Topic: Metastatic breast ca & disability, pensions etc

Forum: Canadians Affected by Breast Cancer — Canadian health care, clinical trials, and life in general in the north.

Posted on: Nov 9, 2021 09:08PM

Posted on: Nov 9, 2021 09:08PM

moth wrote:

Does anyone have information about where Cdns with metastatic disease stand with regard to accessing cpp early or other benefits?

I see our US friends talk about going on disability but that doesn't seem to apply here?

How does it all work?

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- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Radiation Therapy 3/3/2021 External Local Metastases 3/3/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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Nov 10, 2021 12:40AM sadiesservant wrote:

Hi Moth,

I suspect you have seen my numerous posts on related issues. I find this so darn difficult to navigate. In my case I have access to LTD but struggle to understand what will happen if I step away from work completely (I’m working slightly reduced hours now which has created its own frustrations in that I’m defined as rehab/return to work when the opposite is true). Will the oncologist support this? What does it look like when it goes from “your own occupation” to any type of work?

But with regards to CPP disability, I think you would likely be covered although it’s another gauntlet to get there. My insurer required me to apply (any money I get from CPP will go to them until I turn 65). The form was horrendous - pages and pages. They wanted a run down of every test, every appointment but I persevered. Fortunately they could get the physician reports from the insurer. One funny thing (which may be a positive sign) is they fast tracked my application. It normally takes months but they saw MBC and figured I had one foot on a banana peel even though you are supposed to have less than six months to be put to the top of the pile. I received a call from someone within days of sending in the paperwork. Of course, the irony was that she asked if I was working and then how much at which point she said I wasn’t eligible (which I had questioned the insurer about). Apparently you can only earn $5000 per year to be eligible.

The way it works though is you get what you would get if you were retirement age plus a bit extra. When you turn 65 (unlikely in my case) you revert to retirement benefits which will be less than CPP disability but you come out ahead as you will get more than you would have if you retired early.

All to say (sorry - rambling) you should just apply if you are not able to work. The only cost is time and getting your doctor to fill out the medical forms. You need to be as specific as possible about your limitations and if the turn you down, appeal. I’ve been told that they routinely turn people down on the first go although I got the sense that had I not been working I would well have been approved. We’ll see as I will need to tackle those forms again if I reach the point of stepping away from work completely.

PM me if you have any questions.

Dx 4/2001, IDC, Right, 1cm, Stage IIA, Grade 3, 1/10 nodes, ER+ Surgery 5/11/2001 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary Chemotherapy 6/7/2001 CEF Radiation Therapy 12/17/2001 Whole breast: Breast Hormonal Therapy 12/20/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/2/2007 Femara (letrozole) Hormonal Therapy 10/22/2007 Arimidex (anastrozole) Dx 1/3/2017, IDC, Right, Stage IV, metastasized to bone/lungs, ER+/PR+, HER2- Chemotherapy 1/27/2017 Taxol (paclitaxel) Hormonal Therapy 3/29/2017 Arimidex (anastrozole) Targeted Therapy 4/20/2017 Ibrance (palbociclib) Dx 10/12/2017, IDC, Right, Stage IV, metastasized to other Chemotherapy 10/21/2017 Xeloda (capecitabine) Radiation Therapy 11/15/2017 External Local Metastases 11/15/2017 Radiation therapy: Bone Hormonal Therapy 1/19/2018 Faslodex (fulvestrant) Radiation Therapy 8/2/2018 External Local Metastases 8/2/2018 Radiation therapy: Bone Radiation Therapy 11/5/2018 External Local Metastases 11/5/2018 Radiation therapy: Bone Targeted Therapy 10/10/2019 Verzenio Radiation Therapy 11/3/2020 External Local Metastases 11/3/2020 Radiation therapy: Bone Dx 1/22/2021, IDC, Right, 1cm, Stage IV, metastasized to liver, Grade 2, ER+/PR+, HER2- Chemotherapy 2/4/2021 Xeloda (capecitabine) Chemotherapy 10/8/2021 Other Chemotherapy 1/7/2022 Other
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Nov 10, 2021 01:44PM moth wrote:

thank you! I'm poking around the services Canada site and finally remembered how to access my account too so now I can see what potential $ amounts I'm looking at.

They're saying death expected within 6 months, or on the list of "grave conditions". That list includes lung and esophageal ca but not breast...

I'm mostly unclear about is whether I'm disabled or not. I mean they recommended I quit school when I started treatment and I was quite ill but I'm sort of better now. I don't know how they assess that. I'm not bed bound kwim. I'm just slow-mo dying ... but then also I've had this long run on immunotherapy and who knows what happens next or when.

