“Strategies that provide patients with support and resources within their communities may provide an opportunity to improve quality of life and improve patient engagement in their own care among minority and low-income patients with cancer and may help reduce care disparities,” said ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO.
ALEXANDRIA, Va. — Interventions that paired community-based health workers with low-income and minority patients with cancer improved quality of life and may be a more effective and sustainable way to ensure equitable cancer care, according to a study to be presented as part of the 2021 ASCO Quality Care Symposium.
Study at a Glance
Effect of an intervention that paired low-income and racial minority patients with community health workers — trained on symptom burden, quality of life, and engagement of patients in their care
160 patients with newly diagnosed hematologic and solid tumor cancers, who were members of an employer-union health fund in Atlantic City, NJ
Patients partnered with community health workers had greater improvements in quality of life, greater change in engagement in their own care (patient activation), lower acute care use (hospital visits), and emergency department use compared with patients who received standard care.
Longstanding inequities in the cancer care system have led to disproportionately poorer health-related quality of life, greater use of acute care, less understanding of, and participation and agency in their own cancer care (patient activation).
Patient activation has been shown to differ by race and ethnicity: Black Americans have demonstrated lower levels of patient activation than whites, even after controlling for other characteristics. Activation has been shown to be lower in medically underserved populations.1, 2, 3
“The intervention is an example of how collaborations with communities, employers and health plans can yield novel approaches to overcome inequities in cancer care delivery. Such interventions can be expanded to other communities in collaboration with community-based cancer clinics and health plans— such as state-based Medicaid organizations and local employers,” said lead author Manali I. Patel, MD, who is an assistant professor of oncology at Stanford University.
About the Study
In this federally funded study, a total of 160 patients with newly diagnosed cancers were randomized to receive 6 months of standard cancer care or an intervention involving community health workers. Patients were also members of an employer-union health fund in Atlantic City, New Jersey, that represents hospitality workers.
The intervention, known as Lay health workers Engage educate and Activate Patients to Share (LEAPS), uses community health workers trained to encourage and support patients to engage in their own cancer care, and discuss advance care planning and symptom burden with cancer clinicians. The health workers also connect patients with community-based resources to help overcome complications from social determinants of health — the circumstances in which people are born, live, and work, and include social, economic, and physical factors that have a direct impact on health and health care outcomes.
The primary objective was to determine if the intervention improved health-related quality of life between baseline and four months post-enrollment compared with the difference between baseline and four months for those who received usual care. Researchers also looked at the effect on change in patient understanding of and participation and agency in their own cancer care (patient activation) at 4 months post-enrollment compared to baseline, and the change in acute care use within 12 months post-enrollment.
At four months, patients partnered with community health workers (intervention) had greater improvements in quality of life as compared to the control group, greater change in patient activation, and lower acute care use (hospitalizations and emergency department visits).
The majority of patients in the trial were non-white or Latino (74%) and female (53%), with a mean age of 57 years. All patients had household incomes at least 200% below the U.S. poverty level. The most common diagnoses were breast (31%) and lung (21%) cancers. The majority of patients were diagnosed with late-stage disease (63%).
The researchers plan to conduct a large, multi-site randomized controlled trial.
This study received funding from the United States National Institutes of Health.
View the full abstract (includes link to view authors' disclosures)
For your readers:
- Cancer Does Not Affect All People Equally: An Expert Q&A on Cancer Disparities and Health Equity
- Resources on Cancer Disparities and Health Equity
- What Are Social Determinants of Health and How Do They Affect People With Cancer?
View the disclosures for the 2021 ASCO Quality Care Symposium News Planning Team: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2021-qcs-npt-disclosures.pdf
View the disclosures for Dr. Gralow: https://coi.asco.org/share/CKD-HYVM/Julie%20Gralow
ATTRIBUTION TO THE 2021 ASCO QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.
1. Hibbard JH, Greene J, Becker ER, Roblin D, Painter MW, et al. Racial/ethnic disparities and consumer activation in health. Health Aff. 2008 27:1442–1453.
2. Lubetkin EI, Lu WH, Gold MR. Levels and correlates of patient activation in health center settings: building strategies for improving health outcomes. J. Health Care Poor Underserved. 2010;21:796–808.
3. Hibbard JH, Cunningham PJ. How engaged are consumers in their health and health care and why does it matter? Washington DC: Research Brief, Center for Health Systems Change; 2008. [October 2008]. Report No.: 8
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