Thyroid Cancer: Paying for Your Care

There is a high price to pay for thyroid cancer, not only in terms of its side effects, fear, depression, and extreme fatigue, but also in terms of the cost of treatment, which could include the need for hormone replacement therapy and papillary thyroid cancer.

If you've got health insurance, it's time to get familiar with its customer service number and the details of what your plan covers — having insurance often doesn’t mean that every bill will be paid. And if you don't have insurance, you're tasked with finding a way to pay for your thyroid cancer treatment when you may barely have the energy to focus on getting better. Thankfully, there are a number of non-profit organizations to help you find ways to pay for your thyroid cancer care.

Working With Your Insurance Carrier

"In terms of working with insurance companies, many people don't know their insurance company benefits until they are diagnosed with cancer," says Carolyn Messner, DSW, director of education and training at CancerCare in New York.

Though most health care providers will ask questions to make sure that your insurance is accepted and that you have coverage, it's still a good idea to call the insurance company on your own and find out the details. Ask what's covered and what's not and whether you need pre-approval for any treatments, and check back to see that all necessary pre-approvals have come through. You want to know that, if you need them, procedures such ashormone replacement therapy with synthetic thyroid hormone and radioactive iodine treatment are covered and that there won’t be any surprises when the bill comes.

If your insurance company denies a medical procedure, don't assume that you can't appeal the decision and that they won't cover it, says Messner. A good strategy is to go ahead and appeal, and see what the outcome is.

Thyroid Treatment: Linking to Resources

There are many non-profit organizations that help people with cancer — finding support, taking care of their practical needs, or figuring out how to pay for their treatment. Three of the leaders are:

• The American Cancer Society, 1-800-ACS-2345 (1-800-227-2345)
• The National Cancer Institute, 1-800-4-CANCER (1-800-422-6237)
• CancerCare, 1-800-813-HOPE (1-800-813-4673)

"I can't stress enough the importance of connecting with these organizations," says Messner. "This is a whole area of knowledge and information, and you can't know all this when you're first diagnosed.”

These organizations can show you how to navigate the health insurance system and solve problems you may encounter through a wide variety of resources, such as a co-pay foundation to help cover costs that exist even when you have health insurance. Their missions include educating the public about how to find thyroid cancer treatment — procedures and medication — that are free or more affordable if you don't have insurance.

A number of public hospitals will provide care and are increasingly associated with cancer centers,” says Messner. There are also public entitlement programs, like Medicare and Medicaid.

Consider these non-profit organizations your link to cancer services. "They exist to help people get the care they need. People shouldn't think, 'If I don't have coverage, I can't get care' [or] 'I don't know what can be done for me.' We want them to know that a lot can be done,” explains Messner. “We don't want anyone to feel that they are alone."

The Silent Killer: Cancer Care Costs

“All bodies are slow in growth but rapid in decay."  Publius Cornelius Tacitus

The financial costs of cancer are great for both the person with cancer and for society as a whole. In 2009, the National Institutes of Health estimated the 2008 overall annual costs of cancer were as follows:

• Total cost: $228.1 billion
• Direct medical costs (total of all health expenditures): $ 93.2 billion
• Indirect morbidity costs (cost of lost productivity due to illness): $ 18.8 billion
• Indirect mortality costs (cost of lost productivity due to premature death): $116.1 billion

One of the major costs of cancer is cancer treatment. But lack of health insurance and other barriers to health care prevent many Americans from even getting good, basic health care. 

According to the early release estimates from the 2008 National Health Interview Survey: About 24% of Americans aged 18 to 64 had no health insurance for at least part of the past year. About 13% of children in the United States had no health insurance for at least part of the past year. And according to Cancer Facts & Figures 2009, "Individuals with no health insurance and those with Medicaid insurance are more likely to be diagnosed with advanced cancer." This leads to higher medical costs, poorer outcomes, and higher cancer death rates. 

This year, about 562,340 Americans are expected to die of cancer -- that's more than 1,500 people a day. Cancer is the second most common cause of death in the United States, exceeded only by heart disease. Cancer accounts for nearly 1 out of every 4 deaths in the United States. 

Cancer costs billions of dollars. It also costs us the people we love. Reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer. 

References: 
American Cancer Society. Cancer Facts and  Figures 2009. Atlanta, GA. 2009.

Some Mental Health Problems Associated with Thyroid Health Issues

Many women may be unaware of a common health issue that is caused by problems with the thyroid gland. EmpowHer reports that some mental health disorders are caused by a malfunctioning thyroid.