I think I'm going to see if there's a social worker at my center who know something about where the disability lines are drawn.

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- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Radiation Therapy 3/3/2021 External Local Metastases 3/3/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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Nov 10, 2021 08:44PM sadiesservant wrote:

Totally get it Moth. I’m in exactly the same position. I’m not lying in bed all day but… I am finding it hard to keep up with everything while I juggle work and home life. In a recent update I had to send to my insurer I was asked if I need help with household chores. Um… I don’t have help and, while I can do things, it takes me wayyyy longer than it used to and so I feel like I am falling further and further behind. And then, there is the question of how much you can engage in self-care if you are working all the time.

It’s hard for those of used to just soldiering on to wrap our heads around the concept of not being able to work. But then I reflect on the reasons my colleagues take sick days. Multiply that by all the side effects of treatment and the stuff that comes with the disease and it seems we should be cut some slack.

Don’t get bogged down in the list of grave conditions. I suspect the reason we don’t see BC there is that it is typically something treated and then in remission. Not as immediately life threatening as many cancers that have a poor prognosis from the get go. And also new treatments have made even MBC something that we can live fairly normally with for many years (think bone only, estrogen positive - I worked full time at a very demanding job for four years before my knees started to buckle). As I mentioned, I was surprised that not one but two CPP reps put me on the fast track when I filed my paperwork. I think the liver mets got their attention. 😏

If you find a social worker let me know. I’m at a bit of a crossroad and may be stepping back completely given my current status. I really want to talk to someone who can help me navigate this but haven’t been successful finding that support to date.

Good luck and don’t hesitate to reach out if you want to chat. I don’t know much but might have a few tidbits I can share.

Dx 4/2001, IDC, Right, 1cm, Stage IIA, Grade 3, 1/10 nodes, ER+ Surgery 5/11/2001 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary Chemotherapy 6/7/2001 CEF Radiation Therapy 12/17/2001 Whole breast: Breast Hormonal Therapy 12/20/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/2/2007 Femara (letrozole) Hormonal Therapy 10/22/2007 Arimidex (anastrozole) Dx 1/3/2017, IDC, Right, Stage IV, metastasized to bone/lungs, ER+/PR+, HER2- Chemotherapy 1/27/2017 Taxol (paclitaxel) Hormonal Therapy 3/29/2017 Arimidex (anastrozole) Targeted Therapy 4/20/2017 Ibrance (palbociclib) Dx 10/12/2017, IDC, Right, Stage IV, metastasized to other Chemotherapy 10/21/2017 Xeloda (capecitabine) Radiation Therapy 11/15/2017 External Local Metastases 11/15/2017 Radiation therapy: Bone Hormonal Therapy 1/19/2018 Faslodex (fulvestrant) Radiation Therapy 8/2/2018 External Local Metastases 8/2/2018 Radiation therapy: Bone Radiation Therapy 11/5/2018 External Local Metastases 11/5/2018 Radiation therapy: Bone Targeted Therapy 10/10/2019 Verzenio Radiation Therapy 11/3/2020 External Local Metastases 11/3/2020 Radiation therapy: Bone Dx 1/22/2021, IDC, Right, 1cm, Stage IV, metastasized to liver, Grade 2, ER+/PR+, HER2- Chemotherapy 2/4/2021 Xeloda (capecitabine) Chemotherapy 10/8/2021 Other Chemotherapy 1/7/2022 Other
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Nov 14, 2021 01:09PM ilowen wrote:

I was on STD and then LTD following my diagnosis. My insurer required that I apply for CPP Disability Benefits, which I did. The money I receive from CPPDB is deducted from my LTD benefits (heaven forbid if I get paid a cent more than I’m worth *eye roll*).

The CPPDB application was a bit daunting but my appointments and tests were few since I hadn’t been diagnosed for long before I applied. Like Sadiesservant, they fast-tracked my application and I received an initial call from them within a couple weeks of applying. MBC is not a “grave” or “terminal”condition according to the application but it looks like they have lee-way to move you up the list if they feel you’re urgent. A very smooth process and I was approved quite quickly. If you choose to apply, take a step back when you’re completing the sections about your abilities/limitations. It’s easy to downplay how MBC and the treatments have affected you but you need to be very analytical and realistic. For example, I have some nerve damage in my dominant hand; yes, I can use a manual can opener but not as well as I could so, using their example in the application, I described how that affected me. In regards to fatigue, I described how has that affected what I can do now versus what I could do before MBC. Find some real-life examples to describe how it has affected you, sort of like painting a picture for them.

