Colorectal cancer legal and administrative burden support (COLLABS): A pilot clinical trial.

402 Background: Engagement with legal teams after a cancer diagnosis —medical-legal partnerships—can identify, prevent, and resolve health-harming legal needs (HHLNs), such as housing instability, employment concerns, medical debt, etc. Cancer Legal Care (CLC) is a nonprofit providing free legal services to persons affected by cancer in Minnesota. Methods: We conducted a single-arm, mixed-methods pilot study to assess the feasibility and acceptability of delivering legal support, and preliminary efficacy in addressing HHLNs to 20 adults with advanced stage colorectal cancer. CLC staff conducted an initial screening visit and provided structured as well as personalized legal support over the 6-month study period. These services encompassed a wide range of topics such as employment rights, insurance coverage or claims denial, eligibility for Social Security disability, and estate planning. We collected patient-reported outcomes (assessing comfort with health-related tasks, financial toxicity, stress, coping, and self-esteem) at baseline, 3, and 6 months and conducted end-of-study interviews to explore participant experiences. Results: Of the 20 participants enrolled, the median age was 52 years, 12 (60%) were male, 12 (60%) had full or part-time employment, and 8 (40%) had a household annual income of < $25,000. Two patients were withdrawn due to death related to rapid disease progression. The study met pre-defined feasibility (90% of participants completing initial legal checkup visit, 90% remaining engaged at 3 months, 80% received at least 1 legal service) and acceptability (81% of participants recommended the intervention to others) benchmarks. For the 18 participants completing the initial visit, the visit lasted a median of 45 minutes, and 61% had self-identified HHLNs. Using a standard issue-spotting checklist, CLC attorneys identified additional HHLNs for 72% of participants, with a median of 3 total HHLNs per participant. The percentage of participants with moderate/severe financial hardship was high at baseline (70%) and decreased marginally to 63% at 6 months. Measures of stress, coping, and self-esteem remained relatively unchanged. Over the study period, participants expressed greater comfort with tasks such as addressing unexplained bills, guardianship planning, and ensuring insurance coverage. Participants endorsed high satisfaction with interpersonal relationships with CLC staff, felt empowered and supported, and suggested including their care partners in future work. Conclusions: Proactive legal care to address HHLNs through a medical-legal partnership was feasible, acceptable, and valued by patients with advanced colorectal cancer. Despite no requirement for baseline legal need, HHLNs were prevalent and addressable. This work provides essential data on the population, intervention, and outcomes to focus on in future studies assessing medical-legal partnerships. Clinical trial information: NCT06475664 .