Hi everyone, we are back and talking about blood cancer. In this episode Matt explains how the different blood cancers affect the body, which has really helped me to visualise what happens when they develop.
We also have a brief discussion of someone’s right to forget that they have had cancer, in France and Belgium. This is something that is not yet done in the UK, it is an interesting concept, it would open up the options to a lot of people to get insurance and we discuss why that would be a good thing, and also the knock-on effects it would have across the market.
The key takeaways:
- There are 250,000 living with blood cancer in the UK.
- There are different types of blood cancer: leukaemia, lymphoma, myeloma, myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN).
- A case study of life insurance for someone living with CLL phenotypes.
Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website, thanks to our sponsors Octo Members.
If you want to know more about how to arrange protection insurance, take a look at my Protection Insurance in Practice course here.
Kathryn: Hi everyone, this is episode six of season four and today I have Matt back with me. Hi Matt!
Matt: Good morning Kathryn, lovely to hear from you and congratulations on your wedding anniversary.
Kathryn: Thank you, thank you.
Matt: The picture was absolutely lovely and as I’ve maybe mentioned, you looked an absolutely lovely and radiant bride, as expected of course, and Alan looks shocked.
Kathryn: He does. Alan looked shocked. He was very young, he looks incredibly young in the photo as well.
Matt: He does look young, God bless him, but I’m sure those 16 years have –
Kathryn: Aged him, yes.
Matt: Have been great fun. Anyway, moving swiftly on –
Kathryn: Absolutely.
Matt: Lovely to speak to you again.
Kathryn: Lovely to speak to you too. So today we’re going to be talking about blood cancer and insurance applications. So this is the Practical Protection podcast. So for everybody that is sort of like joining in and listening, we’ve got a little bit of a background in terms of things like blood cancers ‘cos I think sometimes we hear some of the terminology and we’re not completely sure whereabouts it sits in the – kind of like where it is cancer-wise and then Matt’s obviously going to help us to really understand the real sort of like technical, medical side of things. So just some quick statistics just to help sort of like put it into perspective as to how much you might speak to people with this condition or these conditions even. So there’s roughly 250,000 people that are living with blood cancer in the UK. Every year, it’s quite a sad statistic, but every year 500 children under the age of 15 are diagnosed with a blood cancer.
So as I was looking into this doing the research, what surprised me is – ‘cos I know a lot of the main ones, you know, there’s certain ones that you do tend to hear more often than the others. But there are more than 100 types of blood cancer and it’s also the third biggest killer when it comes to cancers within the UK. So blood cancers I believe are generally split into sort of like three or four areas. So Matt, do correct me if I’m wrong. So we’ve got the blood cancer which is leukaemia and you will have heard of things like chronic myeloid leukaemia which is known as CML. You’ve got acute myeloid leukaemia which is AML, chronic lymphocytic –
Matt: Yeah.
Kathryn: Yeah, lymphocytic, thank you – leukaemia, CLL and acute lymphoblastic leukaemia which is ALL. So they’re some of the main ones or certainly the ones that I have come across as an adviser. You then also have more the lymphoma side of things and this is one that we’ve probably heard a bit more about especially when it comes to celebrities and things like that. So you have things like Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. You can also then move onto a couple of other areas which is a blood cancer called myeloma and then there’s also – I’m going to say I’m giggling ‘cos I’m going to know how badly and poorly I’m going to pronounce this so I do apologise ‘cos it is a very serious topic. But it is myelodysplastic syndromes so MDS.
Matt: Full marks, Kathryn. Top marks.
Kathryn: Thank you.
Matt: Absolutely spot on.
Kathryn: And myeloproliferative neoplasms which is NPM. So I know – as I say, I just mentioned there’s obviously been some celebrities with different cancer. I do think there’s been quite a lot of stuff at the moment where cancer – I don’t know why but I think it shocks people quite a lot when you hear celebrities with – obviously it always shocks us when somebody we know has it. It always shocks us when we find out a child that we know or hear of has it and then you have people like – I know you’ve got people like there was Andy Whitfield who was one of the main characters in Spartacus or the main character, he was Spartacus even. He passed away from non-Hodgkin’s lymphoma – I think he was diagnosed around the age of 39 but then you also have other people as well – so you’ve got the guy who played Dexter in the TV series – he’s Michael C Hall and he had the Hodgkin’s lymphoma, diagnosed around the age of 38 and he has managed to obviously get through the treatment and is still with us and living.
So obviously I know there’s lots and many types but I think what would be quite good is Matt, if you could give us a summary and I imagine it might be quite hard – well I think it might be that a summary of leukaemias versus a summary of lymphomas might be very different but can you just give us a bit of a background to blood cancers please?
Matt: Yeah absolutely. One of the things – in fact if I can take a step back Kathryn just for 30 seconds is – reading an article recently and it just builds on the numbers of people living with blood cancer – but recent statistics show that one person is diagnosed with a blood cancer every 13 minutes in the UK. That’s 110 people with a diagnosis a day and 40,000 per annum which kind of underpins I think the 250,000 which you mentioned –
Kathryn: Yeah.
Matt: In the introduction. So it is a pretty common disease and the whys and wherefores of why there has been an increase are quite frightening and quite stark really.
Kathryn: Okay.
Matt: And a lot of the thinking is around the environment that we live in with chemicals on agricultural land and various other cancerous – or potentially cancerous-leading substances in our daily diet. It’s quite amazing. Nothing ultimately proved by the way there –
Kathryn: Yeah.
Matt: But you can certainly see that it’s something that’s very much on the increase. Okay, sorry to digress as always with me.
Kathryn: No that was good, thank you.
Matt: We’ve got three particular areas of blood cancer which you’ve alluded to; leukaemia, lymphoma and also myeloma as well. Now these are all different subsets if you like of what’s generally termed blood cancer and really the way that these are broken down in terms of clinical medicine, in terms of the doctors, is rather where they impact and particularly with the terms acute and chronic, how quickly they actually spread. But as with all cancers, the cancers themselves develop from what would normally be cells in the body which uniformly grow if you like into tumour cells and so on and so forth and it’s a slow progress and uniform progress. But with cancer, when something goes wrong with those cells and they don’t uniformly duplicate – replicate, then that is when you would get a cancer. That’s the same with all types of cancers. It’s no different ultimately to blood cancers as well.
