This discussion is unique in that it represents the views and opinions of real people living with cancer. This discussion does not necessarily represent expert opinion, nor the opinions of the American Cancer Society. The information represents what has worked and not worked for others dealing with cancer. As people deal with their cancer in many unique ways, it is up to the listener to determine what is appropriate and relevant for them. We hope the information is helpful and welcome your feedback.

Ron, Maryland

ANDREW:
Ron from Maryland, you're a financial planner. You're now twenty-six years old, but at the age of twenty, you were diagnosed and treated for testicular cancer. Since then, you've gone on to play a very active role with cancer survivors, especially giving them financial advice. Ron, when we think about financial planning when a family is touched by cancer, what are some things that you think are especially important?

RON:
Well, it's very important for an individual who has cancer to really get this area out of their life. And I say this because you want to make sure that they focus on getting well and getting the proper treatment, taking this and letting either someone else take care of it, or knocking it out. When I say this, also they want to make sure that the bills that they may have, hidden bills, they want to make sure they know about them by asking insurance companies for estimated costs so they can outline it, know what they're headed for, looking out for unknowns, basically getting a running total, so that if there's something that they don't understand, instead of being hit with it, they should fully know where the money is going. And looking at completing a will or trust, so that if something did happen, all their estate or their will would take care of it. And of course, finally, making sure their beneficiaries are current. Beneficiaries for insurance policies, banking accounts, etc. along those lines.

ANDREW:
Now let's talk about the bills that will surely come with treatment. Some may be covered by insurance, but not everything. How can you get a handle on this as you're facing a tough diagnosis?

RON:
Insurance companies have usually dealt with forms of this type of cancer before, and a lot of times if you'll call them, they will at least give you some estimated costs. They can at least give you a guideline for what they expect it to cost, and along the way, get a running total if you would call it that. Because they will continue to pile up your bills. They will know where you're at during the time frame you're on.

ANDREW:
Now, what about the importance of asking questions of healthcare providers as you try to get a grip on the whole financial side of dealing with this illness?

RON:
Well, it's so important that you do. The real scenario is, they don't know what you don't know. If you don't ask them, they're not going to know what you don't know. And because they deal with so many different individuals, they're unsure what level you're at. The more questions you ask, the more informed you will be. You're going to be the individual paying the bill. You need to make sure you ask the questions, no matter how small or how large they are.

ANDREW:
Sage advice from a young man. Bob in Ohio. You're a retired attorney who specialized in corporate finance, then later in estate planning. You were treated surgically in 1962 for colon cancer. When someone is dealing with cancer, they've gone through treatment, now they're trying to go on about their life, is this a wake-up call to do estate planning if they have not already?

BOB:
The extent of the planning is dependent upon, first, the outlook of the individual involved. If the individual is a positive thinker, I say to them, go ahead! Let's plan the estate on the basis that you're going to be with us for an unlimited number of years. Now, if they have a negative outlook on life, then I tell them that they need a pretty specific diagnosis. And depending upon the number of years that you feel that you have, plan it along those lines. I see nothing wrong with thinking along those lines.

ANDREW:
The point is, though, that it's important to have an estate plan, am I right?

BOB:
Oh, yes indeed! To not have a will, and today I would say that for middle class America a living trust is a very fine vehicle to take care of the disposition of your estate. You can save yourself a lot of taxes, you can save yourself a lot of administrative costs, and you can decide where it goes within the limits of the two generations.

ANDREW:
As far as being someone who has lived through a bout of cancer, is there any additional thinking you would say that comes into it related to estate planning? Or would you say it's the same as anyone?

BOB:
The same as anybody else. There's no difference. You consider your spouse, your children, your grandchildren, the charities, the educational institutions, and you know, you put them all into the mix and decide where your priorities are.

Now, I have just gone through an estate planning seminar. And as the result of going through that seminar, put on by another estate planning attorney, I immediately came back and I have now fully funded my living trust. That will avoid probate upon my death. It will avoid probate when my wife passes away. So you see, with a little bit of thinking, you can save a lot of money and you have the mental comfort that it's going to go where you want it to go.

