Chen Krista Y, Blackford Amanda L, Bryant Monica F, Doran Joanna F, Henderson Nicole L, Azuero Andres, Rocque Gabrielle B, Hussaini S M Qasim
School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Quantitative Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Netw Open. 2025 Jul 1;8(7):e2524201. doi: 10.1001/jamanetworkopen.2025.24201.
Legal barriers during cancer care contribute to longstanding disparities and lead to adverse health outcomes in vulnerable populations, yet their prevalence remains unknown.
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.
Sociodemographic, financial, and disease-site characteristics of patients.
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.
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.
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.
癌症治疗过程中的法律障碍导致长期存在的差异，并给弱势群体带来不良健康后果，但其普遍程度仍不为人知。
识别并描述向法律导航项目求助的癌症患者所面临的法律障碍。
设计、背景和参与者：这项回顾性队列研究使用了来自Triage Cancer的法律与财务导航（LFN）数据库的数据，Triage Cancer是一个全国性的非营利组织，在2021年3月1日至2024年12月31日期间提供有关癌症患者面临的法律问题的免费教育。参与者包括癌症患者、护理人员以及代表患者致电的医疗保健专业人员。
患者的社会人口统计学、财务和疾病部位特征。
主要结局是促使使用Triage Cancer的LFN的主要法律问题。对患者的社会人口统计学、财务和疾病部位因素进行了描述，并使用逻辑回归模型探讨了这些因素与主要法律问题之间的关联。
共调查了来自美国50个州的患者的5810个电话（患者拨打3883个[66.8%]，护理人员拨打1091个[18.8%]，医疗保健专业人员拨打597个[10.3%]）（3710名[63.9%]为女性；3293名[56.7%]年龄在40至64岁之间）。患者主要有保险（4436名[76.4%]），2533名（43.6%）家庭年收入低于5万美元，2808名（48.3%）正在接受积极的癌症治疗。几乎一半的患者（2807名[48.3%]）存在2个或更多法律障碍。最常见的主要障碍是健康保险（1648名[28.4%]请求帮助处理理赔被拒、上诉或健康保险问题），其次是财务问题（1194名[20.6%]需要财务援助和住房方面的帮助）、就业问题（1095名[18.8%]需要帮助处理非法解雇、在治疗期间工作、请假或失业保险问题）以及残疾保险问题（1082名[18.6%]需要帮助处理理赔被拒或申请及转换残疾保险问题）。与白人患者相比，黑人或非裔美国患者在健康保险方面需要帮助的几率较低（优势比[OR]，0.66；95%置信区间，0.50-0.87）；与白人患者相比，黑人或非裔美国患者（OR，1.52；95%置信区间，1.12-2.05）以及居住在南部地区的患者与东北部地区的患者相比（OR，1.32；95%置信区间，1.04-1.67）更常因财务障碍寻求帮助；家庭收入低于2万美元的患者与超过10万美元的患者相比（OR，0.34；95%置信区间，0.14-0.87）以及那些有医疗补助（OR，0.36；95%置信区间，0.13-0.99）或市场保险（OR，0.