I’d also say the staging in terms of an underwriting practice – also clinical medicine as well is very similar with blood cancers. In other words, you start off down at stage nought slash one where the tumour or the cancer rather is very localised and right up to stage four when you’ve got distant spread. So there are common themes with the way that underwriters will certainly look at cancer with many other types of cancer but nevertheless today is about blood cancers and I’ve mentioned leukaemia and you’re absolutely right, it’s a type of cancer which actually affects the blood and the bone marrow and here you will get those blood cells – particularly white blood cells which rather than acting in a uniform way start to duplicate completely out of control and they’ll impact the blood, they’ll impact the bone marrow and in fact stop the bone marrow from actually doing its job in the body if you like.
And white blood cells, as I’m sure many of you listeners will know, are absolutely key in fighting infection in the body and you certainly I’m sure will have heard of T-cells recently in relation to Covid and you think of an infection there and a virus that impacts the body and white blood cells that we all have are absolutely key to fighting that. So people who are immunosuppressed for one reason or another but usually because they have a form of cancer or a variety of medical conditions, let’s face it, then they will be susceptible to viruses such as Covid. T-cells you’ll see a lot of, I think, if you read articles on Covid. Leukaemia – lymphoma is very much where the cells find themselves in the lymph nodes and the lymph tissues of the cells. That’s typically where they tend to accumulate. Again, the cells act in an out of control manner to phrase it differently and they can block the function of the lymph nodes which – one of them obviously is to transport white blood cells around the body to help infection but also reduces or takes away waste matter as well. So when those types of bodily functions are impacted when those white cells can’t get to an area of infection then the body will find it hard to eventually sustain itself and keep on going.
Myeloma is a – again, a bone cancer which impacts the bone marrow, in particular cells called plasma cells which are very important in transporting lymphocytes around the body to fight infection. The plasma cells are actually formed in the bone marrow and it’s those cells which effectively do not behave themselves when they’re replicating and will clog up and stop other cells forming which are important to the body. Bone marrow, as you probably will know, it’s not just about white blood cells, it’s also about red blood cells which obviously produce oxygen around the body and also platelets which are incredibly important for clotting – blood clotting. When you cut yourself and you bleed then the platelets come in and stop the bleeding.
All of those things can be impacted, so doctors and underwriters will look at the site of the blood disorder – so the blood cancer and will break down or come up with a diagnosis. That will obviously be made by a doctor, a consultant haematologist often or oncologist for that matter and we will act accordingly as an underwriting professional and the doctors will obviously treat those people differently as they see fit. The ways of treating these – does that help, Kathryn, by the way?
Kathryn: It does, I’ve got –
Matt: I’ve kind of splurged out – hopefully not too technical but just given a – hopefully an overview of the different types and it really is the sites of where they are – where the blood cancer is –
Kathryn: Yeah.
Matt: Acute – sorry, go on.
Kathryn: I think it’s helped me. I think probably for me ‘cos I’m very, very visual in the way that I remember things and I take things in and I think in my mind I’ve kind of almost got like a children’s cartoon of a blood artery or something in my mind and like little, you know, cells bopping along in like a red river kind of thing for the blood and I’m trying to sort of like picture in my mind how it works. So I know when you’re sort of like saying look for where the site of it is; for me, when I think of blood cancer, I think of the fact that I, you know, I’m thinking it is the blood and that it’s – and I suppose because it is the white blood cells but I suppose for me I’m kind of framing in a slightly different way. So like when you were saying about the lymphoma. It is a blood cancer but it’s not necessarily that the cancer is travelling around in the blood, it’s that it’s within the lymph node and it’s affecting the function of the cells within the blood that’s now going around the body. Is that the right way to think about of the lymphoma?
Matt: Yes, absolutely. That’s the best way to look at it at a high level, yeah. Absolutely. I mean, you know, with the – you’ll find that the leukaemias tend to – the cancers, at least when they’re localised –
Kathryn: Yeah.
Matt: When in fact when you think bone marrow and bone marrow being a manufacturer of blood and when the bone marrow itself – the cells within the bone marrow cannot function properly, then that can impact the whole – it can impact everything that travels around in the blood.
Kathryn: Okay. So say like with the leukaemia then, so obviously when you’ve said that the blood and the bone marrow – so would you be – is it a case of – just so I can make sure that I’m understanding – so it could be with like leukaemia that they’ve maybe said, “Well you’ve got leukaemia and it’s maybe sited –” I don’t know – I don’t know the name of the actual bones but your thigh bone. Would that be –sort of like – am I understanding that right?
Matt: Yes it can be, yeah. I mean, the cells will travel around and if it’s localised then yes they will travel round and metastasise as we call it –
Kathryn: Yes.
Matt: i.e. settle in a distant organ.
Kathryn: Yeah, I think for me, because of the fact that we’ve always, you know, this is definitely really helpful for me because I’ve just always pitched it as in blood, as in I think of the blood. I don’t think of it as being localised, I think of it – because blood is everywhere in the body, I’ve always felt that it’s kind of like – well it’s everywhere. And that’s completely my lack of – in a sense my lack of knowledge and understanding but I think probably in my mind visually that’s what I’ve always – and felt – I didn’t realise it would be localised to a specific area. But as you say, yes, ultimately it is the blood though and it might probably – obviously start and originate in one place like other cancers can do but it can go off and metastasise. So that’s incredibly helpful for me, thank you.
I suppose the next thing to probably sort of like look at is what are the kinds of symptoms that somebody would generally have for blood cancer?
Matt: When absolutely researching this and particularly in terms of the symptomology, there are two things that I tend to look at. Based on my own experience, so reading thousands of hospital reports over the years with people who sadly suffered from some of these conditions but also looking at the various websites and –
Kathryn: Yes.
Matt: I’m not entirely convinced that the websites are fantastically helpful I have to say and I’ll probably be shot by anybody listening to us today who produces these things because the – what we tend to see is a whole variety of symptoms and it’s, you know, I could be here for half an hour just reading them off the internet to be perfectly honest with you.
Kathryn: Yeah.