ANDREW:
But for somebody who then deals with cancer where maybe your question of whether your life will be long or a little less long, then maybe it brings these estate planning issues into sharper focus.

BOB:
Well, it really shouldn't, because you should have an estate plan whether you're going to live one week or 20 years. It really doesn't come into the game, because you need an estate plan any time. Oh, I'll give you, for example in Ohio, even in an estate that is less than $100,000, by proper estate planning you can save yourself maybe five or six thousand dollars in administrative costs, attorneys' fees. All the nitty gritty things of an estate plan. And the higher the estate, you have to understand, the percentage graduates. A federal estate tax goes up to 55 percent. Now, that's a pretty big bite out of the money that you accumulated by proper investment and hard work. So, I say it makes no difference.

ANDREW:
Thanks, Bob.

Joe, Missouri

ANDREW:
On to Missouri to talk with Joe, a retired hospital administrator. You're a ten year survivor of colon cancer, just like Bob who spoke a moment ago. Having spent so many years as the head of a hospital there in Missouri, maybe you have some comment about how insurance fits into plans for the future.

JOE:
It is well to have insurance. It is well to have a financial plan. And your plan should be evaluated annually because conditions change and situations change. But the Legacy and Bequest Committee of the American Cancer Society has a number of education programs that prepare potential patients and people how to plan for their future. Certainly, insurance is an important part. Had it not been for the insurance, I would have been up a creek in reference to paying the hospital bills.

ANDREW:
Joe, I do have a question for you related to that. Once you have been diagnosed with a cancer, whether you've been treated and maybe even thought to be in a long, long term remission or even cured, I imagine you are deemed to be a bigger risk for an insurance company. What can you do post-diagnosis and treatment of cancer to sort of cover off your insurance needs?

JOE:
Well, some insurance companies will insure risk patients, but your premium would be extremely high. Within the state of Missouri we have a program where high-risk people who cannot be insured through regular commercial insurance can get some kind of coverage. Again, the rate is rather high and I would certainly advise anyone who has that problem to contact their Department of Health in their own particular state and see what is available for high-risk patients and cancer survivors. At least short-term survivors would certainly be considered a high-risk client.

Joe, Missouri

ANDREW:
Now, I just want to go back to one thing you said. The American Cancer Society nationally, then, has programs, as you mentioned, to deal with these insurance and bequest and legacy issues. And of course not solely related to leaving money to ACS, but just overall these financial issues. Am I right?

JOE:
That's correct. I'm on the Legacy and Bequest Committee for the local unit here, and we conduct seminars and we bring in estate planning attorneys. We bring in certified public accountants, we bring in healthcare providers, and in some instances, we have insurance people who can explain all of the ramifications and the planning process, and what should be done.

ANDREW:
Advice to people on getting their house in order related to insurance, estate planning, any views on that.

JOE:
I say individuals should, one, make an inventory of all of their personal assets. And have a complete listing of assets and liabilities so that they can constantly monitor them. They should, so called, have their house in order as far as financial planning is concerned; so far as education as to what should be done. And I agree with Bob, there are numerous legal processes today which make planning a simplified matter.

ANDREW:
Joe, what about somebody who has been in and out of the hospital, or maybe they have a child who has been in and out of the hospital and they just don't have those financial things in place. How do they prioritize the things they need to do in their life in coping with a long-term illness?

JOE:
That's a rather difficult situation to generalize on. Some hospitals do provide charity care, and they write off the hospital bill. But an individual who has numerous problems and tries to get insurance, generally one of the questions from these high-risk insurance companies is if they've had a problem in the last two or three years or have been hospitalized in the last two or three years.

So again, you go back to the point of trying to find a source that would insure you. But, certainly, healthcare insurance is a very important thing. Blue Cross, Blue Shield, and there's AARP, and various other insurance that you get in healthcare. Life insurance is important. And disability insurance is important.

