OBJECTIVE: In recent decades scientific advancements and improvements in treatment options have significantly reduced breast cancer mortality. Unfortunately, not all have experienced these improvements; there is a widening gap in mortality rates between Black and Non-Hispanic, White women. While race may be one factor in this disparity, the interactions between social, environmental, and economic circumstances and their differential impact across racial and ethnic groups invariably contribute to observed mortality differences. Socio-legal concerns are experienced often by patients at safety-net hospitals and have the potential to become barriers to care and impact the receipt of timely care. Regarded as basic life needs, socio-legal barriers are amenable to legal intervention but if the needs remain unmet, negative health outcomes may results. Understanding the burden of socio-legal concerns in at-risk populations is necessary to address these barriers to care. To date, systematic assessment of socio-legal concerns among newly diagnosed breast cancer patients has not been well documented. METHODS: We conducted a secondary analysis of I-HELP survey data collected for Project SUPPORT, an RCT comparative effectiveness study that compared standard navigation to legally enhanced navigation at Boston Medical Center. The survey, administered in English, Spanish or Haitian Creole by trained Research Assistants at baseline, 3 and 6 months, systematically assessed participants socio-legal concerns within four categories: Employment, Disability Benefits, Housing and Utilities and Personal and Family Stability. Demographic information was extracted from participants’ electronic medical records, supplemented by surveys on health literacy and employment. Means, medians, frequencies and percentages were used to describe and quantify the burden, type and change in concern at each follow-up point. T-tests and Fischer exact tests were used to evaluate differences in socio-demographic characteristics on the presence, type and trends among the concerns. RESULTS: Overall 262 breast cancer patients enrolled in Project SUPPORT and completed the baseline I-HELP survey. The racial distribution of the participants reflects the diverse population served by Boston Medical Center with the majority of the participants (n=200, 76%) being non-white. Overall, 77% (201/262) of participants reported 1 or more concerns across all categories with 44% (115/262) reporting 3 or more concerns. Among the four categories of concern, the most frequently reported concern was related to housing with 61% (161/262) reporting at least one housing concern. Participants most likely to express any concern were 50 years old or younger, non-English speaking and employed. For the majority of participants, the burden of concern remained constant or increased during the first 6-months of treatment. Non-white women were most likely to experience a persistent concern over the first six months. CONCLUSIONS: Our findings confirmed that the majority of breast cancer patients experience some kind of socio-legal concern at the time of diagnosis. Also, socio-legal concerns persist throughout the course of treatment. The reported results emphasize the continued need for systematic assessment during cancer treatment. Additionally, collaboration between the medical and legal sectors in cancer care delivery at safety-net hospitals offers a means to address barriers to care and improve health outcomes.

The National Nurse-led Care Consortium hosts this webinar highlighting the recently formed medical-legal partnership in East Tennessee. This session will focus on developing a Medical Legal Partnership (MLP) practice in a rural setting, where the distance between legal and health partners is up to five hours, and the availability of services for low-income patients is scarce. Using tele-technology to communicate between partners, and elevating the combined health and legal priority of children’s healthcare insurance access and optimization, the East Tennessee MLP has tackled some of the common challenges of rural MLPs, and brought new solutions to rural MLP practice. This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (under grant number U30CS09736, a National Training and Technical Assistance Cooperative Agreement (NCA) for $1,350,000, and is 100% financed by this grant). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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