For example, people who are treated for bipolar disorder with lithium can experience symptoms such as depression, fatigue and weight gain, according to Mary Shomon, a thyroid patient advocate and author. However, they may be unaware that these are the symptoms of an underactive thyroid, or hypothyroidism, which is a side-effect of lithium.

Also, hyperthyroidism can cause anxiety or panic attacks, but many people are incorrectly diagnosed with panic disorder.   "It turns out that once their thyroid is properly treated, the panic attacks and the anxiety go away," Shomon told the news source. She added that "there's actually some physicians who consider it a standard practice, before they will put anyone on an antidepressant, to do a complete thyroid evaluation."

According to the Centers for Disease Control and Prevention, treatment for hypothyroidism usually requires the replacement of thyroid hormone by taking a single daily dose of synthetic hormone that is adjusted to produce normal levels.

Hurthle Cell Thyroid Tumor: A Different Type of Thyroid Cancer

Hurthle cell thyroid cancer is usually classified with follicular thyroid cancer, although it really is a distinct kind of tumor. It is an unusual tumor, making up about 4% of thyroid cancers and is only about one-fourth as common as follicular cancers.

• What is a Hurthle Cell?  A Hurthle cell is a kind of thyroid cell which has a distinctive look: under the microscope it is bigger than a follicular cell and has pink-staining cellular material.

• Is the Hurthle Cell Tumor Benign or Malignant?  Like follicular tumors, there are benign Hurthle cell tumors and malignant Hurthle cell tumors, and the pathologist tells the difference between them based on invasion of the capsule and the blood vessels.  Benign Hurthle cell tumors are not a threat at all and should not come back once they are removed.

• How Is Hurthle Cell Cancer Different from Follicular Cancer ? Hurthle cells look different than other types of thyroid cells, and they tend to occur in older patients. The median age is patients with Hurthle cell cancer is 55, about 10 years older than patients with follicular cancer. Like follicular cancer, Hurthle cell thyroid cancer infrequently spreads to lymph nodes (about 10%) but can recur locally (the cancer can come back in the neck) or spread to lung or bone.

Because younger patients with thyroid cancer tend to have a better prognosis than older patients with a very similar tumor, and because Hurthle cell cancers occur in older patients, they have the reputation of being more dangerous. However, if you control for age and other factors like size and initial extent of tumor (whether it has spread locally in the neck or elsewhere in the body), Hurthle cell tumors behave very similarly to follicular tumors. A small Hurthle cell cancer which does not have extensive invasion, especially in a younger patient (under 45), can have an excellent prognosis.

• How Is Hurthle Cell Cancer Treated?  Patients with Hurthle cell thyroid cancer, if there is more than minimal invasion, should generally undergo removal of all or nearly all of their thyroid tissue (see our article on the different types of thyroid surgery). In all areas of well-differentiated thyroid cancer, there is some disagreement about how extensive the surgery should be; however, because Hurthle cell tumors tend to occur in patients with more serious risk factors, the surgery is correspondingly more aggressive. If there are involved lymph nodes, they are removed, although this is uncommon.

Surgery may be followed with radioactive iodine. Radioactive iodine does not work as well for Hurthle cell cancer as it does for follicular cancer, because the Hurthle cells are less likely to "take up" the radioactive iodine and then be destroyed by it. However, it is well-tolerated treatment and may be helpful in some cases. Patients are then followed at regular intervals to check for recurrence, which can be dangerous in Hurthle cell cancer and needs to be watched for carefully.

About the Author: James Norman, MD, FACS, FACE, is recognized as one of world's foremost experts on parathyroid disease and the most experienced thyroid/parathyroid surgeon in the world. He is a Fellow of the American College of Surgeons (FACS) and one of only a handful of surgeons to also be a Fellow of the American College of Endocrinology (FACE). He is recognized as the inventor of minimally invasive radioguided parathyroid surgery in the mid-1990s and is credited with dramatically changing the way parathyroid surgery is performed.

Childhood Radiation Linked to Higher Likelihood of Thyroid Cancer

Research conducted by endocrinologists at the University of Rochester Medical Center has revealed that being exposed to radiation in childhood may increase a person's risk of developing thyroid cancer later in life.

Published in the journal Radiation Research, the study found that children who received low-dose chest radiation treatment for an enlarged thymus grew up to be more than five times more likely to have thyroid cancer.