Matt: But, you know, let’s just look at chronic leukaemia. Now remember I may have just touched on this but acute – when you’ve got the term ‘acute’, what it means is that somebody is suffering from an aggressive form of leukaemia which can spread rapidly, okay? Chronic tends to be the term that is given to somebody who has got leukaemia but it is relatively – compared with acute – slowly growing.
Kathryn: Okay.
Matt: Okay, so there is a differentiation between the two. I know some of the cases that I’ve seen and I think you’ve seen as well Kathryn, are these pre-leukaemic conditions where we’re not ultimately sure whether it’s going to turn into a – what they would define as a chronic leukaemia but there is certainly something abnormal in the blood that could and may not – or may not turn into a cancer. And those are very frustrating cases of course –
Kathryn: Yes.
Matt: To try and underwrite and from a clinical position then it’s a wait and see type scenario. You know, take bloods every year and see if there’s any change where they – then the commission has to get involved and treat – In terms of – I mean, chronic leukaemia – let’s take those, so, swelling of the spleen, liver and lymph nodes. Lymph nodes and cancer I think are pretty well known. They have lumps and bumps particularly in the armpit. Some of the blood cancers, the lymphomas – swelling in the neck and in fact a very good friend of mine I remember on the – before she was even diagnosed, came to me and said, “There’s something in my neck, what do you think it is?” And I said, “Well, don’t know, could be something, could be nothing,” and eventually it started to grow quite quickly and in fact she was diagnosed with non-Hodgkin’s lymphoma a few months later. Still with us, thank goodness, I have to say. I was speaking to her the other day.
Anyway, so if you’re looking at leukaemia, bleeding and bruising. Those are the things that are classic that maybe a lot of the listeners will have read about or heard about. But really when you’ve got a kind of acute, it’s a long old list. A fever, lethargy, bone pain, muscle pain, anaemia, shortness of breath, heavy bleeding during menstruation, you know, I think if we spent a lot of time really thinking about some of these symptoms, I think we would be down the doctor all being extremely worried –
Kathryn: Yeah.
Matt: All of the time. But I think the – for me – I share this with friends and family, is knowing your body, what’s normal for you –
Kathryn: Yeah.
Matt: And if colds and coughs and shortnesses of breath continue more than a few weeks then seek help.
Kathryn: Absolutely.
Matt: Or get a second opinion. These are the types of things but they’re, you know, it’s hard to answer your question about symptoms. Very wide-ranging but I think it’s around thinking what is normal for your body and also common colds, coughs, as we all know, maybe last 10 days or so but once you get to two or three weeks – certainly three weeks, then it’s time to ask a doctor or a medical professional for their advice. Sorry I couldn’t give you a direct answer. Does that help?
Kathryn: No. I think it does help and I think it’s important to know that ‘cos it can be worrying sometimes – like you were saying, ‘cos I mean – obviously, you know, I’m always shattered, you know, I bruise horrendously as well but that’s because of something else, you know, it’s because I’ve got the hypermobility syndrome so I do bruise incredibly well. My tiredness comes from a few health conditions and obviously just generally life and children and work and all this kind of stuff but I think, you know, it’s being, like you say, it’s being aware of your body because obviously I can have that and I have those already so, you know, there could be that thing of sort of like thinking, “Oh no, I’ve got all these things and these are signs, I should get checked.” But then obviously they’re my normal but then also being very vigilant because even though they’re my normal, if it was suddenly more so –
Matt: Yeah absolutely.
Kathryn: Also just so, you know, to not sort of like be complacent with it and I think a big thing – and I’m sure a lot of the people who are listening will be aware of this is obviously I think a lot of people over the last year or so have really put off going to the doctors.
Matt: Yeah.
Kathryn: I think, you know, if it was something – if someone felt a lump then even some people still have put that off but I think a lot of people who would have felt a lump probably would have still probably sought some sort of advice but when we’re talking about these kinds of cancers where there’s probably not a massive – like you said, the symptoms are so broad. You know, it could be that, you know, if you have been extra tired and you have had naps and you have had this and that, you know, that you maybe just think, “Oh well I’m just run down ‘cos I’ve been working from home and I’ve not been able to escape.” But it’s still probably – as you say probably that timeframe. What’s your normal? If you’re outside of what your normal – what your body normally does then there’s no hardship in going and finding out and obviously finding out as quickly as possible.
Matt: Absolutely and I would also say, with doctors and nurses and medical professionals being so busy and I know from my own personal experience, if you know yourself that it’s not normal for you to feel in a particular way, be insistent.
Kathryn: Yeah.
Matt: Don’t get put off by somebody in the medical profession saying, “Oh well look, try another couple of weeks or so,” or, “I’m sure it’s nothing.” Be insistent.
Kathryn: Absolutely. We’re really lucky. Our GP surgery has been absolutely amazing this entire time. Really, really good. But what they’ve also introduced and I don’t know whether or not this is something that other people have. It’s maybe a good idea to look. Our GP surgery has just done this thing where on their online – well their website, they have a specific system where you can like click a link and it says, “Right, are you a patient with us?” And you say yes obviously and then it will say, “Right, what part of your body? Where’s something going on?” And so you choose whereabouts in your body it is and then it says, “Right, so where – what do you think is going on?” and maybe give you a few different things or maybe an other and give you a free text box and it will ask you sort of like, “Well, have you been doing anything? Have you tried anything and it’s not worked so far?” And just like getting some information and then they’ll sort of like say at the end to you, “Right, what times can we not call you?” Probably a bit easier than saying, “When can we call you?” sometimes.
And then it just goes into the system and it has been so efficient and, you know, I’m using that and I’ve used it for the kids, I’ve used it for me and, you know, you get contact so, so quickly back from it and, you know, it’s – I really think it’s the way forward to be honest. I mean I don’t, you know, I definitely still want to see GPs and obviously as well quite a bit of the time they’ve turned round and said, “Right –” They’ve maybe sent us a text or message link and said, “Can you send us a photo of what you’re meaning?” Or, you know, “Can you just pop in and see us?” And it’s just been wonderful and I think, you know, if anybody – if you are uncertain and you are worried about maybe being a pain or something, maybe see if something like that is available on your doctor’s website because as I say I think it’s incredibly useful and also as well do always double check and do –
If you’re an adviser or anybody who’s working with people and they are your client potentially, remind them about those value added services. You know, they potentially do have access to some of the support services whether or not that’s speaking to specialist nurses. Whether or not that is getting remote video GP appointments. Anything like that. It could really help somebody and it might just encourage them – doing something like that might just encourage them to do it rather than them having to wait to go to the GP or feel like they’re wasting the GP’s time.
