I’ve been thinking at lot lately about the costs of treatment. For the moment I have good insurance, so I can see the bills but I don’t need to worry about them – at least not right now. Each year our medical insurance changes, things get eroded, what was covered last year may not be covered next year. The systems in both Canada and the US are designed to bankrupt you before they allow you to access your care on compassionate grounds.

I’m technical finished treatment, but in reality I’m not. It is something that many women with ER+/PR+ breast cancer find hugely annoying. After the dose dense chemo comes hormone therapy. The therapy can be one pill a day for 5, 10, or more years. The younger you are the more complicated this gets. The first choice therapy failed me. Patients don’t fail treatments, treatments fail patients – language matters.  The second round option is quite a bit more expensive and is inconvenient. The daily pills are cheap and easy to take. But because of my age I also need to do ovarian suppression, which luckily for me is a shot once every 3 months (some people do it monthly). For this intramuscular shot my insurance company is charged $36,000. Then every six months they add on an additional medication to help rebuild my bones as the daily pill can cause bone loss. So every six months another $10,000 is added to the bill. So that is $92,000 in treatment per year. This does not include all the doctors visits. This treatment regime is currently expected to run for 10 years – although it seems that the treatment options change, and there is some talk of extending the hormone therapy even longer for some people. Since I had three primary tumors – all hormone positive – I’m an anomaly.

It bugs me but this cost of treatment has got me thinking about whether I should have an oophorectomy (removal of ovaries). That would mean I could skip the shot every three months. If I had a BRCA mutation, then an oophorectomy would be a standard of care, because in addition to increased risk of beast cancer, BRCA also brings a significant increased risk of ovarian cancer. But that isn’t me. So for me the only reason to remove my ovaries would be cost and convenience. Neither of those things seem like a valid reason to remove a body part. But the idea keeps crossing my mind as we look to the future. Can I maintain the shots every 3 months? To add to the issue the last shot I had hit a nerve or something in my gluten, which is now being treated with physical therapy. It has been almost 2 months since that shot and I’m still feeling it. Fortunately the first two times I didn’t have that problem. So, I’m hoping that it won’t happen again, but it is weighing on me. I’m hesitant about getting the next round of shots. Wondering if I can delay them a little. Wondering if they are really necessary. Wondering if it makes more sense to remove my ovaries and avoid the shots. I’d still need the every 6 month bone strengthen shot but that is not intramuscular.

At the survivorship appointment we had with the nurse practitioner, she emphasized that hormone therapy was just as important as chemotherapy in reducing the risk of recurrence. For many women surgery and hormone therapy are their only treatments. It can be very effective. But it isn’t without its side effects, and it isn’t without its inconveniences and costs.

For now I’m slogging my way forward, one pill/shot at a time.