The study's authors wrote that the enlargement of the thymus, a gland between the lungs that produces immune cells, is rarely considered a medical problem today. However, it was treated as one between the 1950s and the 1980s, when the study's participants received radiotherapy for it.

Even after adjusting their data for age, gender and history of goiter, the team found that childhood radiation therapy increases the risk of thyroid cancer for nearly 60 years after it is administered.

They added that the risk drops off after an individual has lived six decades beyond the original treatment. Lead author Jacob Adams suggested that the use of radiation-based medical scans may be at least partially to blame for the increasing rate of thyroid cancer in the U.S.

He wrote that computer tomography (CT) scans and magnetic resonance images (MRIs) are often used to diagnose medical conditions in young children.  According to the study, more than one million CT scans are taken of children aged 5 or younger every year in the U.S.

"Ionizing radiation is a known carcinogen," Adams said. He and his research team suggested that more attention be paid to the types and amounts of radiation being used to diagnose illnesses in children, even though current MRI and CT technologies use less radiation than earlier versions.

Researchers concluded that diagnostic irradiation of children under 5 should be avoided when possible. Over a lifetime, approximately one in 111 Americans develop some form of thyroid cancer, according to the National Cancer Institute.

Jeff Vereecke Relay for Life Co-Chair Battling Rare Form of Thyroid Cancer

Jeff and Karen Vereecke are the co-chairs of this year's Relay for Life.

Although thyroid cancer has a lower fatality rate than other tumors, there has been a 2.4-fold increase in its occurrence over the past 27 years. The Centers for Disease Control (CDC) reports that this form of cancer is more prevalent in women than men; however, men are still at risk.

For example, Relay for Life co-chair, Jeff Vereecke, has been suffering from complications of the disease since 2006 when he noticed a lump on his neck, The Daily Telegram reports. He went to his doctor, who diagnosed Vereecke with papillary and medullary thyroid cancer. Vereecke is one of the first documented cases of someone who has both types of cancer.

Soon after his diagnosis, Vereecke underwent surgery to remove his thyroid and surrounding lymph nodes. He then received radioactive iodine treatment, which involved taking a pill that destroys thyroid cells in the body. After taking the pills, Vereecke had to isolate himself from his wife and children for a few days due to his radioactivity.

Vereecke and his wife, Karen, have been coping with the disease by participating in Relay for Life, which raises funds for the National Cancer Society. Today, Vereecke is still battling complications related to cancer, as it has spread to his bones.

The CDC reports that both of these cancers may be hereditary, and family members of medullary cancer patients can benefit from getting tested for the gene.

Treatment Options for Thyroid Cancer

Thyroid cancer is like skin cancer in terms of prognosis: most cases are mild and cured easily with surgery, while others are deadly. Approximately 85 percent of thyroid cancer patients are diagnosed with limited disease that requires only surgical removal. The remaining 15 percent have persistent, recurrent, or metastatic disease. The lungs are the most common site for metastases, followed by the bones.

Treatment options depend on the subtype. Reference 1 explains how thyroid cancer can arise by several different pathways. Thyroid tissue contains two main types of cells: follicular cells, which produce iodine-containing hormones, and C cells, which perform support services. There are several genetic mutations by which follicular cells can transform into papillary carcinoma. Different pathways lead to follicular carcinoma. Either of these cancer cell types can transform, by further genetic mutation, into anaplastic carcinoma.

The C cell, on the other hand, can transform into medullary carcinoma. Papillary and follicular carcinomas are called “well differentiated”, and have the best overall prognosis. Medullary carcinoma is less common but more difficult to treat. Anaplastic carcinoma is rare, but is one of the most deadly cancers: the median survival time is less than one year.

After surgery, radioactive iodine can be used to kill well differentiated thyroid cancer cells. Thyroxine treatment is used to suppress thyroid stimulating hormone (TSH) production. This approach does not work for medullary and anaplastic carcinomas, because these cells do not take up iodine to produce the T3 and T4 hormones.

Chemotherapy and external beam radiation therapy are used in some patients, but their success rates are low. Current research is focused on targeted therapy drugs. These drugs are intended to disrupt the function of cancer cells specifically, while leaving healthy cells alone. Several of these have been approved for other cancers and are now being tested on thyroid cancer:

1. Sorafenib (Nexavar), approved for liver and kidney cancer

2. Sunitinib (Sutent), approved for kidney cancer and gastrointestinal stromal tumor

3. Gefitinib (Iressa), approved for non-small cell lung cancer

4. Vorinostat (Zolinza), approved for cutaneous T-cell lymphoma

5. Romidepsin (Istodax), approved for cutaneous T-cell lymphoma

6. Decitabine (Dacogen), approved for myelodysplastic syndromes

Check with your doctor to see what the latest results mean for you.

