Pink Fund: Providing Financial Assistance During Breast Cancer Treatment With Founder Molly MacDonald
For individuals with breast cancer, financial toxicity is a significant and often overwhelming part of the fight. Pink Fund is an organization which provides 90-day non-medical cost-of-living expenses, including housing, transportation, utilities, and insurance costs, for patients undergoing active treatment for breast cancer, enabling them to focus on healing before returning to the workplace. In this interview, Pink Fund's Founder, Molly MacDonald, shares the story of how she founded the organization, resources for both patients who are experiencing financial toxicity and for clinicians seeking to support their patients, and crucial messages for raising awareness of financial toxicity during cancer treatment.
Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith, and today I have the pleasure of being joined by Molly MacDonald, who is the Founder of Pink Fund. Molly, thank you so much for coming on the show today.
Molly MacDonald: Thank you for having me.
Oncology Data Advisor: Would you like to start off giving a brief intro about yourself?
Ms. MacDonald: Certainly. With respect to the work that I have the privilege to do now, which is mission-based, I was diagnosed at a time of job transition. I'd been through a financially devastating divorce, had five young children, and was thrust back into the workforce after being out 12 years. My previous career was in print journalism, and that world had changed dramatically and was really hard for me to reenter. Eventually, I segued my career into sales because it didn't really matter where I was. I had five kids, an aging mother, and was in that sandwich generation. As long as I was selling, they didn't care, so I was always making my numbers.
I was really good at this particular job, and I wanted to open a woman-owned division of a company that was producing this product that I sold, which was format graphics out of Kentucky. I quit my job, got my mammogram, got a call back, and had a biopsy. And on Friday, April 1st, I got the call from my obstetrician/gynecologist (OB-GYN), who had delivered all five of my children, delivering what for this year will be a death notice for about 50,000 women in the US. I had breast cancer. My disease was early-stage. It was unlikely to take my life, but it did take my livelihood. I didn't have that job opportunity. Without my income and with the addition of a $1,300 a month Consolidated Omnibus Budget Reconciliation Act (COBRA) premium—because this was pre–Affordable Care Act (ACA)—I didn't have any income. I had no child support, no alimony, and I was left bereft.
I wasn't eligible for Medicaid because at the time, Medicaid was predicated on your previous year's tax return. Now, if you have a change in circumstances and your income drops through the ACA, you may be eligible for Medicaid. So, I'm in treatment, can't make my house payment, house falls into foreclosure, and every 58 days, Ford Credit is asking if I'm planning to make a payment on my vehicle or if they should plan to repossess my car. Then at the end of my treatment, the utility companies, which often will allow people to make small incremental payments, have become quite impatient and are threatening to shut off. I was looking at literally becoming homeless.
The real sort of the Oprah "Aha!" moment that launched Pink Fund was listening to other women in the treatment waiting rooms who had much more aggressive disease, longer-term treatment protocols, and inability to work. They were concerned that their treatment protocol would outlast their Federal Medical Leave Act benefit and they would be left without a job. They were talking about stopping treatment and going back to work, and that was it. I was like, "What?" They were making a choice between their actual lives and their livelihood.
At this point, I had remarried and am still married to this wonderful man, for 21 years. I call him Tom Terrific, because as I say, you have to be pretty terrific to marry a middle-aged woman with five children, night sweats, and a mildly demented mother. I went home to Tom and I said, "I have this idea." By the way, my husband was working at the time, but he worked in the luxury piano business, so his income was not steady. He worked on the concert stage as a piano technician. When performing artists come to the Detroit area, they'll use him. We had some money to make that COBRA premium, but we couldn't make all the other bills.
Anyway, I went home to Tom said, "I have this idea. I think we should pay these women's non-medical bills to their creditors for 90 days while they're on leave, provide some kind of financial bridge, and hopefully that will impact their ability to complete their treatment protocol." He looked at me like I had two heads. He said, "Well, you've not only lost your right breast, but now you've lost your head." But he went along with it, so we launched. To fast-forward, this month we will have paid out $7.3 million in bills to patients' creditors for housing, transportation, utilities, and insurance nationwide.
Oncology Data Advisor: That's absolutely incredible. Thank you so much for sharing your story. Pink Fund is obviously a really unique organization that does some wonderful work, so I'd love to hear more about it. What is some of the specific work that the organization does to help breast cancer patients and survivors?
Ms. MacDonald: We're very simple; we stayed on our mission. Basically, the way our program works, which is essential to the understanding of your viewers and listeners, is that women or men who experience a breast cancer diagnosis and have experienced a loss of household income—either they or a spouse or domestic partner has lost income and they're not able to make their basic bills—can apply for support from us. We will provide up to three months and a cap of about $3,000 in financial assistance. The criterion for qualifying is that with the loss of income in the household, your household income is at or below 500% of the federal poverty level.