Matt: I think those words are very, very powerful without any shadow of a doubt. I think, you know, those systems are useful.
Kathryn: Yes.
Matt: And if I go back to – well touch wood I’ve been okay for the last at least 10 years anyway but either which way, if you go back to the old days when you went to see your GP, the first five minutes if not longer were about the GP asking about your symptoms.
Kathryn: Yeah.
Matt: What that actually does is triage that appointment doesn’t it because the doctor – when, if they do need to see you or speak to you, can already know what the problem is or the potential problem is.
Kathryn: Absolutely.
Matt: And it also gives them time to think, you know, being presented with a load of symptoms immediately, it’s a blimming difficult job and I know GPs do a fantastic job but that’s pretty damn difficult. If you’ve got a, you know, you’ve got to phone up Mrs Smith at nine o’clock this morning and she has A, B, C, D then actually that does give the GP a little bit of time to think about what the issue might be and the poignant questions to ask. So I think it’s a form of triage as I call it as an insurance person and I think it’s great and I think the more doctors introduce that – I don’t know if our doctors do, I have to say – then, you know, it will help doctors and patients and the NHS to no end.
Kathryn: Well I think – I do think it’s brilliant. I do think I confuse them though because I am somebody – I do sort of like – I do Google and obviously I work in obviously the – sort of like doing quite a lot with terms of medical conditions and I’m also obsessed – and I know this is going to sound terrible. I bet loads of people will turn around and go, “Ugh.” I got really obsessed – I don’t know why, in one of my pregnancies – the pregnancy with my middle child, I got obsessed with watching the show Dr Pimple Popper which for most people is obviously absolutely vile. I got obsessed with it and I happened to have it on the other day and I have absolutely diagnosed my Dad with a skin condition and with my eldest he’s had a little bit of something going on. I was thinking, “I know what that is as well ‘cos I saw that the other day on the show.”
And I don’t use the technical terms with the GP but I’m like watching what she’s sort of like saying and I’m like writing symptoms down, “Well it’s this, this, this, this – about the size of this and it’s presenting itself like this,” and all this stuff and obviously when they look at it, it does say, “Mother is Dr Kathryn Knowles,” on the system and they’ll ring me up and go, “Are you a doctor?” and I’ll go, “No I am not. I am sorry, I just write a lot of notes and things.”
Matt: And you see how doctors talk to each other.
Kathryn: Yes.
Matt: And therefore you’re going to – I do exactly the same Kathryn. So don’t –
Kathryn: Absolutely.
Matt: No, we can laugh at ourselves really but it’s – I hope it helps the doctors.
Kathryn: I do. I do really feel though that they’re maybe thinking, “Honestly,” but no I think I’ve been helpful so far. I’m just going to convince myself that I’ve been helpful. I’m going to internalise that I was helpful and not think about being very unhelpful or a sort of like intense parent. But in terms of the blood cancers then, the next bit, so what are the kinds of treatments that you would usually expect?
Matt: When we’re talking bone marrow and we’re talking the disease has advanced – you’ll have heard of bone marrow transplantations.
Kathryn: Yeah.
Matt: And also stem cell therapies that are more common these days and really that’s – a stem cell is just the main body – it’s a cell –
Kathryn: Yeah.
Matt: But it can turn itself, depending on its make-up, to any type of cell. So in other words it will help the bone marrow rejuvenate in simple terms. To be honest with you, you can have many types. You can have chemotherapy, which is very – which, again, is very, very common. Sometimes with – you can have radiotherapy as well if there’s a disease – distant part of disease that needs – cancer that is – that needs tackling. What you will sometimes find when there’s been high dosage radiotherapy or high dosage chemotherapy, then that’s effectively – it’s too strong a word but it kills the bone marrow.
Kathryn: Yeah.
Matt: And impacts it so much that it can’t function properly and bone marrow transplants will come from that. So really you’re looking at the standard forms of cancer treatment from years ago but also you’re looking at immunotherapy as well which is another one – another form of therapy which gets used a lot these days which effectively just stimulates the body to produce a much more positive, more widespread immune response to actually attack the cancer –
Kathryn: Yeah.
Matt: The blood cancer in this particular topic. That’s being seen in many different types of cancer now and with some fantastic impacts and results coming through it. So I’m sure we’ll see more of that. I think I was just – again, the sad person that I am, I was reading an article the other day about – I’m sure it was leukaemia and it was saying that – I think the data period was around 2010 but the five-year – doctors – oncologists, cancer specialists and underwriters love talking – I say love, not the right word, talk about five-year survival rates so how long a person will – or a percentage of people that can get to five years post-treatment. How many survive five years. And with – as I say, it was around 2010, 2014, the mean survival rate for leukaemia was around 69%. This is all age groups. In 1975, so just 25 – 35 years previously, it was at 75 – sorry it was 35%.
Kathryn: Right.
Matt: So you can see already – and this really – if I think about the timeframe of the positive study there, that’s really before I think the interventions like immunotherapy and so on and so forth – that was what, 35 – let’s say double? So things really have progressed with blood cancer, there’s absolutely no two ways about it and again if we look at the youngsters, the tiny ones that get leukaemia, then generally these days there’s a 90% five-year survival rate.
Kathryn: Brilliant.
Matt: So, you know, it’s all heading and moving in the right direction on this and eventually – we can never say when in terms of the underwriting profession working closely with the actuaries obviously, then those terms should be reflected in when people come for life insurance.
Kathryn: Absolutely. So I’ve got a –
Matt: Potentially.
Kathryn: Yeah, potentially. Hopefully and potentially. So I’ve got a thing where I’m sure I’m going to be posing a question at some point as to sort of like why something happens certain ways and everything and I hope you’ll obviously be able to help me but maybe putting you on the spot a little bit. But for this next one I suppose the question I have is, you know, what is the risk, you know, if somebody has had something like leukaemia or lymphoma, what is the risk of that person getting – well, being diagnosed with it again or it recurring compared to somebody else who’s never had it?