References:

1. Romagnoli S et al, “Targeted molecular therapies in thyroid carcinoma”, Bras Endocrinol Metab. 2009; 53(9): 1061-73.

2. Pacini F et al, “Targeted therapy in radioiodine refractory thyroid cancer”, Q J Nucl Med Mol Imaging 2009; 53: 520-5.

3. Woyach JA et al, “New therapeutic advances in the management of progressive thyroid cancer”, Endocrine-Related Cancer 2009; 16: 715-31.

SOURCE: Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

Thyroid Cancer Diagnosis Rates: The Facts

The number of people diagnosed with thyroid cancer is growing at an unprecedented rate and medical researchers don’t know why.  Thyroid cancer increased at a rate of 6.5 percent a year from 1997-2006 making it the fastest increasing cancer among women and men, according to recently released National Cancer Institute data. Over that same period, prostate, breast, lung and colon cancer rates decreased. The 2006 data is the most recent data available; the three-year lag represents the time it takes researchers to compile the statistics.

Experts can only speculate about what is causing a change in the thyroid cancer rate.

“We’re all concerned about this increase,” said Dr. Elaine Ron, a senior investigator at the National Cancer Institute. “We have set up a thyroid cancer working group to see what studies we’re already doing on thyroid cancer, what studies can we do to try and find out more about this increase, but at the moment we can’t really tell you.”

The thyroid, a butterfly-shaped gland that sits at the front of the neck just above the breastbone and overlying the windpipe, produces hormones responsible for controlling heart rate, blood pressure, metabolism and childhood growth and development.

There were approximately 410,000 men and women alive in the United States who had a history of thyroid cancer, as of Jan. 1, 2006. The American Cancer Society predicted more than 37,000 new cases of thyroid cancer were diagnosed in 2008, up from about 17,000 in 1999.

The good news is that thyroid cancer is highly treatable. The mortality rate has remained stable at .5 percent per year meaning about 1,500 people die annually from thyroid cancer.

As the reports of thyroid cancer increased over the past two decades, some experts said the increase was simply because of better diagnostic procedures. For instance, detection methods such as ultrasonography now allow doctors to diagnose thyroid cancer nodules smaller than 1 centimeter.

In their Journal of the American Medical Association article published on May 10, 2006, Dr. Louise Davies and Dr. H. Gilbert Welch wrote the detection of more “subclinical disease,” skewed the thyroid cancer rate. They wrote the increasing rate was “not an increase in the true occurrence of thyroid cancer,” but rather better detection allowed doctors to diagnose cancer that previously would have gone undetected.

Fast forward three years – new research proves there is more to the story than better detection.

More than better detection

Dr. Kenneth Burman, the chief of Endocrinology at the Washington Hospital Center and the current president of the American Thyroid Association, said his understanding and best guess is the increased frequency of thyroid cancer may be in large part related to detection, but it also represents some type of biologic change in the disease prevalence.

“Whether those represent environmental factors, such as radiation exposure, or genetic factors, no one knows,” Burman said. A new study analyzing National Cancer Institute data proves some unknown factor is contributing to the increasing rate of thyroid cancer. "It’s not just improved medical surveillance and diagnosis,” Ron said.

She came to that conclusion based on her review of the Institute’s Surveillance Epidemiology and End Results data. The data includes information on cancer incidence, mortality, survival, prevalence and lifetime risk statistics as well as the type and size of tumors reported.

The study focused on papillary cancer – the most common type of thyroid cancer – because that’s the type of tumor experts say is increasing consistently among all racial and ethnic groups.

“We’re seeing an increase in the larger tumors and also in tumors of regional stage, so it’s not just the very small, early tumors,” Ron said.

The increase in the number of tumors larger than 2 centimeters, and even 5 centimeters, suggests there is more to the increasing rate than better diagnostic procedures.

According to Ron, local stage and smaller tumors are generally picked up during image screening. In contrast, regional stage and larger tumors are generally diagnosed clinically during a physical exam of the neck.

Because of the increase in larger tumors, image screening can no longer be pointed to as the sole reason more thyroid cancers are being reported, Ron said.