My PCP was fully on board with me on this and she knew my diagnosis and current treatment. To make sure she understood how MBC and treatment affected me, I gave her the same information I included in the CPPDB application where I described my abilities/limitations.

I hope this helps.

Dx 10/20/2020, IDC, Left, 4cm, Stage IV, metastasized to bone/liver/lungs, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/20/2020 Kisqali Hormonal Therapy 11/20/2020 Femara (letrozole), Zoladex (goserelin) Radiation Therapy 11/26/2020 External Local Metastases 11/26/2020 Radiation therapy: Bone Targeted Therapy 12/16/2021 Piqray (alpelisib) Hormonal Therapy 12/16/2021 Faslodex (fulvestrant) Targeted Therapy 12/16/2021 Piqray (alpelisib) Hormonal Therapy 12/16/2021 Faslodex (fulvestrant)
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Nov 15, 2021 12:38PM sadiesservant wrote:

Hi ilowen,

Just curious, did your PCP do the paperwork? This is always a question in my mind as normally they want the attending physician which I would assume is your oncologist. I'm never entirely sure who I need to get on board when it comes to adjusting hours as the MOs know what's going on in terms of prognosis/treatment but my PCP knows me... It's a top of mind question for me at the moment as I am at the point that I think it's time to step away from work completely but not sure how to make that happen...

Dx 4/2001, IDC, Right, 1cm, Stage IIA, Grade 3, 1/10 nodes, ER+ Surgery 5/11/2001 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary Chemotherapy 6/7/2001 CEF Radiation Therapy 12/17/2001 Whole breast: Breast Hormonal Therapy 12/20/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/2/2007 Femara (letrozole) Hormonal Therapy 10/22/2007 Arimidex (anastrozole) Dx 1/3/2017, IDC, Right, Stage IV, metastasized to bone/lungs, ER+/PR+, HER2- Chemotherapy 1/27/2017 Taxol (paclitaxel) Hormonal Therapy 3/29/2017 Arimidex (anastrozole) Targeted Therapy 4/20/2017 Ibrance (palbociclib) Dx 10/12/2017, IDC, Right, Stage IV, metastasized to other Chemotherapy 10/21/2017 Xeloda (capecitabine) Radiation Therapy 11/15/2017 External Local Metastases 11/15/2017 Radiation therapy: Bone Hormonal Therapy 1/19/2018 Faslodex (fulvestrant) Radiation Therapy 8/2/2018 External Local Metastases 8/2/2018 Radiation therapy: Bone Radiation Therapy 11/5/2018 External Local Metastases 11/5/2018 Radiation therapy: Bone Targeted Therapy 10/10/2019 Verzenio Radiation Therapy 11/3/2020 External Local Metastases 11/3/2020 Radiation therapy: Bone Dx 1/22/2021, IDC, Right, 1cm, Stage IV, metastasized to liver, Grade 2, ER+/PR+, HER2- Chemotherapy 2/4/2021 Xeloda (capecitabine) Chemotherapy 10/8/2021 Other Chemotherapy 1/7/2022 Other
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Nov 15, 2021 01:30PM moth wrote:

I'm really appreciating all this info. Tank you for sharing. I was in school when diagnosed so no LTD in the picture.

I'm unsure as well whether I should ask my MO or my PCP to do my forms.

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- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Radiation Therapy 3/3/2021 External Local Metastases 3/3/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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Nov 15, 2021 01:45PM - edited Nov 15, 2021 02:33PM by wrenn

Moth I would ask the one who will give the most detail and really 'sell it' to CPP.

Edited to add that I don't mean to bullshit (sell it) but the one who knows you best. You are an ambitious hard working person and if you think you need to be on CPP disability then you absolutely should be so the care provider who knows you best should do the forms.

Or not. I don't know what I'm talking about most of the time but hopefully it makes sense.

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Nov 15, 2021 04:40PM ilowen wrote:

I suggest asking your MO first and see what they say.

I see a GPO regularly (MO works out of Kelowna and I live further in the interior). I had asked the GPO if they should be the one to fill out the CPPDB paperwork or if it should be my PCP. They said to ask my PCP first and if they felt it was outside of their scope, then the GPO would complete it. I was only 6-7 months into the MBC diagnosis/treatment so my PCP was quite up-to-date with everything and more than happy to do it. However, my GPO knew more about the side effects I was experiencing which is why I provided my PCP with those details when I gave them the forms to complete.

