Fifteen years ago, Dr. Fumiko Chino was the art director at an anime company, getting ready to marry the love of her life, when her fiance was diagnosed with cancer.

Today, she’s a radiation oncologist at Memorial Sloan Kettering and studies the impacts financial strain has on cancer patients.

She opens up about her late husband’s diagnosis, the financial toll it had on them, and how she’s determined to help alleviate the financial burden for other patients and their families. 

Getting the cancer diagnosis

Like many 20-somethings, I was still trying to figure out my life. I was so happy to have met someone that I was in love with [and] that I could envision a future with.

When my husband, at the time boyfriend, was getting sick — he was having nausea, throwing up, [and] losing a lot of weight — we really thought it was not cancer. No one [who’s] young thinks, “Oh, this is cancer.” It’s everything other than cancer.

It took a little bit of time to find his actual diagnosis, [which was] high-grade neuroendocrine carcinoma.

We had just gotten engaged. We were planning our future, our family. It was just devastating. A cancer diagnosis [when you’re young] completely interrupts your plans.

What we didn’t realize was in addition to how emotionally and physically taxing it would be [was] how financially taxing it would be.

He had had a number of false diagnoses before he came up with cancer. He was told he had IBS. He was told he had celiac disease because he had a lot of cyclical nausea, vomiting, [and] weight loss. He ultimately went in for an endoscopy [and] they didn’t find anything.

They finally did a CT scan and found all of these enlarged lymph nodes throughout his thorax and, particularly, a mass that was compressing his pancreas, which was causing his GI dysfunction.

When they biopsied it, they found that it was not lymphoma, which is what we thought it would be. I knew we were in for a delightful cancer adventure with [an] unknown destination. It was such a long time period between the initial workup and when we actually found out what kind of cancer he had.

What was it like being a care partner?

Nobody signs up to be a patient and nobody signs up to be a caregiver but you do it because you’re trying to survive and you’re trying to support the people you love. I was so impressed with him [and] his resilience [in] being able to continue working as a computer scientist through really intensive treatment.

He always said — and this is something that he would have researched so I trust him — that he received more platinum-based therapies than Lance Armstrong did. He had a lot of cycles of chemotherapy.

He had standard nausea, vomiting, [and] weight loss. He had diarrhea, incredible pain, [and] a lot of anxiety. It was this constellation thing, which means that we were in the emergency room all the time. We were admitted to the hospital multiple times.

He dealt with a series of infections and it was just a lot to balance everything. I was still trying to work. I think our income was important to preserve as well.

At one point, I remember he wasn’t answering his phone. I texted him, “Are you doing okay?” He didn’t answer the next. Two hours later, I called him. He didn’t pick up the phone and at this point, it’d been four and a half hours [I’d] been trying to get ahold of him. I ended up actually driving home from work to check on him. He was just doing computer science coding.

Financial toxicity of cancer treatment

I always try to highlight financial toxicity. I’ve dedicated my life to researching financial toxicity, access, affordability, and equity. It’s all part of the same sphere. How do we get people the best cancer treatment?

Financial toxicity is incredibly common and, unfortunately, it’s going to manifest in someone in your clinic even if you don’t see it. They are going to see you and if you don’t see them — the whole them, the whole picture for them — you may miss it and you may miss an opportunity to intervene. My baseline is that this is common and you’re going to see it even if you don’t think you’re seeing it.

The second thing I try to emphasize is that there are really discrete effects of financial toxicities on our patients. People are not able to afford their medications. People [have] to skip out on visits. People are not getting the mental health care that they need. They’re not getting the dental or vision care that they need. Sometimes they’re missing scans. And for some people, they’re actually missing treatments.

I always try to emphasize that there are things we can do about them. There are things that we can do on the health policy level, at an institutional level, and within our own clinic to try to improve outcomes for financial toxicity. 

The first step is always just saying it’s okay to talk about it. This is the thing about sexual health or fertility concerns. We need to take the Band-Aid off. We need to say it’s okay to talk about these things. If physicians and patients are both unwilling to talk about this dirty underbelly of cancer care, then it’ll never be properly addressed.

What inspired you to get into medicine?

I was sleeping on the floor of an ICU on a collapsing air mattress when my husband was during his terminal hospitalization. That was my light bulb moment. I think I should go into medicine because I feel like I can try to make a change.

My initial thought was I’m going to be a nurse. I talked to my sister, who’s a physician, and she said, “You don’t want to go into nursing.” I was like, “They’re great!” And she’s like, “Oh, I agree. They’re like saints. There’s a hierarchy in medicine and physicians are at the top. You as a nurse who is going to be smarter” — as many nurses are — “than the physician who’s telling you what to do, it’s going to make you frustrated. Your personality type does not sit with that so you should be a physician.” I thought about that more and I thought, “You’re right.”

Transitioning into medicine was a challenge. I had to go back to school. I have a Bachelor of Fine Arts degree. I had to do some post-bacc classes, but it was absolutely the right decision for me.