Sandra, Ohio

ANDREW:
That brings up a good point. I want to bring Sandra into this conversation. Sandra, you're from Ohio. Now you're forty-one years old, but were diagnosed with lymphoma in 1991, while still in your thirties. You're involved in the insurance business, so maybe you can give us some inside advice.

And I just encourage people. I think that having that disability policy where the check comes to pay the bills while you're recovering, is a valuable coverage that a lot of Americans don't have! I like to say we have more dental insurance than we do disability, and that's because we're a vain society.

But I know in Ohio, the health insurance law, as long as you're with an employer or you change jobs to another employer, and you're coming out of a group plan, you can always get in the health plan without any pre-existing condition. So, you can go from one employer to another without any pre-existing.

Esther, Georgia

ANDREW:
We have that in Washington, too. Let's go over to Georgia for a few minutes. Esther, you're a long-term survivor of breast cancer and a motivational speaker who's active in Reach to Recovery. I'm told that you look far into the future when it comes to planning. Tell us a little bit more.

ESTHER:
I knew early on that I was at high risk for having breast cancer. I am a breast cancer survivor because I have it in my family. My mother succumbed to it, so I started mammography very early, in my thirties, and I was already involved in an IRA with my job at that time. I am now retired from the education profession. I did not see any need to stop once I was diagnosed in 1991. I continued.

I had a modified radical mastectomy, but in the meantime I had married. My husband and I had talked about 'what if,' and as our income increased we increased both our IRAs, and we continued to plan for the future.

But, the important thing is to have a plan, and this is what we have done. We have since retired and just a couple of years ago we went forward and we did our will because we thought that would be the intelligent thing to do, and get that behind us. We went forward and we determined who we wanted to have as power of attorney in the event that neither of us was in the position to make a decision for ourselves at a given time.

So, we just continued living life to the fullest, as we are doing right now. Cancer has not been an end of life issue, and is not something that I dwell on daily, and I'm going to live throughout this day.

ANDREW:
So, Esther, if you were just going to tick off just sort of the do's for a long-term survivor about moving ahead in the future, what would the do's be?

ESTHER:
Well, the do's would be to certainly keep in place whatever it is you would do in terms of your financial plan. Think of it just being a pause in your life and you are going to get back to what you were doing. Another thing is that make sure that you go ahead and put in place how you want your estate to be handled, because you know, whether you succumb to cancer or some nut drives past and smashes you to smithereens or some other kind of catastrophe happens to you and you lose your life not necessarily from cancer. But go ahead, because that's going to give you the additional peace of mind that you're going to need and that's going to release you to live and enjoy your life.

Bob, Ohio
Esther, Georgia

ANDREW:
Let's broaden the area of discussion for a couple of minutes. You and your husband are retired, Esther. But as a parent with three young children, the oldest of whom is eight, I worry about how to take care of my kids if I become incapacitated through treatment for leukemia. I'm sure other cancer patients who have young children worry about the same thing. Bob, our estate planning expert, any comment about that?

BOB:
Well, I would recommend that they talk to an attorney, simply because the attorney deals with these things day in and day out. And if they have a friend who is an attorney, an acquaintance make an appointment, go see him. Find out, what do you do in this situation?

If you have minor children you should provide for somebody to watch over their well-being in the event you're not going to be around. There are very cogent plans to take care of those situations.

ANDREW:
Is there a specific kind of attorney?

BOB:
Well, basically, an estate planner, because an estate planner gets all the facts together, makes up the package, gives you direction, tells you how to take care of grandchildren; how to take care of children; how to take care of your spouse; how to take care of an aged parent. This is something we haven't covered, but you know a lot of us today have aged parents for whom we have to provide care. Do some planning.

ANDREW:
Esther, you had a comment?

