Nationwide analysis of legal barriers impacting patients with cancer and caregivers.

Abstract

300 Background: The extent of legal barriers requiring appropriate navigation in patients following cancer diagnosis is unknown. We performed a nationwide analysis of a patient navigation program to investigate prevalence of such barriers. Methods: This retrospective analysis used the Triage Cancer Legal & Financial Navigation Program’s de-identified electronic database. Triage Cancer is a national, nonprofit organization that provides free education on legal issues that impact individuals diagnosed with cancer. Sociodemographic, financial, disease-site, and medical-legal navigation information were obtained for descriptive analysis. The main study outcome was the primary legal issue prompting a call to Triage Cancer for assistance. Associations between variables and the primary legal issue were explored with multinomial logistic regression analysis. Results: We investigated 2613 callers (1679 patients, 463 caregivers, 373 providers) between 2021-2023 in reference to patients who were 61% female, 57% aged 40-64y, 48% White, 37% employed, 32% on employer-sponsored insurance, and 45% with income <$50k. Breast (27%), hematologic (18%), and GI (10%) cancers were most common, and 39% of all patients were on treatment at time of call. Majority called for assistance with 1 (51%) or 2 (32%) legal barriers. Most common primary issue was health insurance (29% - insurance options, navigation, and appeals), followed by financial (20% - financial assistance or life insurance), disability (18% - applications and appeals), employment (17% - taking time off, working through treatment, returning to work, laid off, new job search, and unemployment benefits), and other (16% - housing, estate planning). Compared to health insurance, navigation for disability-related barriers was significantly higher among Black (OR 2.1) patients, and those with GI (OR 3.1) and lung cancer (OR 2.9) (Table). Employment barriers were higher among Black (OR 2.5) and Hispanic (OR 2.5) patients, and financial barriers among Black (OR 2.9), Hispanic (OR 2.4), and those on Medicaid (OR 2.9). Conclusions: This study highlights the prevalence of legal barriers impacting patients with cancer and their caregivers. It underscores an urgent need for accessible legal navigation programs, and potential for federal policy-level efforts in building legal safeguards to improve care.[Table: see text]