On the CPPDB application, you have to identify the professional who will be submitting the medical paperwork and list all of the doctors you’ve seen, why and what their roll is/was. I expect if the reviewers wanted more details from the GPO/MO, they would have been able to reach out to them.

Dx 10/20/2020, IDC, Left, 4cm, Stage IV, metastasized to bone/liver/lungs, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/20/2020 Kisqali Hormonal Therapy 11/20/2020 Femara (letrozole), Zoladex (goserelin) Radiation Therapy 11/26/2020 External Local Metastases 11/26/2020 Radiation therapy: Bone Targeted Therapy 12/16/2021 Piqray (alpelisib) Hormonal Therapy 12/16/2021 Faslodex (fulvestrant) Targeted Therapy 12/16/2021 Piqray (alpelisib) Hormonal Therapy 12/16/2021 Faslodex (fulvestrant)
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Nov 15, 2021 04:52PM moth wrote:

just so I'm clear, the only way to access CPP early is to do the disability thing, right?

Also, does anyone know about locked in RRSPs? When I left my federal gov't job I opted to take my pension & put it in a locked RRSP. Can I take out that money early somehow without getting a huge tax bill? I mean I guess it can just be part of my estate but I wonder if it might be better for it to be taxed in my hands rather than my husband's as I have no income right now...


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- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Radiation Therapy 3/3/2021 External Local Metastases 3/3/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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Nov 15, 2021 06:50PM - edited Nov 15, 2021 06:54PM by sadiesservant

Hi Moth,

You can't access normal CPP until you are 60 so, I believe, that would disqualify you (and me until after next April). Given this, I believe CPP disability is the only option.

With regards to your locked in retirement funds, you can access them if you have a shortened life expectancy: If a person has a shortened life expectancy (as certified by a physician) due to a physical or mental condition, the funds may be withdrawn in cash or transferred to a tax-deferred savings vehicle such as an RRSP or an RRIF subject to any applicable income tax rules. You may also be able to access them for high medical expenses. Normally you can't access these funds until age 55. One disadvantage to moving your locked in RRSP to a RRIF is that you lose protection from creditors.

I don't know all the ins and outs in terms of tax benefits but I anticipate you would be hit with the withholding tax for withdrawals which vary based upon how much you are taking out. Apparently there is a minimum RRIF withdrawal regardless of when you start it but I'm not sure how much tax they take. Any payments in excess of the minimum are subject to the following withholding tax rates: 10 per cent if the excess payment is less than $5,000, 20 per cent if the excess payment is between $5,000 and $15,000, and 30 per cent if the excess payment is more than $15,000.¹ Of course, if you are low income, you should get that tax back at the end of the year whereas if it goes to your husband, he will get less (assuming he is working).

I would say it's worth a conversation with your bank or an advisor.

Edited to add: There is no withholding tax on the minimum withdrawal from a RRIF.

Dx 4/2001, IDC, Right, 1cm, Stage IIA, Grade 3, 1/10 nodes, ER+ Surgery 5/11/2001 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary Chemotherapy 6/7/2001 CEF Radiation Therapy 12/17/2001 Whole breast: Breast Hormonal Therapy 12/20/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/2/2007 Femara (letrozole) Hormonal Therapy 10/22/2007 Arimidex (anastrozole) Dx 1/3/2017, IDC, Right, Stage IV, metastasized to bone/lungs, ER+/PR+, HER2- Chemotherapy 1/27/2017 Taxol (paclitaxel) Hormonal Therapy 3/29/2017 Arimidex (anastrozole) Targeted Therapy 4/20/2017 Ibrance (palbociclib) Dx 10/12/2017, IDC, Right, Stage IV, metastasized to other Chemotherapy 10/21/2017 Xeloda (capecitabine) Radiation Therapy 11/15/2017 External Local Metastases 11/15/2017 Radiation therapy: Bone Hormonal Therapy 1/19/2018 Faslodex (fulvestrant) Radiation Therapy 8/2/2018 External Local Metastases 8/2/2018 Radiation therapy: Bone Radiation Therapy 11/5/2018 External Local Metastases 11/5/2018 Radiation therapy: Bone Targeted Therapy 10/10/2019 Verzenio Radiation Therapy 11/3/2020 External Local Metastases 11/3/2020 Radiation therapy: Bone Dx 1/22/2021, IDC, Right, 1cm, Stage IV, metastasized to liver, Grade 2, ER+/PR+, HER2- Chemotherapy 2/4/2021 Xeloda (capecitabine) Chemotherapy 10/8/2021 Other Chemotherapy 1/7/2022 Other

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