Advertisement


Manali I. Patel, MD, MPH, on Equitable, Value-Based Care: The Effectiveness of Community Health Worker–Led Interventions

2022 ASCO Annual Meeting

Advertisement

Manali I. Patel, MD, MPH, of Stanford University School of Medicine, discusses clinical trial findings on the best ways to integrate community-based interventions into cancer care delivery for low-income and minority populations. Such interventions may improve quality of life and patient activation (often defined as patients having the knowledge, skills, and confidence to manage their health), as well as reduce hospitalizations and the total costs of care (Abstract 6500).



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
I'm so excited to present our work that's been a multi-year collaboration with a community-based organization and employer union health fund that provides health benefits to individuals who would otherwise not have health insurance. These are individuals that drove us to McCormick. They're individuals that work in our hotels here in Chicago. They're also individuals that work in casinos across the United States. They approached us almost 10 years ago, asking for us to help to consider how to redesign cancer care, such that their employees, once they were diagnosed with cancer, would be able to achieve equitable care at lower costs. 10 years ago, we launched an initiative. We conducted a pilot study in Chicago amongst individuals here where we paired them with a community health worker to help to engage patients in advanced care planning, as well as symptom management. And we found significant improvements in goals-of-care documentation. Using community-based participatory research methods, which means that we involved a community advisory board who guided us throughout every aspect of the project, we created a randomized trial of the pilot. Individuals that were randomized to the intervention arm received a community health worker as part of their care. This community health worker was bilingual and bicultural and would assist patients with advanced care planning and symptom management, but then also assisted patients with screening for complications from social determinants of health. So, for example, they would screen for food insecurity and connect patients to the local food bank, or they would screen for housing insecurity and connect individuals to the housing authority. Individuals as part of usual care received a benefit redesign. Every individual, either in the intervention arm or in the usual care arm, which received usual care, which was the control group, they received cancer care services that were free of charge if they went to the oncology provider that was the highest performing in the city. We conducted this randomized trial in Atlantic City and Chicago. There were 160 individuals that were randomized, 80 into each arm. And we followed patients for 12 months in an intent-to-treat analysis. And what we found was a significant improvement in our primary outcome, which was health-related quality of life. And that was an improvement of almost 11 points in the functional assessment cancer therapeutics general assessment. We also found significant reductions in acute care use, meaning hospitalizations reduced over a 12-month period. So mean hospitalizations amongst individuals in the intervention arms was significantly lower than those in the control room. We also found significant improvements in people's engagement and confidence to manage their own health, something called patient activation. And then here at ASCO, we presented the results on total cost of care as well, and found a significant reduction in total cost of care of almost 50% median total cost of care difference. These results move us from action of disparities to interventions that help to achieve health equity. And the next step is to disseminate this work across all the employer union health fund practices across the United States.

Related Videos

Breast Cancer

Nancy Davidson, MD: In It for the Long Haul: Outcomes in Hormone Receptor–Positive Breast Cancer

Nancy Davidson, MD, of the Fred Hutchinson Cancer Research Center, reviews results from four abstracts about the importance of long-term follow-up in studies of adjuvant endocrine therapy for hormone receptor–positive breast cancer. Because the natural history of hormone receptor–positive breast cancer is long, an effort is underway to improve selection of patients by clinical parameters or biomarkers, refine the endocrine therapy background, and administer more effective combinations of endocrine therapy with other agents.

Lung Cancer
Immunotherapy

Gilberto de Lima Lopes, Jr, MD, MBA, and Karen L. Reckamp, MD, on NSCLC: Overall Survival Results With Ramucirumab Plus Pembrolizumab vs Standard of Care

Gilberto de Lima Lopes, Jr, MD, MBA, of the Sylvester Comprehensive Cancer Center at the University of Miami, and Karen L. Reckamp, MD, of Cedars-Sinai Medical Center, discuss phase II findings from substudy S1800A of the Lung-MAP protocol. The data showed that ramucirumab and pembrolizumab improved overall survival compared with the standard of care for patients with advanced non–small cell lung cancer who were previously treated with immunotherapy and platinum-based chemotherapy (Abstract 9004).

 

Colorectal Cancer
Genomics/Genetics

Michael J. Overman, MD, and Smitha Krishnamurthi, MD, on RAS Wild-Type Metastatic Colorectal Cancer: Refining Treatment Strategy

Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Smitha Krishnamurthi, MD, of the Cleveland Clinic, review three abstracts, all of which enrolled patients with newly diagnosed RAS and BRAF wild-type metastatic colorectal cancer with left-sided primary tumors. The discussion centers on what the study results indicate about the use of an EGFR therapy and weighing the risk to quality of life from rash, in particular (Abstracts LBA3503, LBA3504, LBA3505).

Breast Cancer
Immunotherapy

Lisa A. Carey, MD, and Shanu Modi, MD, on Breast Cancer: Is T-DXd a Potential New Standard of Care for HER2-Low Disease?

Lisa A. Carey, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and Shanu Modi, MD, of Memorial Sloan Kettering Cancer Center, discuss the phase III findings from the DESTINY-Breast04 trial, which compared fam-trastuzumab deruxtecan-nxki (T-DXd) vs treatment of physician’s choice (TPC) in patients with HER2-low unresectable and/or metastatic breast cancer. T-DXd is the first HER2-targeted therapy to demonstrate clinically meaningful improvement in progression-free and overall survival compared with TPC in this patient population, regardless of hormone receptor or immunohistochemistry status or prior use of CDK4/6 inhibitors (Abstract LBA3).

Head and Neck Cancer
Immunotherapy

Nabil F. Saba, MD, on Head and Neck Squamous Cell Carcinoma: Phase II Findings on Pembrolizumab and Cabozantinib

Nabil F. Saba, MD, of Winship Cancer Institute of Emory University, discusses new data from a trial of pembrolizumab and cabozantinib in patients with recurrent metastatic head and neck squamous cell carcinoma. The study met its primary endpoint of overall response rate. The regimen was well tolerated and exhibited encouraging clinical activity in this patient population (Abstract 6008).

Advertisement

Advertisement




Advertisement