Matt: It’s a very, very good question and I still – I think partly the answer to that is from an insurance actuarial perspective, in other words where an insurance company will feel confident setting their rates, we’re probably too early to say – to have the range of statistics –
Kathryn: Right.
Matt: Required for insurers to say, “Well okay, this person –” I think you mentioned an example a while ago now and I think from memory there was a woman who was close to 30 who was diagnosed with leukaemia at three and a half, had a recurrence at age five, was that about it?
Kathryn: Yes that’s the one that I was going to chat about next.
Matt: Oh I’m sorry, go on.
Kathryn: No it’s alright. No, no.
Matt: I think to answer your question directly without me digressing whatsoever – sorry, as always, the statistical basis in terms of the numbers – absolute numbers of people surviving for a significant period afterwards are not there yet.
Kathryn: Okay, yeah. I understand that because obviously as well I do appreciate that insurers have to go off statistics, it’s part of the basis of all underwriting and actuarial work, there we go.
Matt: No absolutely, yeah.
Kathryn: But yeah, so with this one it was somebody that I was supporting a little while ago. So yeah, it was a woman and she was close to 30 and she’d had acute lymphoblastic leukaemia at three and a half years old and it recurred at age five. And what was difficult – what I found really difficult with this one is the fact that I could get her life insurance on the standard market, you know, it wasn’t – obviously a very long time ago so it wasn’t really a huge thing to get her the cover in many ways. You know, she’d been cancer-free for over 20 years but the problem that I found with it is that I couldn’t get critical illness cover for her and I found that very, very frustrating and to be honest I got a bit annoyed about it as well. And the reason being is that there was this steadfast rule, “If you’ve had, you know, the leukaemia twice, that’s it, you are never having critical illness cover.”
And it felt incredibly harsh and that was, you know, basically we only had I think a couple of insurers that were kind of okay-ish to maybe consider and then once it was the fact we said, “Oh it happened again at age five,” so it was a year and a half later than the first time, over 20 years since she’d had it, you know, even when she’s in her 60s or in her 50s or whatever, she will not be able to get critical illness cover based upon the current rules. And I just don’t think that’s fair. You know, when I was saying – asking about the recurrent side of things, I mean I appreciate that everyone is individual and there can’t always be complete – there’s got to be rules and sometimes there will be cut-offs and things like that but it does kind of feel like, you know, surely you’d maybe think well after 20 years – is there really – is she at any more risk than someone else?
Matt: Yes, an interesting debate here. First of all I think that you did mention that this particular lady came to you a while ago. Is that – did I hear that correctly?
Kathryn: It was – I think it was either last year or the year before. I’ve kind of lost 2020 in my head so I’m not sure if it was last year or the year before.
Matt: Okay, well in which case for me being very much a wrinkly, that’s yesterday. So my take on the particular rule that you mentioned around if somebody has had a reoccurrence, they can never have – it’s critical illness that you had the problem with isn’t it?
Kathryn: Yeah it was just – life as I say wasn’t particularly an issue because, you know, it was just a case of finding the right insurer. But some of them are still a little bit so-so but the majority of them are fine. But yeah it was the critical illness cover and it just – there was just no movement whatsoever.
Matt: Yeah, my view – rather like a few of the case studies that we’ve talked about over the year is that given the particular circumstances, I think that rule is kind of irrelevant.
Kathryn: Yeah.
Matt: And also yeah, it’s – I don’t think it would really come into specifically that rule. It can’t really come into a case like this where you’re looking at a three and a half-year old I think and recurrence at age five. My goodness, that’s such a long time go that – and also the treatments weren’t the same. If I just go back to my statistical – my dreaded statistical 35 to nearly 70%.
Kathryn: Yeah.
Matt: I appreciate we’re talking critical illness here and not life insurance but those statistics certainly tell you something and I would have thought that you should be able to get critical illness cover. You might get a cancer exclusion.
Kathryn: Yeah.
Matt: But you should certainly get critical illness cover. I find it a little bit baffling to be perfectly honest that in those particular circumstances that you mention, that it wasn’t available. That’s all I can really say to that. It does seem ludicrous. You know, the reoccurrence of cancer is kind of irrelevant within the context of this particular case.
Kathryn: Absolutely.
Matt: So yeah, I’m sorry – again it’s not the first time that you and I have had –
Kathryn: Yeah, a chat about something similar.
Matt: Where these things, you know, can’t be done.
Kathryn: It’s really interesting –
Matt: I tell you though, there are, you know, there are statistics that do show reoccurrence a long time later. They’re quite high percentages in insurance terms. Not in clinical terms –
Kathryn: Yes.
Matt: But in insurance terms.
Kathryn: That could be very interesting as well by the way. I am speaking to somebody at the moment – a completely different condition set and what’s strange is that, you know, obviously in terms of what the GP is maybe saying, the GP is saying it’s quite a standard – it’s quite a normal thing, not to worry about it. It’s kind of like a secondary symptom – secondary condition to an initial one.
Matt: Yeah.
Kathryn: The GP says that and the problem is that then obviously as an adviser and you’re on the frontline and you’re speaking to the underwriters and you know the insurers are not going to see it in the same way. You know, it’s – and that is really, really hard but, you know, it’s probably similar with something like this though. I’ve just done a little bit of a divert there as well. But yeah, so with this one, I just found it really interesting and it’s something – I did a piece recently that went out in Money Marketing with some of the work that I’ve been doing with different people about the concept – I know it’s definitely available in France and I think it’s in Belgium now as well and for some reason I want to say Australia but I’m not sure if I’ve just made Australia up in the grand scheme of things. About a person’s right to forget that they’ve had cancer – and that’s something that is done definitely in France and in Belgium where after a certain amount of time they don’t need to tell insurers that they’ve had cancer.
