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Topic: Free/universal healthcare (non Americans)

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Feb 8, 2021 12:57PM

illimae wrote:

This is not a political debate post but as the US considers future healthcare options, I have questions for those of you from countries that already provide it.

1. What country are you from?

2. Are you able to choose your doctor and hospital or are you assigned to one?

3. Are tests and results scheduled in a timely manner, like two weeks?

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can’t see how it would be possible to provide it without raising taxes)

5. What’s the best/worst things about your healthcare system?

Thanks for sharing your experiences :)

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Feb 8, 2021 02:01PM Redcanoe wrote:

I am in Canada

I could request a new doctor but was very happy with the surgeon and the oncologist I was assigned to. My surgeon is a professor and expert on oncoplastic surgery and my oncologist is the head of clinical trials at a highly regarded teaching hospital.

I had some delays in diagnosis but that is largely due to the fact that I live in extreme rural/remote community and not due to UHC. Once I was transported to a major centre, my wait times for things like full body ct with contrast, breast mri and ultrasound guided biopsy have been anywhere from 1 to maybe 10 business days? Certainly less than 2 weeks.

I don't think our taxes are that much worse than American taxes plus insurance premiums plus co-pays. We get taxed more, yes but we don't have to pay for health insurance with our after tax income and there is no such thing as a co pay.

Honestly, since being diagnosed with cancer, I do see some disadvantages of our system. For starters, I think if I was being treated in the US, I'd probably be getting TCHP but I'm not getting perjata because it hasn't been proven to improve odds significantly enough to justify the side effects and expenses. But I'm only 34 so I want all the drugs. If I won the lottery tomorrow, I'd probably fly to MD Anderson and pay for everything I can get.

In conclusion, I'm overall pretty happy with our system. I havent paid a cent out of pocket for treatment or medication since being diagnosed with cancer. I have access to experts. The only disadvantage is that I can't pay to elect for more aggressive treatment.

Toni - age 34, mom to 4 kids ages 11, 8, 5 and 3 Dx 11/19/2020, DCIS/IDC, Right, 2cm, Stage IIB, Grade 3, 2/5 nodes, ER+/PR+, HER2+ (IHC) Surgery 12/14/2020 Lumpectomy: Right Targeted Therapy 1/11/2021 Herceptin (trastuzumab) Chemotherapy 1/11/2021 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 6/8/2021 Whole-breast: Breast, Lymph nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 8, 2021 02:13PM moth wrote:

1) Canada.

2) You choose your family doctor - but there's a shortage of family doctors and some people are struggling to find regular ongoing care & relying on drop in clinics. The cancer agency in Vancouver now has Nurse Practitioners to provide ongoing care for those who don't have a family GP. For an oncologist, you are kind of assigned but you can make requests and changes and get 2nd opinions. But the cancer care system in my province is highly integrated - all the cancer centers work together from the same guidelines and any cases that don't fit into neat categories are discussed at regular tumor board conferences so my sense is there is not much variation in treatments. I had a choice of surgeons and endocrinologists etc.

3) For me they have been. I'm in a large metropolitan area though. In some smaller towns there are delays and levels of service are not the same. Everything for me has been smooth and quick, even during covid.

4) in my group of friends & family, yes. There is also pretty broad support for expanding healthcare to include a pharmacare program (currently drugs are not covered unless you are on social assistance and even then, not always; or if you have private extended health insurance through an employer. Cancer therapy drugs are *mostly* covered but the drugs to deal with side effects are not.Also, new cancer drugs are often not covered.) and also some coverage for dentistry

5) best - we don't go bankrupt for medical care whereas I understand it's one of the leading causes of bankruptcy declarations in the US. Worst- things take a while to get approved (we're often a couple years behind the US for cancer drugs for ex) and some are approved but NOT covered by the gov't. Nationwide, decisions on whether a cancer drug will be recommended for financial coverage are based on recommendations that will benefit the most people. So a very expensive drug that only helps a few and only a bit, will likely not get approved because it's better to provide other, more effective therapies to more people. Needs of the many outweigh the needs of the few....
And again, on the worst side - wide disparities based on region. Remote areas of Canada have greater health challenges and poorer services.

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/2/2021 External: Bone
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Feb 8, 2021 02:16PM Beesie wrote:

1. What country are you from? Canada. It's important to note that healthcare here is managed by the provinces, so there are differences from one province to another (similar to differences between the States in the U.S.). However there are 5 principles within the federal healthcare act that all provinces must deliver to: 1) universality; 2) portability; 3) accessibility; 4) comprehensiveness; 5) public administration.