The study – authored by researchers from the Institute, Walter Reed Medical Center and Brooke Army Medical Center – was published in the March issue of Cancer Epidemiology and Biomarkers and Prevention. Ron’s team analyzed data from 1980 to 2005.

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Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Financial Assistance and Other Resources for Thyroid Cancer Patients

Cancer imposes heavy economic burdens on both patients and their families. For many people, a portion of medical expenses is paid by their health insurance plan. For individuals who do not have health insurance or who need financial assistance to cover health care costs, resources are available, including Government-sponsored programs and services supported by nonprofit organizations. Cancer patients and their families should discuss any concerns they may have about health care costs with their physician, medical social worker, or the business office of their hospital or clinic.

Listed below are Government agencies, organizations, and programs that are designed to provide assistance for cancer patients and their families. However, resources provided by individual organizations vary, and it is important to check with a specific group to determine if financial aid is currently available. Organizations that provide publications in Spanish or have Spanish-speaking staff have been identified. This fact sheet is divided into four sections: Cancer Treatment, Practical Needs, Other Resources, and International Resources.

CANCER TREATMENT

• Hill-Burton: A program through which hospitals receive construction and modernization funds from the Federal Government. Hospitals that receive Hill-Burton funds are required by law to provide a reasonable volume of services to people who cannot afford to pay for their hospitalization and make their services available to all residents in the facility’s area. Information about Hill-Burton facilities is available by calling the toll-free number or visiting the Web site shown below. A brochure about the program is available in Spanish. Telephone: 1–800–638–0742 (Maryland residents call 1–800–492–0359)Website:http://www.hrsa.gov/hillburton/default.htm

• Medicaid (Medical Assistance): A jointly funded, Federal-State and State health insurance program for people who need financial assistance for medical expenses, is coordinated by the Centers for Medicare & Medicaid Services (CMS). At a minimum, states must provide home care services to people who receive Federal income assistance such as Social Security Income and Aid to Families with Dependent Children. Medicaid coverage includes part-time nursing, home care aide services, and medical supplies and equipment.
  
  
  Information about coverage is available from local state welfare offices, state health departments, state social services agencies, or the state Medicaid office. Check the local telephone directory for the number to call. Information about specific state contacts is also available on the Web site listed below. Spanish-speaking staff are available in some offices. Telephone: 1–877–267–2323 Website: http://www.cms.gov/medicaid/consumer.asp

• Medicare A: Federal health insurance program also administered by the CMS. Eligible individuals include those who are 65 or older, people of any age with permanent kidney failure, and disabled people under age 65. Medicare is divided into two parts, Part A and Part B. Part A pays for hospital care, home health care, hospice care, and care in Medicare-certified nursing facilities. Part B covers medically necessary services, including diagnostic studies, physicians' services, durable home medical equipment, and ambulance transportation; Part B also covers screening exams for several types of cancer. To receive information on eligibility, explanations of coverage, and related publications, call Medicare at the number listed below or visit their Web site. Some publications are available in Spanish. Spanish-speaking staff are available. 
  
  
  Telephone: 1–800–633–4227 
  Website: http://www.medicare.gov/ 

• The State Children's Health Insurance Program (SCHIP): Federal-State partnership that offers low-cost or free health insurance coverage to uninsured infants, children, and teens. Callers will be referred to the program in their state for further information about what the program covers, who is eligible, and the minimum qualifications. In most states, uninsured children age 18 and younger whose families earn up to $34,100 a year (for a family of four) are eligible. For a list of health insurance coverage and eligibility by state, go to http://www.insurekidsnow.gov/states.asp 
  
  
  Telephone: 1–877–543–7669 
  Website: http://www.insurekidsnow.gov/

• The Veterans Administration (VA) Provides eligible veterans with treatment for service-connected injuries and other medical conditions. The VA offers limited medical benefits to family members of eligible veterans. The VA cancer program provides users of the veterans health care system easy access to cancer prevention, detection, and treatment services. Its Web site offers cancer facts, information about care, a list of VA-designated comprehensive cancer centers, and the VA's national cancer strategy. For more information about the VA cancer program, visit the VA Cancer Web page at http://www1.va.gov/cancer/index.cfm on the Internet. Some publications are available in Spanish. Spanish-speaking staff are available in some offices. 
  