To give you an idea—the chart is on our website under "Get Help"— but to give you an idea, for a single person in this country in 2023, 500% is about $74,000. In some zip codes, that puts you well below the federal poverty level, but allows us in other zip codes to kind of bring in the middle class that is often left out of supportive services. Many supportive services, not only for copay assistance—which is medical assistance or the kind of support we have—will look at maybe 250% or 300% of the federal poverty level. We feel that this differentiates our program because people in the middle class are just as vulnerable, if not more vulnerable, to falling into a poverty situation because of a critical illness like cancer.
Oncology Data Advisor: If anyone is interested in learning more about Pink Fund or interested in learning more about how to receive assistance, how should they go about finding out more information?
Ms. MacDonald: Go to our website and click on "Get Help." You will be asked five pre-qualifying questions. One is, are you on active treatment for breast cancer? By our definition, this means mastectomy, chemotherapy, or radiation therapy. It does not include reconstruction that is received months or years after your initial treatment plan. It does not include the aromatase inhibitors, the tamoxifen or anastrozole, that you are prescribed to take for up to 10 years. Active treatment, household income at or below 500% of the federal poverty level, and a demonstrated loss of income are the criteria.
Then you'll provide your email address once you've answered those questions, and we'll email you the application. The application is sometimes challenging for patients. We ask for a lot of information because we are good stewards of the donor dollar. I look at it this way—for every dollar that a donor gives us, we want to know if we're spending it wisely. While people can tell us their narrative and their story, which they do, and those stories are heartbreaking, all our decisions are based on a fully filled-out application with supporting documentation. Supporting documentation is a copy of your federal income tax return, two months of bank statements, copies of the bills you want paid, and a copy of your driver's license.
Then we get some of your medical information. There's a personal form that you fill out where you identify your name, age, who's in the household, all those kinds of things. That application is processed and put into a database. Then on the second Monday of every month, a volunteer group of individuals come in and work in pairs or threes. They review that application and then help make funding decisions on how to best help the patient over the three months that we are able to provide support.
Oncology Data Advisor: Awesome. That's great to know. We'll definitely share the link to your website, that way anybody who's interested can learn more. To switch gears a little bit, since the majority of our audience is clinicians—we do have a lot of patient viewers as well, but our target audience has historically been oncology clinicians—is there anything that health care professionals can do to help alleviate financial toxicity that their patients are experiencing?
Ms. MacDonald: It's very difficult for a patient, at the beginning of diagnostic testing and presentation of a treatment protocol, to understand if they're going to experience financial toxicity. Two things happen. They're in a complete brain fog, trying to digest not only the diagnosis, but what the treatment protocols looks like. One of the things that's really important on the clinician side is to have a discussion about, "Do you have any concerns about being able to get to treatment?" Transportation is a huge issue. In some cities you have public transit, but in rural areas you've got to have a car and you may have to drive several hours to a major cancer center. Are you concerned that you may not be able to work following your chemo infusions? Those things need to be discussed, and they're real possibilities.
Some people go through chemo. My husband's going through chemo right now for head and neck cancer, and he comes to work every day. He gets there at 1:00, and he'll work until 8:00 or 9:00 at night and then come home and sleep. But he's able to adjust his schedule. Many people are not able to work with an employer that way, particularly if you're working in retail and you have set hours. Two things have to happen. A lot of people think about the cost of cancer treatment as the medical costs. What is your deductible? What is your copay?
Those things need to be discussed in the provider setting. I don't know if it would be the clinician, but if there's a patient navigator or a financial navigator or a social worker, those discussions need to take place and they need to take place early on. Often what we find out is that patients get to us closer to the end of treatment when all hell is breaking loose. In my situation, my home went into foreclosure. I was able to rescue it with the help of my mother, but that would have left us in a terrible situation if we would not have been able to even rent an apartment. When I say we could have been homeless, we could truly have been homeless.
Often in the clinical setting, their job is to cure the patient, to treat the patient, but they don't understand that financial toxicity is a piece of it. We've got transportation barriers, we've got loss of income barriers, and then we have a new term that I just learned about called time toxicity barriers. How much time am I going to have to arrange for a sitter for my children? How much time is it going to take me to get to the treatment center? These conversations need to be done sensitively and carefully because patients are already in a very vulnerable state. They're often concerned that if they express any concern around not being able to afford their care, they will not receive the best care. We've had people tell us, "My doctor said that they could give me a lower dose of chemo so my side effects wouldn't be as acute." Well, in my mind, a lower dose of chemo might mean an increased risk for recurrence down the road.
My suggestion is that these conversations take place. The patient, who may be an introvert and also vulnerable and scared and flooded with all this emotion and can't think, should bring an advocate with them, whether that be a spouse, a friend, or another person who's been in treatment for cancer—somebody who will speak up for them so that they don't have to speak for themselves. I think that's a very effective thing to do because that makes the advocate the bad guy or good guy, and the patient can just be the patient. The other beauty of having the advocate with you in a meeting is that they can take notes for you, and then after the end of the meeting, you can review what you think you heard. Often, we're told that what the patient hears and what the advocate has written down are not the same.
