Recommendation 1

Provide assistance with understanding what is covered under insurance and how to navigate changes when switching to a new insurance provider.

Recommendation 2

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Ensure high‐quality insurance that covers required and elective cancer‐related services with low copays, premiums, and deductibles.

Recommendation 3

Expand insurance coverage for lymphedema‐specific materials and lymphedema management, including long‐term physical therapy and complementary and alternative medical treatments.

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Recommendation 4

Address psychosocial costs by expanding support groups and buddy services.

Recommendation 5

Expand the availability of home health care services after cancer treatment.

Recommendation 6

Provide domestic assistance with household chores, childcare, and transportation.

Recommendation 7

Expand eligibility for financial aid and social services to those who are not in poverty.

Recommendation 8

Provide financial counseling or navigation throughout the diagnosis and treatment process.

Recommendation 9

Expand policies that protect employment and medical leave to offer more acceptable leave time. 

Each recommendation was a product of the interviewees’ personal experiences with the disease; in the case of recommendation 9, for example, one patient who had lost work as a result of her diagnosis noted that her employer terminated her without warning after her medical leave exceeded 3 months.

The authors of the Cancer article suggested that these patient recommendations may help to improve trust in the health care space in the US, which, because of rising costs and poor transparency, is particularly low among patients with breast cancer.6 Policies derived from engagements with patients and long-term survivors may simultaneously reduce the economic impact of disease management on patients and their families — and may improve patient confidence in the health care system generally.

There are, however, according to Dr Dean, some barriers to the recommendations becoming policy. “The challenges to implementing patient-based recommendations are both in the attitudes we have towards health care in this country, as well as the way our health care system is set up,” she said. “For patient recommendations to be followed, we need to value that everyone should have access to good health care, regardless of ability to pay, and we need to have a system that keeps costs realistic for patients. Both of those things can be done, and there are examples of other countries that do this well.”

Until these things happen, however, the increasing cost of care in the US, coupled with the increasing breast cancer incidence and survival rate, could lead to greater survival inequalities associated with socioeconomic status — either because patients cannot afford treatment, lose work, or are unable to afford care. 


  1. Cohen RA, Boersma P, Vahratian A. Strategies used by adults aged 18–64 to reduce their prescription drug costs, 2017. National Center for Health Statistics Data Brief, no 333. Hyattsville, MD: National Center for Health Statistics. 2019.
  2. Johnson SB, Park HS, Gross CP, Yu JB. Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst. 2018;110(1):121-124.
  3. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upocn an aging, changing nation. J Clin Oncol. 2009;27(17):2758-2765.
  4. Davidoff AJ, Erten M, Shaffer T, et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer. 2013;119(6):1257-1265.
  5. Dean LT, Moss SL, Rollinson SI, Jaramillo LF, Paxton RJ, Owczarzak JT. Patient recommendations for reducing long‐lasting economic burden after breast cancer [published online March 6, 2019]. Cancer. doi: 10.1002/cncr.32012
  6. Dean LT, Moss S, McCarthy AM, Armstrong K. Healthcare system distrust, physician trust, and patient discordance with adjuvant breast cancer treatment recommendations. Cancer Epidemiol Biomarkers Prev. 2017;26(12):1745-1752.