APA: Medical-Legal Needs of Cancer Patients Cited

SAN FRANCISCO, Aug. 21 -- Cancer patients may need an attorney working hand-in-hand with their oncology team.

A cancer diagnosis may be complicated by concerns about employment, finances, certain health care needs, and estate planning, said Michael Zevon, Ph.D., chairman of psychosocial oncology at the Roswell Park Cancer Institute in Buffalo, N.Y.

"Clearly the legal-medical needs of these patients are not being met," said Dr. Zevon at the American Psychological Association meeting here. His study was published online in May in Cancer.

"Our findings underscore the need to integrate legal resources into cancer care in order to enhance patient quality or life and reduce stress associated with treatment of life-threatening illnesses."

Discussing how well cancer patients' legal concerns were addressed, he reported on 50 patients assessed by the Concept System, Version 4, a multivariate statistical program. The 28 women and 22 men, mean age 52, rated items of a legal nature on a 5-point scale system, with 5 indicating that it was "very much" of importance to the patients and 1 indicating "very little/not at all important."

Of the 50 patients, 17 had leukemia, 15 were diagnosed with lymphoma, nine had gynecological malignancies, and nine had mixed diagnoses.

The patients scored health care-related legal issues -- such as a living will, health care proxy rights, and do-not-resuscitate decisions -- as the most important with this cluster of concerns generating a 3.93 score in importance.

However, the patients rated the level of how much these needs were met at 2.87. "That indicates we are not doing a good job at providing these needs to the patients," Dr. Zevon said. "We are falling short."

The patients rated employment legal issues second highest with a score of 3.7. Their rating for fulfillment of issues such as those pertaining to family leave, unemployment, Social Security, pension was just 2.37.

In the financial domain, patients said concerns about financial planning, stock ownership, Internal Revenue Service and tax implications rated 3.5 out of 5. The success in addressing these issues received a 1.97 rating.

The patients rated estate-related issues such as inheritance, property distribution, probate issues, child custody and other problems as 3.34 out of 5. However the actual care given to such issues was rated at 1.81.

"The results of this study illustrated the striking contrast between the impact of medical-legal needs in patients' quality of life and the degree to which these needs are addressed in their care," Dr. Zevon said.

"These issues are very important for patients with life-threatening illnesses -- and actually even for people without illness at present," commented Merla Arnold, Ph.D., a private practice psychologist and a board member of Psychologists in Long-Term Care.

"It is a good idea to address these estate issues, end-of-life issues and health care issues with the help of legal counsel as part of overall treatment of a patient with illnesses that could become life-threatening," said Dr. Arnold.