And I imagine that underwriters listening to this and actuaries are absolutely recoiling in terror at the thought of that and just going, “No, no, Kathryn’s gone too far now, we’re not going to do that kind of thing. We can put up with some of the things she says but this is absolutely pushing it.” But it’s an interesting concept and, you know, and especially as well like in the mental health space as well, you know, we were talking about and that’s the piece that I was saying, you know, in the piece for Money Marketing. You know, if somebody has had a suicide attempt in their teens and they’re now in their 40s, you know, why do we still hold somebody to that, you know, when they’re a completely different person to what they were. They’re in a completely different life environment so I think it’s something that’s interesting and I imagine that I’ll pop up every now and then talking about things like rights to forget maybe.
I’d just find it really interesting to sit down, you know, just put me in a – then again, I’m going to say this and I’ll probably regret it, but put me in a room full of underwriters and actuaries and just get them to tell me why it doesn’t work. If it can work in other countries and I know that obviously other countries have different laws and legislations and obviously in France it is a law and in Belgium it’s a law as well that they have the right to forget and I imagine the pricing would significantly change for everybody with it but it’s kind of that thing of well, you know, for one thing it kind of feels like the right thing to do and I know obviously we are businesses so we can’t just always go by what’s the right thing to do but the amount of people who have had something like a cancer who would be – who cry out wanting things like these insurances and they are struggling so much, you know, without the statistics to say, “Well yes, you are very likely to sort of – the likelihood of you having a recurrence is this, this and this.” It’s almost a case of, you know, we’re kind of – we’re stopping people from getting insurance on data we don’t have which also doesn’t feel great. If that makes sense?
Matt: Yeah, yeah. Also very controversial.
Kathryn: I know, I know. I’m waiting for people to contact me and say, “What are you on about?” Alan will say to me, “Kay, what have you said?” You know, kind of thing.
Matt: Well I think to be perfectly honest with you, you know, I’ve been around a long time in underwriting and there are a few things I would agree with, other things that I will say, “Well okay, I can understand the social position on it, but let’s fully understand what that would mean for the industry.”
Kathryn: Of course. And there’s the claims pay outs, you know, it would have to be – it would definitely not be an overnight thing and there would still be things where it wouldn’t be able to happen. You know, I think that would have to be obvious as well. But especially this one, so this person who’s in their 30s, who was almost 30, this woman, it just feels like she should have – she shouldn’t have an issue getting critical illness cover. It just doesn’t feel right. Even from – I don’t know, I know I don’t understand all the underwriting side of things, but it just doesn’t sit right that she can’t get it.
Matt: Well I think it doesn’t sit right in the circumstances that she cannot get critical illness cover with an exclusion –
Kathryn: Yes! Yeah.
Matt: To have critical illness cover with cancer cover, then I would say, I believe there are statistics around to show that that would not be the same risk as somebody who’s never had those – leukaemia at such a young age. But also there I’d throw in, even if there aren’t those statistics, then unfortunately the way that insurers will look at it – but they will look at it in the round and from the big picture, I can absolutely assure you –
Kathryn: Yeah.
Matt: Is that they will say, “Well if we don’t understand the risk, we ain’t doing it.”
Kathryn: Yeah, I imagine that’s exactly what the thing would be.
Matt: You know, if you take any commercial – and I know you’re very au fait with commercial realities of businesses and how they work, but I don’t think you’d find anybody saying, “Well if I don’t understand what I’m buying,” – I don’t mean this from the lady buying critical illness – “What I’m putting my money into, then I’m not going to put my money into it.”
Kathryn: Yeah, you know, I think – as I say, I don’t think it’s something –
Matt: It’s the unintended consequences, I think –
Kathryn: Yeah.
Matt: Of some of these things that – you know, I have to say, I completely agree that it is worth sitting down with X, Y, Z, the powers that be and talking it through. But I also think that if we look back at some of the risks which wouldn’t have been taken – certainly wouldn’t have been taken when I first started –
Kathryn: Well a perfect example would be something like people living with HIV, you know –
Matt: Absolutely, you’ve taken words out of my mouth, I know that it’s something you feel very, very strongly about then, you know, the insurance industry does move on and when they feel comfortable with the risk they’re looking at, then they will write it, they will offer cover for it. So I think some of these areas – well it’s an interesting thing, Kathryn, I’ll throw this one at you as an adviser, again I work on the fringes of these things so you’ll have to excuse my ignorance here, but one of the things that seems to be bandied around in the press an awful lot is that people think that insurance is too expensive.
Kathryn: Yes.
Matt: Particularly critical illness insurance.
Kathryn: Absolutely and the price is only going to go up, if there’s a right for getting there as well.
Matt: So, if we’re going to cut out critical illness in terms of people disclosing history of cancer and if – there is another important factor in this, but I won’t go into it for the sake of today – what will that do to the basic price?
Kathryn: Yeah.
Matt: Hike it and hike it and hike it and nobody will then buy it.
Kathryn: Exactly. Yeah.
Matt: So are we throwing the baby out with the bath water here? You know, I’d love to be part of that room, Kathryn.
Kathryn: The thing is, it would be fascinating, so I’m not saying – sort of when I say these things, it’s not me saying, ‘”Oh we need to do this tomorrow,” or anything, I think what we need to do is, you know, we need to watch what France and Belgium are doing and the statistics that they see and things like that and maybe, you know, sort of like cancer is something where, I say maybe that’s possibly a bit too much of a push at the moment based upon data and stuff – I do think the mental health side of things though we could certainly –
Matt: Also, it’s a very good one, I would hate to think that somebody who’d – I can’t remember the exact wording of the example that you gave, around having thought about suicide or tried to commit suicide 30 years ago, or 25 years ago. I would hope that most insurers would look at that on a, “Well yes, he has completely changed his lifestyle,” and that was down to, I don’t know, late adolescence confusion, or exam pressure, or something like that. And they would look at it and treat it as anybody else.
Kathryn: Yeah. You would hope so and I think –
Matt: That particular example.
Kathryn: No, no, absolutely and I think a lot of the time insurers are like that. I think, you know, can have sometimes things though where – I mean no matter what, obviously, we are asking people to think about something that happened a long time ago, which is obviously not a positive situation for some people. I always think of some of the ones that stand out for me as well though, yes it is for people who have maybe have other strong mental health conditions. I know we’re completely going off on a tangent here, but just now that I’ve started, I’ll have to finish it. But say like somebody with borderline personality disorder or bipolar disorder could well have had multiple suicide attempts before they were diagnosed, probably in their teens and medicated and again that would stay with them. But obviously as soon as you start getting to multiple ones, you know, you might find with some insurers that as soon as there’s three suicide attempts in the history, then that’s an absolute resounding no, regardless of time frames.