  
  Telephone: 1–877–222–8387 (1–877–222–VETS) TTY: 1–800–829–4833 
  Website: http://www1.va.gov/health/

• CancerCare: A national nonprofit agency that offers free support, information, financial assistance, and practical help to people with cancer and their loved ones. Financial assistance is given in the form of limited grants for certain treatment expenses. Services are provided by oncology social workers and are available in person, over the telephone, and through the agency's Web site. CancerCare's reach also extends to professionals—providing education, information, and assistance. A section of the CancerCare Web site and some publications are available in Spanish, and staff can respond to calls and e-mails in Spanish. Information about financial assistance for all cancers is available at
  http://www.cancercare.org/get_help/assistance/cc_financial.php 
  
  
  Telephone: 1–800–813–4673 (1–800–813–HOPE) 
  Website: http://www.cancercare.org/

• NeedyMedsA 501(3)(c) nonprofit organization with the mission of helping people who cannot afford medicine or health care costs. The information at NeedyMeds can be obtained anonymously and is free of charge. NeedyMeds is an information source similar to the Yellow Pages; it does not supply medications or financial assistance, but helps people find assistance programs and other available resources. 

          Website: http://www.needymeds.com/

• The Patient Advocate Foundation (PAF) provides education, legal counseling, and referrals to cancer patients and survivors concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters. The PAF also conducts outreach to African American and Hispanic/Latino American populations. 
  
  
  Telephone: 1–800–532–5274 
  Website: http://www.patientadvocate.org/

• The Co-Pay Relief Program provides limited payment assistance for medicine to insured patients who financially and medically qualify. 
  
  
  Telephone: 1–866–512–3861. 
  Website: http://www.copays.org/ 

• Patient Assistance Programs are offered by some pharmaceutical manufacturers to help pay for medications. To learn whether a specific drug might be available at reduced cost through such a program, talk with a physician or a medical social worker or visit the drug manufacturer's Web site. Most pharmaceutical companies will have a section titled “patient assistance programs” on their Web site.

WHAT ABOUT PRACTICAL NEEDS?

In addition to cancer treatments, many cancer patients need assistance paying for transportation to and from medical appointments and basic living expenses such as food and housing. Listed below are organizations dedicated to helping cancer patients and their families during and after the patient's treatment.

• Eldercare Locator is a referral service provided by the U.S. Administration on Aging, an agency within the U.S. Department of Health and Human Services. Eldercare Locator information specialists will link callers with state and area agencies on aging for information and referral to local agencies that provide a wide array of senior services. This service is available Monday through Friday from 9:00 a.m. to 8:00 p.m., Eastern time. 
  
  
  Telephone: 1–800–677–1116 
  Website: http://www.eldercare.gov/Eldercare/Public/Home.asp

• GovBenefits.gov is a partnership of Federal agencies with a shared vision to provide improved, personalized access to government assistance programs. This Web site's online screening tool is free, easy-to-use, and completely confidential. The user answers a series of questions, then the Web site generates a list of government benefit programs that the user may be eligible to receive, along with information about how the user can apply.
  
  
  Telephone: 1–800–333–4636 (1–800–FED–INFO)
  Website: http://www.govbenefits.gov/govbenefits

• The Social Security Administration (SSA) is the Government agency that oversees Social Security and Supplemental Security Income. Social Security provides monthly income for eligible elderly and disabled individuals. More information about these and other SSA programs is available by calling the toll-free number listed below. Spanish-speaking staff are available. Additional contact information for the SSA is available at http://www.ssa.gov/reach.htm on the Internet. 
  
  
  Telephone: 1–800–772–1213 TTY: 1–800–325–0778 
  Website: http://www.ssa.gov/

• Supplemental Security Income (SSI) is administered by the SSA and supplements Social Security payments for aged, blind, and disabled people with little or no income. It provides cash to meet basic needs for food, clothing, and shelter. Information on eligibility, coverage, and how to file a claim is available from the SSA. 
  
  
  The Benefit Eligibility Screening Tool:   https://s044a90.ssa.gov/apps7/best/benefits/ 
  Website: http://www.socialsecurity.gov/ssi

• The American Cancer Society (ACS) offers programs that help cancer patients, family members, and friends cope with the treatment decisions and emotional challenges they face. Information is also available in spanish> 
  
  
  Telephone: 1–800–227–2345 (1–800–ACS–2345) TTY:1–866–228–4327 
  Website :http://www.cancer.org/

• The Health Insurance Assistance Service (HIAS/ACS) aids cancer patients who have lost or are in danger of losing their health care coverage, along with identifying policy solutions to help others in similar situations. The service, a joint effort of the ACS and the Georgetown University Health Policy Institute, connects cancer patients who call the ACS cancer information number with health insurance specialists who work to address their needs.

