Underwriting Cancer Survivors
As early detection and treatment for people with cancer becomes increasingly improved and widespread, more and more cancer survivors are applying for insurance with favorable outcomes—and receiving standard policies.
Unfortunately, initial treatment with radiation, chemotherapy, hormonal therapy or surgery can sometimes result in both local and systemic problems years forward, including treatment-related new cancers. Careful surveillance for both a late recurrence of a primary cancer and the evolution of a second primary one is essential, not only to prolonged survival but also to successful underwriting.
There are not a lot of statistics and studies available that address long term monitoring, surveillance and preventive care for cancer survivors. Many cases in which cancer has been successfully addressed don’t have necessary follow-up by experts such as oncologists. Plus, primary care physicians sometimes lose sight of a previous cancer diagnosis in treating other problems of age. The coordination of care with an oncologist is important—not only in maintaining good health in the present but also in being on the lookout for potential problems before they become difficult to address in the future.
Breast cancer, for example, is still one of the most common of all malignancies developing in up to one in eight women. Yet successful initial treatment doesn’t always guarantee a lifelong cure. Breast cancer can recur as either local disease or as distant metastasis years after treatment has been completed. Remaining affected and even unaffected breasts must be examined regularly to detect any early recurrence.
When treated with radiation, second malignancies may occur later in the radiation field. This is similarly true with chemotherapy, where bone marrow suppression, cardiotoxicity and second malignancies can likewise occur. Long term survivors have also been found to have a higher risk of cardiovascular disease and must be monitored carefully over the years.
Prostate cancer is another disease in which late recurrence can happen even after early successful therapy. Lifelong follow-up must occur, with clinical examinations and PSA measurements.
Colorectal cancer that has been treated with surgery has a 10 to 50 percent recurrence rate (depending on stage, pathology and degree of extension); thus, regular colonoscopies should be done in succeeding years. No follow-up can be potentially fatal with colon cancer that is not monitored over time.
Head and neck cancer is particularly deserving of careful follow-up. The most common cause of death three or more years after treatment is actually a second primary cancer, because aero-digestive cells are also affected by the same carcinogens (tobacco and alcohol) that were contributory to the original malignancy. Continued smoking after cancer treatment is particularly ominous in this regard. Thyroid cancer is quite common when a neighboring organ has been treated.
Lung cancer is another type that is noteworthy to mention. More people now survive lung cancer than ever before; however, continued and careful follow-up is necessary for those survivors. For instance, patients who have received chemo or radiation therapy for lung cancers have a two to three times higher risk of developing cardiovascular disease. Respiratory problems are also common in lung cancer survivors. Many have some degree of chronic obstructive lung disease before treatment, and surgery and chemo-radiation can further compromise lung function.
Chest wall malignancies such as sarcoma are also found in higher frequency post radiation therapy for lung cancer.
Medical advances have created more and more cancer survivors, and many of those survivors have insurance needs as their lives are graced with more years. While many of them now have standard life expectancy, they are at higher risk for recurrence and complications of therapy. For that reason, careful and regular follow-up and health maintenance are keys to an underwriter in making the best offer possible for insurance.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life.