And again, it kind of, you know, I’m sure there’s some people again, who’d be listening thinking, “Well, that makes sense,” but again, you know, if we were – and it does happen, we speak to people a lot who have had this and they are a good 20, 30 years later and it’s still stopping them. And it feels like it’s almost – it almost feels a bit like a punishment. It almost feels a bit like a punishment, because there wasn’t enough mental health support services when they were a teenager and them getting sort of the medication and everything that they needed. But anyway, that’s probably a podcast all unto itself. Maybe that’s it, maybe we need to do a podcast, a bit of a roundtable – I can’t imagine that there’s anybody in the underwriter or actuary world, bar you Matt, who would put themselves forward to have that kind of a debate on the podcast. But if you do want to, get in touch, because I think it would be an incredible one and a bit of right to forget podcast.
Matt: I’m sorry Kathryn –
Kathryn: No, go on.
Matt: But I would also say, I mean you and Alan know this and your team know this far better than anybody – or most other IFAs – there is often – where you guys are willing to put yourself out, there is often a solution out there.
Kathryn: Yes.
Matt: You know, I think you were absolutely right that some insurers have archaic views but I would hope the majority of the insurers out there will take into account the holistic scenarios which you have outlaid on mental illness.
Kathryn: Absolutely.
Matt: I can’t guarantee it but, you know, there are often solutions out there. Going back to non-Hodgkin’s lymphoma, when I came out of the corporate insurance world, I placed £1 million worth of cover on a lady who had non-Hodgkin’s lymphoma. She’d had a recurrence and it was stage four and yet I got cover for her in the high street name. So really, all I would really say out there to people is there is often a way – a solution, please do contact those people who specialise in it.
Kathryn: Yeah. Oh, absolutely. I know I’ve been talking on a little bit of worst case scenarios there but there are options, you know, not every insurer is going to decline somebody for obviously multiple suicide attempts a good few years ago.
Matt: I certainly hope not, good grief.
Kathryn: No, not everyone will. Not to worry, that’s certainly not the case. And, you know, the same for the cancers except obviously, you know, with the – when we’re talking potentially about a recurrence and with the critical illness cover side of things it might be that more specialist routes are needed. So again, it’s not necessarily a no, it just may mean that it’s a specialist route. But specialist routes don’t always mean silly prices. So I think sometimes people hear specialist and think, “Oh well, I’m just never going to be able to afford that.” That’s not always the case. So it’s always about individual consideration and looking at what’s available.
So to finish off, I do have a case study, where we’re going to be talking about things. So this is somebody – and I found this one really interesting and it’s not somebody who has, in a sense, blood cancer, but they were somebody who had the potential for blood cancer. So that’s why I found it, I just thought it would be a good one to have. So I spoke to somebody and it was a gentleman who was close to 60 and he was a non-smoker. And what had happened is, about a year and a half before he’d come to us, he’d started – he’d gone to the doctor, he had some lower back pain and they were doing lots of tests, they couldn’t really figure it out. And for some reason, I’m not sure why, but it ended up being some kind of a blood test of some sort or some kind of check which showed that he had what’s known as CLL phenotypes within his cells. So that’s the chronic lymphocytic – that one – leukaemia and basically we had the letters from the consultants and everything, saying, “This is not leukaemia, it is absolutely not that. But it means that at the moment,” – I suppose that’s what you were saying before though, about it being so localised Matt – so yeah, in his back, they were showing that some of his cells had the potential that they might develop into CLL.
So this was unusual because obviously, we’re not having to disclose that he has leukaemia because he doesn’t. But it’s also something that we can’t not disclose because there is that potential there and we never want to go into the kind of non-disclosure route at all. So, what we did is – so obviously I spoke to a number of insurers and I had two insurers who said, “Okay, we might be prepared to look at this” ‘cos we were covering a mortgage liability. “We might be able to look at this, so what do we have?”
So I got obviously the sort of like medical reports and things like that, so I was going through it. So there was lots of things that came into play with this. So when we’re talking about the blood tests, there was things like – I was looking at the white blood cells, the haemoglobin, the platelets, the lymphocytes, the neutrophils and some other things, so I could make sure that when I went to the underwriter, I said to them, “This is all the stuff I have and, you know, what do you think?” And I went to see obviously two and they said, “We could be prepared to give it a go,” so I went to one of them who seemed to be indicating better and we went through it and it went to the medical reports and everything and it came back that they wouldn’t cover him. And I was very, very confused and, you know, obviously he got me a copy of his medical report, his most recent one, just so that we could compare it and I went back to him and I was like – I said, “Right –” What was fantastic was that the underwriter at the insurer was absolutely amazing because what they did is they really took the time with me. So I basically contacted them and I wrote it all down because I knew that if we did it over the phone and things like that, that I would maybe get confused with some of the more technical wording and things like that and maybe – obviously, we’re saying random technical words and numbers and everything and I wanted to make sure that I didn’t say anything wrong, really.
So I wrote it all down and I just sent an email through and I was like, “Look, I completely respect the decision. I’m not going to be challenging, but I am confused because from what I can see, you know, I had all this information and now I’m – from his previous blood tests and his most recent one – I’ve got all of this. And I’m looking at it and actually, these two figures seem like they’re better and like things have improved. So I’m confused as to why it’s changed. I’m sure there’s – obviously, you’ve got reasoning for it and can you let me know why?” And what was brilliant is that the underwriter came back with almost like an essay to me. Really informative and helpful and said, “Right okay, really appreciate you’ve gone through all this,” and they were saying, “Right, well you can see this and this, so this has increased over this time, this has decreased over this time. Well for us, when we’re looking at it, we actually see this change here as well. So that one looks a bit favourable, that one actually to us doesn’t seem as good, even though it kind of – you might think it looks better.”