2. Are you able to choose your doctor and hospital or are you assigned to one? Yes, I can choose, and I can opt for a second opinion. Second opinions can be more difficult in smaller locations where all doctors work for the same hospital or in some provinces where there is a provincial cancer authority that manages and coordinates all care.

3. Are tests and results scheduled in a timely manner, like two weeks? Depends on the situation and location. I'm in a large city so there are lots of hospitals and lab/screening facilities and I can usually get most tests done within 48 hours. Biopsies have generally been scheduled out a week. MRIs tend to be booked up so when I was getting annual screening MRIs, I'd be sure to call to book a couple of months in advance and as a result I'd always have my MRI right on schedule. When I needed an MRI prior to surgery, as I recall it was scheduled about 10 days out. Our system runs on priority of need, so urgent needs are always slotted in quickly while less urgent needs may have to wait. In small towns, where there may only be one testing facility, waits can be much longer, but I would expect this is true in U.S. small towns too.

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes) Yes, absolutely. And keep in mind that we don't have huge insurance costs. That said, our system doesn't cover all costs, and what is covered differs by province. Here in Ontario, for example, drugs (and not all but most) are covered for children, for those over 65, and when administered in hospital (i.e. chemo). The rest of us have to pay for our drugs. Dental and vision care coverage depends again on age and the procedure. For example, being under 65, my eye exams aren't covered but my glaucoma tests are (glaucoma being a disease and I have a family history); when I hit 65 this year my eye exams will be covered. Many people get supplemental insurance coverage from their employer to fill in the gaps, or policies can be purchased, but they are cheap compared to U.S. insurance policies. I have lived without supplemental coverage and my costs, covering meds, dental and vision, have generally been just a few hundred dollars a year.

5. What's the best/worst things about your healthcare system? Best - not having to worry about cost. Worst - in Ontario, and I think all provinces, while doctors have full authority to decide what tests and procedures they want a patient to have, they do have to work within treatment guidelines. In some situations, they can veer off the guidelines easily, but in other situations (ordering PET scans, for example), there is a formalized approval process that they have to go through. Some docs are willing to go to bat for their patient but others aren't. Probably not that different than getting insurance approvals in the States but here it's only necessary in unusual situations and it's the doctor deciding yes or no to the extra procedure, not some backroom insurance clerk. Annoying - the PCP is the gatekeeper so everything is supposed to go through the PCP. If you want to see any specialist, the PCP needs to send in a referral, although once you are a patient of a specialist, you can continue to see them without the PCP's involvement. My current and previous (now retired) PCPs have always given me specialist referrals when I've wanted them (and sometimes when I wasn't sure it was necessary) but some PCPs prefer to handle things themselves and are stingy with referrals. So from this sense, the quality of care is very dependent on the quality of the PCP - but I suspect that's true to some degree everywhere.


Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Feb 9, 2021 12:15PM SondraF wrote:

1. What country are you from?

Currently in the UK; have used both NHS (public, universal care provider) and private services

2. Are you able to choose your doctor and hospital or are you assigned to one?

Under NHS - I was assigned to a hospital for my initial dx, and would have had surgery there had that been the proper route. I was not happy with the surgeon OR the hospital, which was miles from my house, and I felt it was of questionable cleanliness. I was then reassigned to a different hospital for oncology, and reassigned to a new oncologist who I only saw once, instead mostly seeing junior oncologists/researchers/registrars. Appointment times were down into the 8 to 5 minute range and every new oncologist meant they had no idea who I was or my concerns. It drove me nuts so I switched to private care, where I was able to choose my oncologist and hospital and I see JUST HER every month, so she know me as a person and I feel much more at ease opening up to her.

3. Are tests and results scheduled in a timely manner, like two weeks?

Depends - my scans were moved from 3 to 4 months right away, mostly due to Covid pressures. Results were hit or miss, I once waited almost a month for the outcome of some scans. At diagnostics it took two weeks to find out I had cancer (for sure), then another two weeks to find out it was terminal, and then another 8 weeks before I started treatment. Under private treatment I use the same facilities but am "bumped to the head of the line" - my scans are now scheduled when they are convenient for my schedule (end of day), I can make changes, and my results are done within 24 hours. The same doctors work in the NHS and private systems as I don't think they can have hospital privileges without agreeing to see a certain percentage of NHS patients.

