{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:58:52Z","timestamp":1791259132896,"version":"4.1.0"},"reference-count":70,"publisher":"Wiley","issue":"S13","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["AD\u20101304\u20106272"],"award-info":[{"award-number":["AD\u20101304\u20106272"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["RSG\u201013\u2010368\u201001\u2010CPPB"],"award-info":[{"award-number":["RSG\u201013\u2010368\u201001\u2010CPPB"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K07CA221899"],"award-info":[{"award-number":["K07CA221899"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sociolegal barriers to cancer care are defined as health\u2010related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safety\u2010net medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers. English\u2010speaking, Spanish\u2010speaking, or Haitian Creole\u2010speaking patients with breast and lung cancer were eligible within 30 days of diagnosis. The primary outcome was <jats:italic>timely treatment<\/jats:italic> within 90 days of diagnosis. Secondary outcomes included patient\u2010reported outcomes (distress, cancer\u2010related needs, and satisfaction with navigation) at baseline and at 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 201 patients with breast cancer and 19 with lung cancer enrolled (response rate, 78%). The mean patient age was 55 years, 51% of patients were Black and 22% were Hispanic, 20% spoke Spanish and 8% spoke Haitian Creole, 73% had public health insurance, 77% reported 1 or more perceived sociolegal barrier, and the most common were barriers to housing and employment. Ninety\u2010six percent of participants with breast cancer and 73% of those with lung cancer initiated treatment within 90 days. No significant effect of enhanced navigation was observed on the receipt of <jats:italic>timely treatment<\/jats:italic> among participants with breast cancer (odds ratio, 0.88; 95% CI, 0.17\u20104.52) or among those with lung cancer (odds ratio, 4.00; 95% CI, 0.35\u201045.4). No differences in patient\u2010reported outcomes were observed between treatment groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Navigation enhanced by access to legal consultation and support had no impact on timely treatment, patient distress, or patient needs. Although most patients reported sociolegal barriers, few required intensive legal services that could not be addressed by navigators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>In patients with cancer, the experience of sociolegal barriers to care, such as unstable housing, utility services, or food insecurity, is discussed. Addressing these barriers through legal information and assistance may improve care.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>This study compares standard patient navigation versus enhanced navigation partnered with legal advocates for patients with breast and lung cancers. Almost all patients in both navigation groups received timely care and also reported the same levels of distress, needs, and satisfaction with navigation.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Although 75% of patients in the study had at least 1 sociolegal barrier identified, few required legal advocacy beyond what a navigator who received legal information and coaching could provide.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33965","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T09:56:54Z","timestamp":1655200614000},"page":"2623-2635","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Patient navigation to address sociolegal barriers for patients with cancer: A comparative\u2010effectiveness study"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8475-1212","authenticated-orcid":false,"given":"Tracy A.","family":"Battaglia","sequence":"first","affiliation":[{"name":"Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine Boston Medical Center and Boston University School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Gunn","sequence":"additional","affiliation":[{"name":"Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine Boston Medical Center and Boston University School of Medicine  Boston Massachusetts"},{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon M.","family":"Bak","sequence":"additional","affiliation":[{"name":"Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine Boston Medical Center and Boston University School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoHanna","family":"Flacks","sequence":"additional","affiliation":[{"name":"Medical\u2010Legal Partnership Boston (MLPB)  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerrie P.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Boston University School of Public Health  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Wang","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Data Analytics Center Boston University School of Public Health  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9689-9601","authenticated-orcid":false,"given":"Naomi Y.","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hematology, and Medical Oncology Boston Medical Center and Boston University School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha J.","family":"Morton","sequence":"additional","affiliation":[{"name":"Medical\u2010Legal Partnership Boston (MLPB)  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"The Societal and Economic Impact of Cancer Health Disparities","author":"Susan G Komen for the Cure","year":"2010"},{"key":"e_1_2_8_3_1","volume-title":"US Cancer Statistics: 2009 Cancer Types Grouped by Race\/Ethnicity","author":"National Program of Cancer Registries"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010200502000\u201000007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21680"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.90.8.1212"},{"key":"e_1_2_8_7_1","volume-title":"About Social Determinants of Health (SDOH)","author":"Centers for Disease Control and Prevention (CDC)","year":"2020"},{"key":"e_1_2_8_8_1","volume-title":"Health Affairs: Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health","author":"Castrucci B","year":"2019"},{"key":"e_1_2_8_9_1","volume-title":"Standardized Screening for Health\u2010Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool. 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