So we kind of went backwards and forwards like that and they gave me this really, really clear explanation, which was brilliant because it then meant that I could go to the person – to the client and say, “Right, this is what they’ve said, but let’s go to this other one, this other insurer that we had as a potential.” And what was good is that we went to the other insurer, but we were able to say to them, “Right, this is what it was like then, this is what it’s like now. What do you think?” So before obviously we do all the application forms and everything like that, we got them to have a look at it and they said, “Do you know what? Even with that most recent one, we can cover this.” So I was really obviously pleased we were able to go ahead.
Obviously there is that kind of thing of it’s unfortunate if you go one place for your client and it declines and then you’re trying to obviously convince them to go somewhere else. And luckily, with this client, they were just so, so eager to get insurance that I didn’t have any sort of like difficulty in convincing them to try the second insurer. And obviously, what was brilliant was that we then were able to get him – as I say just remember, he’s close to 60, so we’ve got him decreasing life insurance of £130,000 over eight years. It actually came back with a 250% loading on the premium so it became £79.77 per month.
And the reason I’ve included the loading here, whereas sometimes I don’t always say that, depending upon the situation, is that I thought it was really interesting to say, “Right, well actually, all of the market, bar two insurers had said to me no. Then one insurer said, “Hmm, maybe,” but then it was a no. But then there was still someone who is prepared to offer 250%. And the 250% loading is not the highest that insurers will go to. So I just think it’s a really good example to say just because you’ve spoken to quite a few people, don’t assume it’s a no for everybody. And even if it is going to be yes with someone, don’t assume it’s going to be like the absolute maximum rating that they may offer. We’ve had it plenty of times where people have come to us, declined by some insurers and we’ve been able to get them standard terms elsewhere. So it is really a case of knowing the market and knowing whereabouts the different underwriting philosophies lie.
So that’s the end of that case study, Matt.
Matt: I kind of think it reiterates some of the – on a positive note, some of the conversations we were having earlier really.
Kathryn: Yeah.
Matt: And also, you know, on the NHL case, the non-Hodgkin’s lymphoma lady that I found cover for.
Kathryn: Yeah.
Matt: I think there were seven no’s and one yes.
Kathryn: Yeah.
Matt: So, you know, it just shows that in a lot of cases, I believe cover can be obtained, particularly for basic life insurance. I think when you get into critical illness or income protection, you know, that’ll change. But it just shows you, more power to your arm. I seem to remember this case, historically and yeah, it was highly interesting and very, very complex as most of these kind of pre-cancer blood disorders are. And I am sure – I obviously guarantee that a consultant medical opinion was sought on the case. You know, it’s not something that an underwriter, even after 40 years, would look to try and decipher without another view.
Kathryn: Yeah. Absolutely.
Matt: So great! It’s great news and just shows you what the industry can do.
Kathryn: Yeah. It’s just showcasing what people can do and obviously, you know, yes Cura are specialists and it is something that we’re very familiar with and some people want to be able to do that, some people just say, “You know, actually I’ll signpost it to people,” but it’s more sort of like just giving that information out there to say, “Don’t feel like you’ve hit a brick wall or whatever, just keep going and –”
Matt: Absolutely! 100%.
Kathryn: “And, you know, you should be able to get something, somewhere.” And also as well, that thing of saying the underwriters – I think sometimes, with advisers, we can sometimes grumble, you know, when we get underwriting decisions we don’t expect, we can think the world is very unfair when that happens. But, you know, with a bit of respectful conversation with an underwriter a lot of the time, you can learn so much – incredibly learn a lot about a medical condition. It helps you going forward with that client and future clients. It builds a good rapport with the underwriting team as well.
Matt: Yeah.
Kathryn: And, you know, they are an incredibly useful resource when it comes to the knowledge of these things.
So, we’re at the end of the podcast. So thank you so much for joining me again, Matt. It’s been brilliant to have your insights and for us to go a little bit controversial for a bit. I think that’s the first time we’ve gone controversial on the podcast.
Matt: It is I think, yeah.
Kathryn: I’m looking forward to seeing what is said – what people say.
Matt: Yes, there is nothing wrong with being controversial, I don’t think. And it’s good for the underwriting fraternity to be asked why?
Kathryn: Yeah. No, absolutely.
Matt: And nobody grows. We don’t grow as an underwriting fraternity, we don’t grow as an industry, if we are not willing to think about actually the why.
Kathryn: Yeah.
Matt: But you know, after 40-odd years, I have seen some great, great progress –
Kathryn: Yes.
Matt: In underwriting terms out there and long may it continue. I am sure it will. And hopefully maybe in 10 years or so, or whatever – I just picked that number out of the air, some of your concerns, you can say, “Oh, why was I worrying about that?”
Kathryn: Absolutely.
Matt: Because life will have moved on and yeah, it’s great. Never, ever please, feel sorry for asking why.
Kathryn: Absolutely. I think that’s good.
Matt: It would be the death of the industry, if you don’t have people asking why.
Kathryn: Yeah. On all sides as well. You know, insurers ask advisers and advisers ask back to insurers.
Matt: Yeah.
Kathryn: So next time, I’m going to be back a little bit earlier than usual, we’re going to have a small, inbetweenysode. So, there’s been a lot of debate at the moment on social media – lots of different platforms, about things like advisers. Advisers who take commission and advisers who take fees. It’s not an episode where I’m going to be doing debates and things like that, I’m just going to be talking about the way that the different options work. The positives, the negatives of both options. Just so that anybody who isn’t sure about how different ways work can listen in and find out.
If you’d like a reminder of the next episode, please do drop a message on social media or visit the website, practical-protection.co.uk. As always, don’t forget to collect your CPD certificate through the website or via Octomembers who are the sponsors for the website. And I’m incredibly proud, because I’ve just figured out a way to automate the CPD certificates to go out when people request them off the website. So I think Lindsay, who does a lot of the editing and a lot of the marketing side of things for me, I think she’s absolutely bouncing off the walls, so excited that she doesn’t need to keep going in and doing sort of like – she loves emailing people, she really loves chatting to people and emailing but obviously we’re getting quite a few in now and now it’s all automated, it just means that she can focus on properly chatting to people rather than doing the certificates. But thank you again Matt for your time today.
Matt: Absolutely no problem. Lovely to talk to you again.
Kathryn: Lovely to speak to you. Speak to you soon.
Matt: Bye.
Kathryn: Bye.
