Legal Navigation Services Key to Addressing Disparities in Cancer Care

A significant number of patients with cancer, caregivers, and health care professionals face significant disparities in legal issues, with the most common needs revolving around health insurance, finances, employment, and disability insurance. | Image Credit: irissca - stock.adobe.com

Recognizing that federal policies now support reimbursement for care coordination and social services, health care teams must better understand cancer-related legal issues to provide more accessible legal navigation services for patients and caregivers who need it most, according to a study published in JAMA Network Open.1

Socioeconomic status, race, ethnicity, geographic location, housing, food security, education, and access to health care are all social determinants of health (SDOH).2 These factors significantly impact every stage of cancer care, from prevention and early detection to treatment and survivorship. Even with advances in cancer treatment, survival rates are not distributed equally. To tackle these disparities, policy-driven solutions like expanding Medicaid, creating patient navigation programs, diversifying the health care workforce, and increasing minority representation in clinical trials need to be implemented.

Medical-legal partnerships have emerged as a solution, embedding lawyers directly within health care settings like outpatient clinics.1 The goal is to help patients from underserved communities with legal needs as they arise. However, these partnerships are often limited by location, as they're tied to specific institutions. Only a few small studies have looked at how common these medically related legal needs are at the institutional level.

Collecting comprehensive patient data, including SDOH, is crucial for delivering equitable value-based cancer care.3 Coral Omene, MD, PhD, associate professor, Rutgers Cancer Institute and RWJ Barnabas Health, told The American Journal of Managed Care® that value goes beyond just survival rates and should also include metrics on a patient's quality of life. Insurance hurdles oftentimes create delays and further anxiety for patients, ultimately reinforcing the need for support systems to help with these issues.

The authors conducted a retrospective study with a nationwide cohort of patients with cancer who were receiving legal navigation services.1

Of the 5810 unique calls, most were from individuals with a cancer diagnosis (66.8%). Caregivers made 18.8% of the calls, and health care professionals made 10.3%. The calls from health care professionals included social workers (6.9%), patient advocates and community health workers (1.7%), nurses (1.2%), and financial navigators (0.4%).

The calls were made by or on behalf of patients from diverse backgrounds: White (48.9%), Black or African American (10.3%), Hispanic or Latinx (10.3%), Asian or Pacific Islander (4.8%), Middle Eastern or North African (0.9%), and American Indian or Alaska Native (0.3%). A small percentage were of another race, ethnicity, or origin (2.2%), while a significant portion either chose not to share this information or had an unknown race or ethnicity (22.4%).

The majority of patients were women (63.9%), and over half (56.7%) were between the ages of 40 and 64 years. The highest volume of callers was in California (15.5%), Texas (7.5%), Illinois (5.7%), New York (5.3%), and Florida (5.2%).

The patient group was largely insured (76.4%), with the most common coverage being employer-sponsored health plans (34%). The remaining patients were covered by Medicare (14.8%), Medicaid (12.8%), or individual plans (10.1%), with 5.7% being uninsured. The patients' financial situations varied, with a large segment (43.6%) reporting an annual household income of less than $50,000. Additionally, the employment status of patients was split, with 39.8% employed and 24% unemployed, on medical leave, or retired.

Patients in the study had over 30 different primary cancer types. The most common were breast cancer (27.8%), hematologic cancer (19.5%), gastrointestinal cancer (9.8%), gynecologic cancer (6.2%), and lung cancer (6.1%). Regarding their treatment stage, nearly half of the patients (48.3%) were currently in treatment. The remaining patients were either pretreatment (6%), posttreatment (12.3%), or their treatment stage was unknown (33.3%).

From 5810 calls, patients requested help with 9755 legal barriers. Almost half of the patients (48.3%) called about multiple issues, with most of these calls concerning 2 different problems (32.2%). The most common primary issues were health insurance (28.4% of patients), finances (20.6%), employment (18.8%), and disability insurance (18.6%).

Compared with White individuals, Black or African American individuals were less likely to call with a primary legal issue related to health insurance (OR, 0.66; 95% CI; 0.50-0.87). Caregivers (OR, 1.47; 95% CI, 1.24-1.74) and health care professionals (OR, 2.13; 95% CI, 1.71-2.64) were more likely than patients themselves to call on behalf of a patient for health insurance issues. Uninsured individuals (OR, 5.36; 95% CI, 2.54-11.33) and those with individual marketplace plans (OR, 2.04; 95% CI, 1.34-3.10) were more likely to seek help for health insurance issues than those with employer-sponsored insurance.

Black or African American individuals (OR, 1.52; 95% CI, 1.12-2.05) were more likely than White individuals to call for help with financial barriers. People living in the South (OR, 1.32; 95% CI, 1.04-1.67) were more likely to call for financial assistance compared with those in the Northeast. Households with an annual income between $50,000 and $100,000 (OR, 1.71; 95% CI, 1.12-2.59) were more likely to seek financial help than those earning over $100,000.

Individuals with individually purchased marketplace insurance (OR, 0.37; 95% CI, 0.23-0.60), Medicaid (OR, 0.36; 95% CI, 0.13-0.99), or no insurance (OR, 0.32; 95% CI, 0.16-0.64) were less likely to seek employment help than those with employer-sponsored insurance. Similarly, households with an annual income below $20,000 (OR, 0.34; 95% CI, 0.14-0.87) were less likely to call for employment assistance than households earning over $100,000.

Younger individuals were more likely to call for disability insurance assistance than those 65 years or older. Specifically, those aged 40 to 64 years (OR, 3.05; 95% CI, 2.08-4.49) were over 3 times as likely, and those 39 years or younger (OR, 2.34; 95% CI, 1.56-3.51) were more than twice as likely.

Individuals with lung (OR, 1.97; 95% CI, 1.40-2.77), neurologic (OR, 1.95; 95% CI, 1.37-2.78), and gastrointestinal (OR, 1.69; 95% CI, 1.27-2.26) cancers had higher odds of making calls for disability insurance compared with those with breast cancer.

The findings may be biased toward individuals who are more engaged with health care networks, as these people are more likely to have been exposed to the Triage Cancer organization. Information bias was also a factor, as some patient data was provided by proxies, and it was not always possible to distinguish whether legal barriers pertained to the patient or a caregiver. Furthermore, the study may underestimate the true prevalence of legal barriers because it did not capture data from individuals who needed, but could not get, legal services. Finally, due to a lack of patient identifiers, a small portion of the demographic and financial data might be duplicated from individuals who made multiple calls.

“Health care teams could leverage existing systems and partnerships to provide additional training around legal topics to patient-facing staff, and research teams could further explore the impact of legal barriers faced by patients with cancer and develop interventions that evaluate the effectiveness of legal navigation in reducing financial distress and improving outcomes and quality of life for both patients and caregivers,” the study authors concluded.

References

1. Chen KY, Blackford AL, Bryant MF, et al. Nationwide analysis of legal barriers to cancer care. JAMA Netw Open. 2025;8(7):e2524201. doi:10.1001/jamanetworkopen.2025.24201
2. Abdullah A, Liu Z, Molinari M. From diagnosis to survivorship: the role of social determinants in cancer care. Cancers (Basel). 2025;17(7):1067. Published 2025 Mar 22. doi:10.3390/cancers17071067
3. Joszt L. Data collection helps the delivery of equitable value-based cancer care: Coral Omene, MD, PhD. AJMC®. June 11, 2025. Accessed July 31, 2025. https://www.ajmc.com/view/data-collection-helps-the-delivery-of-equitable-value-based-cancer-care-coral-omene-md-phd