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes)

The NHS is essentially a state religion in the UK and the link between tax payments and affording the health service has been broken. There is very much a sense of entitlement to "our NHS" - you get a lot of stories of timewasters who are drunks in the ER at 3 am every Saturday, or people going to the GP because their toe hurt, that sort of thing. Similarly you get people who "don't want to waste the NHS time, its just a little thing" when it actually is something that SHOULD be checked out, but there is this perception that the all-holy NHS can't cope year after year after year so we must all support it by... not using it?!

It is free at point of access so people push that to the limit. I am in a high tax bracket and pay over 40% of my salary on taxes, a lot of which goes to supporting the NHS. That is before you account for the local services monthly tax and the 20% VAT tax on everything else. My workplace 100% funds my medical insurance and I have no other deductibles and maybe a small copay (I had to pay the difference for my genetic testing - a whole £14). As a cancer patient, any medicine prescribed for me is free - so my letrozole or amoxicillan or whatever the GP may prescribe is always free, as are my Ibrance and other drugs. You can access other drugs in the private system as there are certain equations used to determine if a drug is useful to offer to the wider population.

Is it a fair trade? I think a small form of personal contribution to access services (say £10 for a GP visit, or £100 if you are using the ER as a drunk tank on the weekend) would help encourage people to take care of themselves better, fund improved services and access, and get people to realize that health care isn't free and no, the NHS can't just always patch you up and off you go. Many people in this country don't pay any form of income/contributory tax, so if you are stuck in the higher tax bracket, but below the super rich, you are paying a lot of money in contributions to the health system for others who won't take care of themselves (not everyone is like this, but you see the disincentive).

A small fee could also help fund better preventative care - mammograms dont start here until 50 (even then is every 2 years), its every 3 years for a PAP (which doesn't include breast/pelvic exam). The GP system acts as a gatekeeper into the NHS services so if you are "too young" for cancer they are more likely to put you off rather than refer to get something checked out. It took me almost four weeks to get my initial appointment to be seen for my breast lump. GP offices are not great - usually somewhat shabby with older equipment and I have never EVER had a single GP actually touch me. I had one diagnose my back problem from sitting behind a desk.

5. What's the best/worst things about your healthcare system?

Best - it is good to know it is there in case of job loss or whatever. They are really good at acute care, but that is because that means someone else is getting shoved off or things have been allowed to deteriorate so far that a simple issue BECOMES acute care.

Worst - it is just as political as the US system, and above challenge. It is essentially run at this point on the goodwill of nurses and doctors to push themselves to the limit of their time and energy and conscience, without proper compensation. To me, that is unacceptable and hides the true cost of healthcare delivery. Ten years of under investment, many layers of bureaucracy, etc and there are tens of thousands of nursing roles open that you better believe won't be filled now. I make 4x what a junior doctor makes, and frankly I wouldn't be surprised if a lot of doctors and nurses leave the NHS and emigrate to Australia or NZ after this is all over. Why would you put up with this bs if you could leave, move to a country with sun and beaches, make enough for proper housing and a good life, and work in updated surroundings?

To sum - I think everyone should have access to a base standard of healthcare, and not be subject to bureaucratic accountancy whims (that is true for a state system or an insurance system), with some sort of small contribution at access and for there to be insurance that serves as a top up on the state system (I believe Germany has this system) in case of larger issues. Unfortunately to bridge the gap would require a significant increase in wages and living standards that I just don't think is possible.

"The closer we come to the negative, to death, the more we blossom" - Montgomery Clift Dx 9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/29/2019 Ibrance (palbociclib) Hormonal Therapy 11/29/2019 Femara (letrozole) Surgery Prophylactic ovary removal
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Feb 10, 2021 07:00AM illimae wrote:

Thank you for the comments, I really appreciate your first hand experience.

Sondra, NHS does not sound like perfect model that some would like us to believe it is. I understand nothing is perfect but as a source of pride, almost no one mentions the flaws. And waiting a month for results stunned me, even if it’s uncommon, it is certainly shocking.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Feb 10, 2021 11:41AM - edited Feb 10, 2021 11:42AM by exbrnxgrl

I am American and wanted to share my perspective. Countries that have national healthcare systems are usually happy but most I know freely acknowledge that it is not perfect. In the US, we have a tangled patchwork of ways to get medical coverage. Wait times for appointments, tests and results are all over the place and the reality is that if you have a very good insurance plan, you are often served more quickly and given more options. If you don't have insurance or have a plan that doesn't cover much, you're in for many more delays and fewer, if any, choices. Bottom line? If you have the money you can get great care, if not your care choices become limited. I have been fortunate to have very good insurance but would gladly “give up" some of the conveniences I've enjoyed sothat everyone can get decent medical care. So many other nations have figured this out. Why can't we?

