Anne Koller was diagnosed with late stage colon cancer in 2011 and has been fighting it since.
But it's not just the cancer she's fighting. It's the bills.
"Think of those old horror flicks, the horror movies, the swamp creature that comes out and is kind of oozy and it oozes over everything."
Koller, who just turned 65 years old, is petite and sports a stylish auburn wig. When she was able to work, Koller was in the corporate world and safely middle class with health insurance and plenty of savings.
At first, she was too sick to deal with the bills. They piled up.
"You start looking at these bills and as much as you know it's expensive, the shock itself is like, what?" Koller says.
In the U.S., spending on cancer - like much of health care - has been climbing for years. New therapies, treatments and earlier screenings drive the trend. Total cost of cancer care in the U.S. is projected to reach more than $150 billion by 2020, according to the National Cancer Institute.
Middle income patients are - more than ever - feeling the weight of that financial burden, says Dr. Neal Meropolat Cleveland's University Hospitals. He took over Koller's care a couple of years ago.
"Patients now are facing, when they get their treatment, they are facing head on the cost of that treatment in a way that didn't happen in the past because of cost sharing," Meropol says.
High deductible health plans and soaring drug prices are to blame, says Meropol. He says a sea-change happened for his colon cancer patients when new anti-body drug therapies were first approved for treatment.
"We went from drugs that cost a few hundred dollars for a course of therapy that might be a month or six months or a year to drugs that were costing $10,000 dollars a month," Meropol says.
Those price hikes are not unique to colon cancer. And that spells financial trouble for patients like Koller.
"Here's what happens. I was talking about that swamp thing... but you know, OK, you go to collections. you, you end up with a court thing.I had been talking to the hospital, asking for help, nothing nothing...finally, they went to a sliding payment scale," Koller says.
Still, her credit is ruined. So she's driving an old car. Small expenses, like an internet connection are out of the question. And there are other challenges...
"Socially things change a lot, you talk to people and if you dare say God you know I can't afford this. For instance let's go out to lunch on the day you can eat. You, you think twice about it," Koller says.
The U.S. Centers for Disease Control and Prevention released a study last year that found cancer survivors were less likely to work and more likely to struggle financially. Another study out of Washington state found that the longer a cancer patient survived, the higher the rate of bankruptcy.
University of Chicago's Dr. Jonas de Souzaargues that it's time for oncologists to begin considering the financial consequences as a real side effectto cancer care.
deSouzaCUT: We talk about hair loss; we talk about numbness and tingling in the hands and feet. We talk about this chemotherapy will cause low blood counts. Right. Should we also be talking about, well, this chemotherapy is expensive?
He says it needs to be addressed. de Souza and Meropol are part of a growing field of researchers studying the impact of costs for cancer patients.
For her part, Koller says she wishes more financial information had been given earlier in her treatments.
"Now, looking back, what could make it better for other people?" Koller says, adding finances should be addressed.
Koller wants someone in the medical community responsible for telling patients the financial challenges they face.
Koller isn't alone in her hopes for change. And doctors are beginning to listen.