• Hope Lodge, a temporary housing program supported by ACS, provides free, temporary housing facilities for cancer patients who are undergoing treatment. For more information about this program, or to find locations of Hope Lodges, call the ACS's toll-free number above or http://www.cancer.org/docroot/SHR/content/SHR2.1xHopeLodge.asp .

• The Road to Recovery is an ACS service program that provides transportation for cancer patients to their treatments and home again. Transportation is provided according to the needs and available resources in the community and can be arranged by calling the toll-free number or by contacting the local ACS office.

• The ACS offers Taking Charge of Money Matters , a workshop for people with cancer and their loved ones about financial concerns that may arise during or after cancer treatment, regardless of the person's health insurance coverage. The session provides an opportunity to discuss financial matters with guest speakers who are knowledgeable about financial planning. More information about this workshop is available on their Website 
  
  http://www.cancer.org/docroot/SHR/content/SHR2.1xTakingChargeofMoneyMatters.asp

• The ACS's "tlc" Tender Loving Care® publication contains helpful articles and information, including products for women coping with cancer or any cancer treatment that causes hair loss. Products include wigs, hairpieces, breast forms, prostheses, bras, hats, turbans, swimwear, and helpful accessories at the lowest possible prices. The publication strives to help women facing cancer treatment cope with the appearance-related side effects of cancer. 
  
  Telephone:1–800–296–1217 
  Website: http://www.patienttravel.org/

• CancerCare operates the AVONCares Program for Medically Underserved Women, in partnership with the Avon Foundation. This program provides financial assistance to low-income, under- and uninsured, underserved women throughout the country who need supportive services (transportation, child care, and home care) related to the treatment of breast and cervical cancers. 
  
  
  Telephone: 1–800–813–4673 (1–800–813–HOPE) 
  Website: http://www.cancercare.org/

• The LIVESTRONG™ SurvivorCare partnership between CancerCare and the Lance Armstrong Foundation provides financial assistance to cancer survivors. For patients who are 6 months post-treatment with no evidence of disease, limited financial assistance is available for transportation to follow-up appointments, medical copays, cancer-related medications, and neuropsychological evaluation 
  
  
  Telephone: 1– 866–235–7205 
  Websites: http://www.cancercare.org/http://www.livestrong.org/

• The National Patient Travel Helpline provides information about all forms of charitable, long-distance medical air transportation and provides referrals to all appropriate sources of help available in the national charitable medical air transportation network. 
  
  
  Telephone: 1–800–296–1217 
  Website: http://www.patienttravel.org/

• Ronald McDonald Houses, supported by Ronald McDonald House Charities, provide a "home away from home" for families of seriously ill children receiving treatment at nearby hospitals. Ronald McDonald Houses are temporary residences near the medical facility, where family members can sleep, eat, relax, and find support from other families in similar situations. In return, families are asked to make a donation ranging on average from $5 to $20 per day, but if that isn't possible, their stay is free. To search for a Ronald McDonald House location, go to http://www.rmhc.org/search_cm 
  
  
  Telephone: 630–623–7048 
  Website: http://www.rmhc.com/

OTHER RESOURCES

In addition to the Government-sponsored programs and organizations already listed, these general resources may also be helpful:

The Health Resources and Services Administration's (HRSA) Bureau of Primary Health Care offers Health Centers that provide health care to low-income and other vulnerable populations. Health Centers care for people regardless of their ability to pay. They provide primary and preventive health care, as well as services such as transportation and translation. To locate a Health Center, visit the "Service Delivery Sites" Web page at http://ask.hrsa.gov/pc/ on the Internet.

Some nonprofit community hospitals are able to provide care for patients in need of financial assistance. Other hospitals have indigent or charity care programs funded by state and local governments. For information about these programs, contact a hospital social worker, who will be able to explain these types of programs. Another type of assistance may be offered through your local health department. The National Cancer Institute's (NCI) Cancer Information Service may be able to provide information about local programs by phone at 1–800–4–CANCER. The NCI is a component of the National Institutes of Health.

State and local social services agencies can provide help with food, housing, prescription drugs, transportation, and other medical expenses for those who are not eligible for other programs. Information can be obtained by contacting your state or local agency; this number is found in the local telephone directory.