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Feb 10, 2021 12:38PM Olma61 wrote:

this is great information from everyone and I thank illimae for starting the thread and the other ladies who took time to contribute in so much detail!

I do think that we in the USA are still pretty far away from a national system like Canada and the UK have

What I see in the immediate future with the new administration and Congress is that they will be shoring up the ACA, expanding subsidies and trying to get coverage for low income folks in states where Medicaid was not expanded.

And *maybe* lowering the age to qualify for Medicare by a couple of years.

If or when major change happens, we will probably have something closer to Germany, Switzerland or the Netherlands, which still has “choice” with heavy regulation of insurance providers.

Just my two cents and hope it is not a thread hijack

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External: Bone
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Feb 10, 2021 12:47PM illimae wrote:

exbrnxgrl and olma, I agree and I’m not excluding the American perspective but want to encourage real, first hand experience by those who have national healthcare. There’s lots of talk about us doing what other countries do but I, like most people, don’t actually know the details of how other systems work, not enough to have an honest opinion of it anyway.

I appreciate all participation here, it’s very helpful.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Feb 11, 2021 06:03AM - edited Feb 11, 2021 06:04AM by flashlight

Hi illimae, This is an interesting topic. I retired from health care in 2018 and saw it evolve to more of a business in the US. Even saying that I wouldn't trade my health care for socialized medicine. I don't think that is the answer. Neither is having a $6000.00 deductible. I'm thankful for Medicare, but it isn't free. Medicare is only as good as the supplement (s) you buy in to. My husband has a less expensive supplemental plan and unfortunately this was his year to be ill. They denied his last hospital stay and all the tests. Nothing is ever easy.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole-breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Feb 11, 2021 08:14AM illimae wrote:

flashlight, I agree. I had a government job with great insurance and am now on Medicare with a Medicare advantage plan through my retirement plan. My costs are almost nothing, which I am extremely grateful for but being 45, it wouldn’t be available to me if I wasn’t stage IV. I see many young people struggle with the system we have now and I’m hoping there’s an affordable compromise somehow.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Feb 11, 2021 08:50AM Beesie wrote:

The thing that you have to keep in mind is that even if there was a perfect system out there in some other country, the U.S. would not be able to replicate it.

Any system that already exists somewhere else has decades of history behind it. In Canada, for example, our healthcare act passed in 1968 and we've had universal health care implemented in all provinces since 1971. What this means is that during the early decades baby boomers were barely using the system but they have been paying into this system through their taxes for all of their working lives. Starting a new single payer system now, when baby boomers are older, many retired, and many heavily using the healthcare system, would be a completely different dynamic with very different financial and coverage implications.

You also have to consider that the U.S. has a huge medical infrastructure and millions of people in the medical and medical insurance industries. The U.S. system is completely different than what any other country has. Whatever changes the U.S. makes will have to be built up from the existing system which obviously means that what results will be different than what's in other countries.

Lastly, every system is dependent on decisions made by politicians and bureaucrats and medical interest groups. Even with identical systems, the decisions of the politicians in one area will be different than the decisions of the politicians in another area. We see that in Canada in how our healthcare systems differ by province. Here in Canada we are able to pick our own doctor (I think this is true in all provinces). Doctors may be full and not taking new patients, but no doctor can refuse a universal healthcare patient (since every patient in Canada is a universal healthcare patient). Would the same decision be made in the States? To my understanding, you already allow doctors to not take patients on Medicare (I think; my info is old on this, from my parents lived in the U.S. 10+ years ago and my Dad complained that fewer and fewer doctors were accepting Medicare patients) and patients with insurance are restricted to doctors within their network. Doesn't seem like a stretch then to think that with a single payer system, the U.S. might implement restrictions on which doctors patients can see.

The U.S. should have acted decades ago. Hillary-care. Don't know how you implement something now without drastic harm (financial, employment) to some industry or interest group.


Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Feb 11, 2021 11:10AM illimae wrote:

All good points Bessie. It’s much more complicated than most realize, myself included.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Feb 11, 2021 11:44AM flashlight wrote:

Most doctors/hospitals in the US accept Medicare patients. Doctors/hospitals/nursing homes can limit their Medicaid patients because they don't receive any financial benefit. Usually they will lose money. Hospitals are able to make money off of private insurances that helps to balance out the reduced cost that Medicare offers. Yes, its so confusing.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole-breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Feb 11, 2021 11:59AM exbrnxgrl wrote:

Remember too that most who belong to unions bargain for health care so it is treated as a contractual negotiating point. That makes things even more complex!
Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Feb 11, 2021 12:08PM SummerAngel wrote:

My parents are 81 and 83 and they have difficulty finding doctors who accept Medicare, so I wouldn't say "most" accept Medicare.

Healthcare has been an interest of mine for many years. I think it started when I was 22 and working in retail and a middle-aged man I worked with told me he would never retire and never have any money because he would be paying off his wife's cervical cancer treatments. She died from the cancer. I was so shocked and sad for him it triggered my interest.

When I was working as a consultant I traveled to Germany a few times. I specifically spent time asking the people around me how they felt about their healthcare system and what it was like. Those I worked with were very happy with it and said they would never trade what they had for what we have in the US. Granted, I have no idea if any of them had ever experienced a serious health issue or not, but that's what they said.

Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node. Dx 3/27/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 6/1/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right Surgery 6/1/2015 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/27/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/3/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
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Feb 11, 2021 12:14PM Olma61 wrote:

illimae, I learned a lot about healthcare around the world in a couple of Facebook groups about health care policy, which have since gone dark, unfortunately. They were not specifically focused on cancer care, either, but still incredibly informative.

Kaiser Health News (khn.org) is a good source if you really want to dive in deep to US health policy news.

I would love to hear more from people here about cancertreatment in other countries, especially Germany and Switzerland. Even though, in the end, it is true, whatever continues to develop here is going to be unique to the USA, building on our current health care system and within the bounds of what is possible politically.

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External: Bone
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Feb 11, 2021 12:16PM exbrnxgrl wrote:

SummerAngel, I agree that, increasingly, people are finding fewer and fewer doctors who will accept Medicare. This will be a big problem going forward

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Feb 11, 2021 01:40PM mightlybird01 wrote:

I am German, but have lived in the US for some 15 years now, and when I was still living and working in Germany (I left Germany when I was 35) I hardly ever was sick. So my experience is limited, yet I have 2 80 year old parents and my sister and her family still live in Germany and I know what they experience.

In Germany, we have 2 types of health insurance, one is "universal" and one is privat. Every person has to have one or the other. If your job is well paying you can choose the private insurance otherwise you have to have the universal. Even within the universal, there are several policies but they are rather similar. If you don't have a job and no means to pay for the health insurance via savings or pension the "Bundesversicherungsanstalt für Arbeit" (a governmental organization) will pay it for you.

I calculated the costs for universal health care based on a 3,000.- EUR salary before tax (see below). The employee pays 1/2 and the employer the second half. In total, the monthly cost is 290.25 EUR (and the same amount is paid by the employer). The price is calculated based on income. The more you earn the more you pay (currently 15% of your income before tax). There are no deductibles and the patient never sees any bill. One can go and see any Dr. at any time. There are no in "in network" or "out of network Drs". Also as far as I know you don't need a referral for a specialist. However, it sometimes can be a wait times for specialized Drs. That's were the private insurance comes in a bit better, Drs. usually prefer private patients because they can charge more for their services. When I was still working in Germany, I had a well paying job so I chose the private insurance, which has a slightly higher monthly premium and a deductible (which I could choose on my own). The higher the deductible, the lower the monthly cost. When I needed an appointment and I was told the next available would be in 3 weeks, I said I was a private patient and so my next appointment was usually available within 1 week. Usually one can get an appointment within 3-4 weeks for any sort of Dr. even as a universal health patient. If it is an emergency, one can get it much quicker, or obviously can go straight to the hospital.

My mother has universal health insurance, but she has a private "supplement", which allows her a few extra perks, such as single rooms in the hospital and extended sick pay, and for her, because we live at the Swiss border, she can also go to Switzerland for treatment if she wishes to do so.

