Pensions, but unless people with cancer get information about benefits and other financial help early, while they are in the clinical pathway, they will continue to suffer needless financial damage.

A senior health policymaker recently commented to Macmillan that the NHS is not in the business of sorting out people's financial problems, while the DWP remains uncertain about its role in advice-giving to patients. With cancer incidence and survival both rising, cancer poverty will grow too without cross-departmental action; and that won't happen unless ministers show they want it.

Peter Cardy is chief executive of Macmillan Cancer Support.