Again, I think that you need to check in with the patient when they come in for monthly infusions. Along the treatment plan, the protocol, the timeline, I think you need to continue to check in. Are you okay? Are you able to work? If you're not able to work, how many hours are you losing or how much income? Then they can begin to point them towards resources. The most important thing is that treatment adherence is not impacted because of loss of income. When treatment adherence is impacted, the patient is not going to call you and say, "I'm not coming to chemo today because I can't get there." They're too embarrassed. Now you have a chair that's left in the provider setting and they're not able to bill on that. It becomes a whole holistic problem.
Just checking in on the financial wellbeing of patients and caregivers along the treatment protocol is best. While the Pink Fund works exclusively in the breast cancer space, we know of course that there are all kinds of disease states for cancer. One of the other national organizations that's a great one is Cancer Care. They'll provide other resources about financial support. Triage Cancer is a fabulous website for all kinds of legal and insurance things. Both of those organizations list resources. Then on the medication assistance side, your clinicians probably know about this, but the Patient Advocate Foundation, Patient Access Network Foundation, and Health Well are the three big ones that can help with medication support. We call it prescription abandonment when the prescription is filled, but the patient doesn't pick it up because they can't afford the copay.
Oncology Data Advisor: Great, thank you. Those are all really helpful resources and definitely great ones that clinicians can share with their patients. My final question for you is, since October is Breast Cancer Awareness Month, are there any messages you would like to share with either patients or clinicians in hopes of raising more awareness of financial toxicity?
Ms. MacDonald: We kind of refer to October as Breast Cancer Unawareness Month, and I don't have my ribbon here, but we turn that pink ribbon upside down to show a sign of distress. People are very much aware, I believe, that one in eight women will be diagnosed in the US with breast cancer in her lifetime. About 2,000 men will be diagnosed per year. That's something that people are very much unaware of, that men get breast cancer. Men don't check their breasts, unlike women, who are told to know about their breast health. If a man feels a lump, he may not think anything of it until it's really bulging out or weeping, they don't get checked. I would say that's something to really do more education around, and we'll be doing that at Pink Fund.
The issue around financial toxicity is that it's not just insurance copays and deductibles. I think it's really that lost income. When those things all collide, that's when life begins to fall apart. I'd like to wrap this up with one thing. I describe your life as a Jenga tower, if you've ever played Jenga with those blocks of wood. When you get a cancer diagnosis, regardless of what type of cancer, immediately the foundation of your life is rocked. That middle block is not the one that's pulled out. It's one on the right or the left. Then you find out that that insurance plan that you elected had a very high deductible, but you never thought you'd get cancer. It wasn't in your family. You had no knowledge of any genetic predisposition to get cancer. And oh, by the way, it's November and that deductible's going to reset in January.
Your life is full of holes, and you've sat with your treatment team and been told you probably aren't going to be able to work two or three days after chemo. You may have to take time off. Now we've got high deductibles and lost income and no work. What do you tell your employers? What I say is your life is starting to do this. It's swaying, and it's not collapsing yet, but it's swaying. In Jenga, you know those blocks, that pressure keeps mounting and that affects your mental and emotional health. Organizations like Pink Fund come along, and we don't fix this problem permanently, but we come along like scaffolding. We're trying to hold you together for a period of time. We hope that we can get you through the treatment protocol and on towards survivorship, and that we can also point you to other resources to cobble together more support.
Oncology Data Advisor: That's a really great analogy. Thank you so much for sharing these messages and for telling us more about Pink Fund. It's really a fantastic organization, and I'm looking forward to sharing information about it with our audience.
Ms. MacDonald: Thank you so much. If anybody has any questions or concerns, we have a Community Outreach Manager, Rosalind Sample. You can email
Oncology Data Advisor: Awesome, that's great to know. Thank you so much again for sharing all this today. It was really great talking with you.
Ms. MacDonald: Thank you, Keira.
About Ms. MacDonald
Molly MacDonald is the Founder and CEO of Pink Fund, which provides 90 days of non-medical financial aid to help breast cancer patients cover their living expenses. She started the organization in 2006 after undergoing treatment for early-stage breast cancer. To date, Pink Fund has paid $7.3 million to assist patients with housing, transportation, utilities, and insurance costs. Ms. MacDonald has received several local and national awards, and she is a sought-after thought leader and keynote speaker regarding cancer-related financial toxicity.
For More Information
Pink Fund (2023). Real help for the other part of the fight. Available at: https://pinkfund.org/
CancerCare.org (2023). Available at: https://cancercare.org/
Triage Cancer (2023). Available at: https://triagecancer.org/
Patient Advocate Foundation (2023). Available at: https://www.patientadvocate.org/
PAN Foundation (2023). Available at: https://www.panfoundation.org/
Health Well Foundation (2023). Available at: https://www.healthwellfoundation.org/
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.