From what my parents tell me, in recent years there are fewer and fewer small local practices and more and more large centers, which means longer travel for them and navigating new places. For example, she told me that in our home town of 30,000 people no longer has a local gynecologist. Local family Dr. getting rarer and rarer too, many also prefer to work in Switzerland where salaries are higher. Opticians the same thing. My mom's optician retired recently and none of the other close-by opticians would take on any new patients when she called. In this case, one can call the insurance and they have to find a Dr. for you. They will then make the appointment. Drs. cannot refuse a patient, at least in theory.

I guess the biggest thing right now in Germany is the tendency that the small local offices disappear. But on the other hand, large new modern centers arise, but they require more travel and maybe for the elderly not as convenient. Germans like to do things local :-)!


But overall, Germans are very satisfied with their health care, I have never met anyone who had any dept from paying of medical bills, no matter what sickness they had. Also the premiums are universally accepted. The more you earn the more you pay seems fair to everyone. It has always been that way, so noone really questions it.






Ihr voraussichtlicher monatlicher Beitrag zur Kranken- und Pflegeversicherung 219,00 EUR Krankenversicherung (7,3 %)

Sie und Ihr Arbeitgeber teilen sich den Beitrag zur Krankenversicherung. Jeder von Ihnen zahlt 7,3 %, berechnet auf Ihre Bruttoeinnahmen.

18,00 EUR TK-Zusatzbeitrag (0,6 %)

53,25 EUR Pflegeversicherung für kinderlose Mitglieder ab 23 Jahren (1,775 %)

290,25 EUR Gesamtbeitrag


Dx 4/12/2019, IDC/IDC: Medullary, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Chemotherapy 5/21/2019 AC + T (Taxol) Surgery 11/8/2019 Mastectomy: Right
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Feb 11, 2021 02:46PM hapa wrote:

Great topic Mae! I'm just starting the process of qualifying for Portuguese citizenship and I am wondering how their healthcare system compares to ours. My impression is that if you are poor, young, and/or have a chronic condition, you are probably better off with universal healthcare. If you are wealthy or have something really weird or rare, the care you get with an employer-funded health plan in the US is really hard to beat. This is because most large employers are actually self-insured -- your company foots the bill, the insurance company on your card is just an administrator. So they'll approve everything because they're not paying. But if you have a standard, marketplace plan with the same insurance company getting things covered is a whole different story.

My plan is to retire in Europe and if my cancer comes back to go through treatment there. When things get sticky and I've run through several treatment options, I may want to come back to the US because as far as I can tell we get access to the newest treatments first.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Feb 11, 2021 05:37PM - edited Feb 11, 2021 05:38PM by MinusTwo

Yes, Mae - great topic. I am on Medicare and chose to stay with the traditional (original) plan rather than move to an "advantage" plan when they were developed.

With traditional Medicare, I also pay for a Medigap policy that covers the 20% Medicare doesn't pay. Between the two policies, I have not paid anything else except the yearly deductible that was $183 last year. That said, there are several Medigap policies you can choose with different rules. Example - some require a $20 deductible for each visit. But there are no "gatekeepers" and I don't need a referral for any kind of specialist.

In 11 years I have never found ANY docs who wouldn't accept Medicare. The only exception was my old PCP who converted to be a "concierge" doctor. You paid something like $1500 each year (in addition to regular costs) and were guaranteed a personal answer or appointment immediately. Needless to say, I found a new PCP. I live in a big city so finding docs who accept Medicare may be different in a rural area.

The Advantage plans cover more services for less money, but usually requires you to be part a specific network. If the doc you like isn't in that network, its not covered. And you have to have a referral from a primary care physician before you see a specialist. Hopefully I'll be able to continue with my current plan and have treatment wherever I want.

Not mentioned yet is Long Term Care. When those insurance policies were instituted, I was unable to afford the premiums. And premiums have continued to increase exponentially, which most of us didn't understand to be part of the original deal. Many people have dropped out as premiums increased. I'm still unable to afford Long Term Care insurance. Medicare does NOT pay for nursing homes for very long - 90 days maybe now?? And it does not pay for home care. I have no idea what I'll do when I can no longer take care of myself. I just keep sticking my head in the sand.