The Internal Revenue Service (IRS) can provide information about tax deductions for medical costs that are not covered by insurance policies. For example, tax deductible expenses might include mileage for trips to and from medical appointments, out-of-pocket costs for treatment, prescription drugs or equipment, and the cost of meals during lengthy medical visits.

Deductible-qualified medical expenses include those incurred by the patient, spouse, and dependents. Medical expenses may also be deducted for someone who would have qualified as a dependent for the purpose of taking personal exemptions except that the person did not meet the gross income or joint return test. Nursing home expenses are allowable as medical expenses in certain instances. If the patient, a spouse, or dependent is in a nursing home, and the primary reason for being there is for medical care, the entire cost, including meals and lodging, is a medical expense. The local IRS office, tax consultants, or certified public accountants can determine whether medical costs are tax deductible. 


Telephone: 1–800–829–1040 
Website: http://www.irs.gov/

Community voluntary agencies and service organizations such as the United Way of America , Salvation Army, Lutheran Social Services, Jewish Social Services, and Catholic Charities may offer help. These organizations are listed in your local phone directory. Some churches and synagogues may provide financial help or services to their members.

Working During Thyroid Cancer Treatment

When you're dealing with thyroid cancer and treatment, having to work may seem like a challenge or may improve your outlook. Whether you choose to work or you have to, here's help to keep fatigue from getting in your way.

You may want to keep working during your treatment and recovery from thyroid cancer, especially if finances and maintaining a sense of normalcy are concerns.

Going to work every day can give you a sense of purpose, enable you to pay your bills, and take your mind off your thyroid cancer symptoms and diagnosis. But treatment side effects can rob you of your stamina.

Even when you are able to focus on work, you may find yourself overcome by the extreme fatigue that's often a part of thyroid cancer treatment. Following a healthy lifestyle can increase your energy level and make it easier to get through your workday when your medical team gives you the go-ahead to return to work.

Working Through Thyroid Cancer Treatment

To help you balance work demands with your cancer treatment and recovery, start by finding out how much work you may actually need to miss.

"Individuals with thyroid cancer frequently need time off from work during the process of diagnosis and treatment," says Matthew Old, MD, assistant professor in the department of otolaryngology and head and neck surgery at the Ohio State University Medical Center in Columbus. "The length of time varies per individual and depends upon age, health, and extent of surgery. For a thyroidectomy, plan on a minimum of two weeks off. Some individuals wish to go back after one week, but most need two to three weeks off and sometimes longer."

It's also important to understand how other aspects of your treatment may make you feel. For instance, says Dr. Old, some patients need to stop taking their thyroid medication after surgery to prepare for the radioactive treatment that will kill any remaining cancer cells. Not taking this medication will significantly decrease energy levels. "This will make working tough for most individuals," Old cautions.

The follow-up treatment to surgery and the restrictions that surround it are generally more complicated than the surgery itself, says Mira Milas, MD, director of the Thyroid Center at the Cleveland Clinic in Ohio.

Your radiologist and endocrinologist will give you very specific, individually tailored instructions about what you can and can't do in terms of public activities and how many days you’ll have to be away from people, explains Dr. Milas. "During the time there's actual radioactive iodine therapy within the body, a person should not work." It’s not safe to be anywhere near other people.

Fighting Off Fatigue

To better prepare yourself for when you are able to be at work or work from home, focus on taking the best possible care of yourself — don’t shortchange yourself on any of the cancer recovery guidelines your medical team gives you.

Having plenty of energy during the day requires getting the right amount of restful sleep the night before — seven to eight hours — and eating right and exercising.

"A well-balanced diet, adequate sleep, and regular exercise are key components to maintaining and improving energy levels," says Old. "Also, avoid caffeine and alcohol consumption prior to bedtime."

When you’re in the office, you’ll need to pace yourself and remember to take the time to eat lunch and any snacks and to drink water to stay hydrated. "At work, take frequent breaks and go for a walk or stretch," says Old. "If you are extremely tired, take a short nap."

If you just can't manage your fatigue or find enough energy to get through your day, Old suggests asking your doctor about possible adjustments to your medication or other lifestyle changes that can help you feel more energized.

Talking to your doctor about what you can expect at each stage of your treatment and how much work you're likely to miss will give you a good idea of how to schedule your work responsibilities accordingly.

Last Updated: 09/28/2010