ESTHER:
Yes, I wanted to say something about looking at guardianship. For those people who may not be able to afford an attorney, they can seek advice through the Legal Aid Society. And they can also seek advice sometimes from their healthcare professional who may refer them to a specific organization, so they're not just out roaming and looking for someone.

ANDREW:
Esther, that's a great piece of advice.

Susanna, Texas
Bob, Ohio

ANDREW:
Let's bring in Susanna. Susanna, you're a long-term breast cancer survivor and a Reach to Recovery volunteer, like Esther.

Let's say a woman's breast cancer treatment is behind her. But she still has those little kids. She doesn't know if she'll have a recurrence ever, or next week, or next year, or five years from now. What advice would you give her about how to make sure that, no matter what, her kids are taken care of?

SUSANNA:
Actually, whether or not you have a diagnosis of cancer, if you have small children you should be making preparations and plans in the event that something happens to one or both parents. Part of the responsibility for a parent and planning for their children's future, is to take care of the details and don't put them off! You know, if you get a call from an insurance man and you keep putting him off because you don't want to face the fact that there may be some trauma happening to your family at some future time. You really need to wake yourself up and pay attention to the fact that even if you are perfectly healthy right now, tomorrow, you could be hit by a car; you could have a cancer diagnosis; you could lose one or both parents at the same time. And not having a plan in place to take care of the children is a terrible tragedy for the children!

BOB:
One of the ways of doing that is to get a life insurance policy and make the child the beneficiary.

SUSANNA:
That's only part of what needs to be done. You need to have life insurance, you need to have medical insurance, you need to have a guardianship a legal guardianship in place; you need to have a trust; you need to have the ability to provide for those children in some way, if one or both parents are not able to do that any longer.

BOB:
The trust is fine if you've got the assets to fund the trust.

SUSANNA:
Well, actually I believe that everybody ought to have a trust, because one of the things that happens when you have a trust is that when you know that you have the trust in place, you are inclined to put your assets into that trust.

BOB:
In addition to that, you have continuing guidance.

SUSANNA:
Yes. You also need to have things like, for instance, your home needs to be protected in some way so that if you ever have astronomical medical bills, and your home will be saved for the family. If there's a college fund, that will not be invaded. Your spouse's retirement account could be wiped out by medical bills. And if you have the proper planning in place, that is not going to happen!

BOB:
That's correct.

Susanna, Texas
Bob, Ohio

ANDREW:
We've been talking about the personal side of making plans but I'd like to take our conversation into a different area, if you will. The area of business planning. Susanna, I know you were in a high stress business when you were diagnosed, dealing very closely with clients. This is a question a lot of long-term survivors have: do you disclose that you've dealt with cancer in your life?

SUSANNA:
I do that very selectively. Lots of people know that I work very closely with the ACS and various volunteer programs, and obviously those people know. Some of my clients know. Every once in awhile I'll run into a client who is having the same kinds of problems that I have already dealt with, and I tell them, because it's relevant to the situation. If it's not relevant to my business dealings, I don't tell them, because there's no reason to inject that into a conversation or a business dealing.

ANDREW:
Bob, do you have a view on that?

BOB:
Yes, I do. I had my cancer in 1962, and I practiced law for another 22 years, and never hesitated to tell a client or a friend or anybody who would stop to listen for a minute or two, that I had gone through the experience, that I was a survivor, and that I was going on living without regard to what had happened.

ANDREW:
And did it affect your business?

BOB:
My business grew. Every year was better than the previous year. And I will say this. In addition to that, after I had the surgery I went around the world. I went on a safari to Africa. I've been to China and walked the Great Wall. I've been to New Zealand. I've been to Australia. I've been to Europe. You name it! And the only reason I recite those things is, I did not stop living! And I think the reason I didn't stop living, I admitted what my situation was, and I told everybody I was living with it.

ANDREW:
Bob, that's a great attitude. And a positive note on which to end our conversation.

So, to summarize what you all have said is that just because someone has been diagnosed and treated for cancer there is no reason to avoid responsible planning for the future of your family or your business.