Nationwide Analysis of Legal Barriers to Cancer Care.

Importance: Legal barriers during cancer care contribute to longstanding disparities and lead to adverse health outcomes in vulnerable populations, yet their prevalence remains unknown. Objective: To identify and characterize legal barriers for patients with cancer who reached out to a legal navigation program. Design, Setting, and Participants: This retrospective cohort study used data from the Legal & Financial Navigation (LFN) database of Triage Cancer, a nationwide nonprofit organization providing free education on legal issues faced by individuals with cancer, between March 1, 2021, and December 31, 2024. Participants included patients with cancer and caregivers and health care professionals calling on a patient's behalf. Exposures: Sociodemographic, financial, and disease-site characteristics of patients. Main Outcomes and Measures: The main outcome was the primary legal issue prompting use of Triage Cancer's LFN. Sociodemographic, financial, and disease-site factors of patients were characterized, and the associations of these factors with the primary legal issue were explored with logistic regression models. Results: A total of 5810 calls (3883 [66.8%] by patients, 1091 [18.8%] by caregivers, and 597 [10.3%] by health care professionals) were investigated in reference to patients from 50 US states (3710 [63.9%] female; 3293 [56.7%] aged 40 to 64 years). Patients were primarily insured (4436 [76.4%]), 2533 (43.6%) had annual household income below $50 000, and 2808 (48.3%) were in active cancer treatment. Almost half of patients (2807 [48.3%]) had 2 or more legal barriers. The most common primary barriers were health insurance (1648 [28.4%] requested help navigating claim denials, appeals, or health insurance), followed by finances (1194 [20.6%] needed help with financial assistance and housing), employment (1095 [18.8%] needed help navigating wrongful termination, working through treatment, taking time off, or unemployment benefits), and disability insurance (1082 [18.6%] needed help navigating claim denials or applying for and transitioning off disability insurance). Black or African American compared with White patients had lower odds of needing assistance with health insurance (odds ratio [OR], 0.66; 95% CI, 0.50-0.87); Black or African American compared with White patients (OR, 1.52; 95% CI, 1.12-2.05) and patients living in the South compared with the Northeast (OR, 1.32; 95% CI, 1.04-1.67) more often sought assistance for financial barriers; and patients with household income below $20 000 compared with over $100 000 (OR, 0.34; 95% CI, 0.14-0.87) and those with Medicaid (OR, 0.36; 95% CI, 0.13-0.99) or marketplace insurance (OR, 0.37; 95% CI, 0.23-0.60) vs employer-sponsored insurance less often sought assistance for employment. Conclusions and Relevance: This cohort study examining legal barriers to cancer care access faced by patients with cancer and their caregivers found that certain populations may have greater need for legal navigation. In light of recent federal policies supporting reimbursement for complex care coordination and unmet social services needs in patients with cancer, these findings suggest a need for health care teams to better understand cancer-related legal issues and design more accessible legal navigation services.