Sorry - didn't mean this to be so long. One last note - I have some 50 year old friends who took early retirement and moved to Panama. They love the health care set up there. Of course neither has ever been sick yet.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Feb 12, 2021 06:18AM - edited Feb 12, 2021 08:23AM by flashlight

MinusTwo you make a good point. I have a Medigap policy and haven't had any trouble finding doctors who accept Medicare and I don't live in a big city. My husband has more of an "advantage" policy and doctors who accept his plan are few and inbetween. I think that is the difference. They accept Medicare, but not your supplement. Also some of the doctors I worked with either went into a concierge practice, retired, or went to work for an insurance company. If any of you are getting ready to go on Medicare make sure you study the plans before starting that hour long phone call. Long term care is another troubling issue. My brother plans on buying into an independent living apartment, when the time is right. He hopes to find one that has an assisted living and long term care on their campus where they guarantee a resident a bed. My MIL is in an assisted living with hospice care. Medicare part B helps with the hospice cost.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole-breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Feb 12, 2021 10:33AM Celand wrote:

I have been very fortunate in my lifetime of always being covered by medical insurance - my parents when I was a child until young adult, then when I was a young, single adult employer based coverage, then thru my husband's employer based coverage when I got married. Although at some point in time my husband got a single policy and I covered myself and our two girls on a family policy because it was cheaper for us to do that.

Now I have also been fortunate in that I was relatively healthy when I was younger other than an occasional cold, virus only going to the Dr for my annual wellness check up.

But once I turned 51 my breast cancer diagnosis, surgery and treatment changed all of that for me. Once again, I am fortunate that I am covered under my employer based health insurance plan, all of my dr's are in network and I have managed to be able to pay my co-pays and very little more. (One of our family physicians became concierge practice so had to switch to another PCP as our family could not afford her fees)

Now what frightens me is what my 30 yr old daughter is going through with getting medical coverage. She makes too much money to qualify for help with expense of coverage but cannot afford to buy a policy! She did pay for the cheapest ACA policy which was $35 per month but $8000 deductible! She reasoned that she could not afford the deductible so discontinued that policy! She has not been to the dr since age 26 when my insurance stopped covering her. I fear for her and others in the same situation as her. She has gone to Urgent Care a couple of times for minor things and luckily a mental health professional will see her every 3 months for $80 to prescribe her depression medication (Good RX). The USA will have to come up with some type of public health option for people in this situation.

My younger daughter is disabled and over age 26 but my meducal insurance has included her on my policy for life although she still gets Medicaid but my insurance is her primary so private drs will still see her.

Celand

Dx 10/17/2016, DCIS/IDC, Left, <1cm, Stage IB, Grade 1, 0/5 nodes, ER+/PR+, HER2- Surgery 10/28/2016 Lumpectomy: Left Radiation Therapy 12/14/2016 Whole-breast: Breast Hormonal Therapy Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 12, 2021 03:28PM SondraF wrote:

Just to flag - but today the UK govt body that selects drugs to be made available on the NHS has provisionally rejected the use of Verzenio/Fulvestrant as it has "not been found to be a cost effective use of NHS resources". This means that an NHS doctor cannot prescribe that combination to MBC patients, though it can be accessed privately. They haven't yet assessed Ibrance/fulvestrant and Kisqali/fulvestrant is under review. So something that is considered a solid second or even third line in other countries cannot be accessed on the public option here due to cost considerations. A lot of times I see people skip right through to Xeloda or Piqray when there could be an opportunity to squeeze on some more time on endocrine therapies.

When you get down into dealing with MBC and the vast range of responses to drug types, its a little bit more difficult to accept limitations on drug availability due to cost, though its possible to see why limitations have to be placed. However, this is something many countries in the world face, is really just the US where for the right price you can acquire anything.

For various reasons we want to return to the US in the next 18 months at some point, though I do worry about health insurance and I am too young for Medicare (and nor do I want to quit working before I have to in order to access it). We aren't in a bad situation here, but it isn't home.

"The closer we come to the negative, to death, the more we blossom" - Montgomery Clift Dx 9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/29/2019 Ibrance (palbociclib) Hormonal Therapy 11/29/2019 Femara (letrozole) Surgery Prophylactic ovary removal
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Feb 12, 2021 04:00PM moth wrote:

SondraF, I think in my province verzenio/fulvestrant didn't get approved till May 2020. It's back to the "needs of the few vs needs of the many" calculations that publicly funded health plans have to make. It's frustrating when it's *us* that are the few. I heard in chemo room gossip last time I was there that a gyne cancer pt was driving over to the US for trodelvy for something like 20k/month. Eeek.

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/2/2021 External: Bone

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