In order to obtain a loan in France, there is a need for full disclosure of all medical history. This would include all history of cancer and chemotherapy if the patient received it. Based on the medical history, the insurer may ask for higher premiums (increasing the cost of insurance by 50-300%), limit the insurance policy by excluding some risks (including cancer), and refuse to give any insurance policy. Not disclosing the complete medical history will result in cancellation of the contract, even if the damage is completely unrelated to cancer and might even result in prosecution for fraud.
Dr. Dumas described the published French study on access to a loan after a history of childhood cancer1. This study included patient-reported outcomes and data from medical files. All participants needed to fill out a questionnaire, and the response rate was 72% out of 1920 participants. The mean age of participants was 36, with a mean time since diagnosis of cancer being 31 years. Out of the 1920 participants, 47% tried to obtain a home loan, 30% of them reported some difficulty in obtaining the loan, with 15% of them being rejected, 23% of them having to pay an extra premium, and 62% having significant insurance exclusions.
When assessing the factors associated with difficulties in accessing loan-related insurance, the disclosure of childhood cancer was the most significant factor, preventing the participants from getting insurance. In France, 31% reported difficulty in accessing loan-related insurance, while in other countries such as the Netherlands, this percentage ranged between 9-22%, depending on the type of childhood cancer.
Dr. Dumas then discussed on the “right to be forgotten.” This issue of complete medical history disclosure led the people to organize since the 1990s until the law was finally adopted in 2016. According to this law, cancer survivors do not have to disclose their history of cancer to the insurer, and have a right to be forgotten… If the person is younger than 18, after five years had passed from the treatment, he/she does not need to report cancer. Similarly, in adults older than 18 at time of diagnosis, they do not need to disclose the history of their cancer, if ten years had passed from treatment. The newly adopted law also forbids premiums and all sorts of exclusions. For each cancer, specific conditions were formulated on the specific amount of time that needed to pass to allow the participant not to be mandated to report on his cancer history.
Dr. Dumas concluded the discussion stating that access to insurance can impact material living conditions and social well-being, Update of the list of conditions entailed in the “right to be forgotten” include working group gathering, health care professionals, epidemiologists, insurers, patient’s representatives, national cancer institute, and national authority for health.
- Dumas et al. J Cancer 2017
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23, 2018, Munich Germany