Patient Assistance Programs Provide Psychosocial but Not Practical Help

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“Patients with breast cancer who connect to relevant patient assistance programs receive useful informational and psychosocial but not practical help,” concluded Nina A. Bickell, MD, MPH, of Mount Sinai School of Medicine in New York, and colleagues who conducted a randomized trial among 374 women in need of adjuvant treatment after surgery for early-stage breast cancer. “Although these programs can provide patients with cancer with resources and support beyond those provided by hospitals at little to no cost to the institution, they do not affect rates of treatment,” the authors added.

Recruited from eight inner city New York teaching hospitals, 190 women were randomly assigned to intervention and 184 to usual care. The average age was 56.7 years; 79% were high school graduates, and about 50% lived with a significant other.

High rates of patients in both groups received treatment: 87% of intervention patients and 91% of usual care patients who underwent lumpectomy received radiotherapy (P = .39); 93% of intervention recipients and 86% of usual care recipients with estrogen receptor (ER)-negative tumors ≥ 1 cm received chemotherapy (P = .42); 92% of the intervention group and 93% of the usual care group with ER-positive tumors ≥ 1 cm received hormonal therapy (P = .80).

Study Design

“All patients were surveyed at baseline to measure breast cancer experiences, knowledge, attitudes, and beliefs, followed by a needs assessment,” the investigators explained. An individual action plan was created for each patient to enable contact with identified high-quality assistance programs, and at follow-up 2 weeks later, intervention patients were asked whether they had contacted the programs specified in their action plan. If not, they were asked if they still needed help, and those with unmet needs were assigned to an outreach worker. Usual care patients were mailed a New York State Department of Health pamphlet about breast cancer that included resource contact information and were called to confirm they received it.

“High rates of [intervention] patients with needs connected with a program within 2 weeks (92%),” the authors reported. At 6 months, both groups used patient-assistance programs at similar rates (75% vs 76%, P = .54). The intervention did not result in more women connecting with programs or receiving treatment.

A majority of women (288 [77%]) reported at least one need; 143 were randomly assigned to intervention, and 145 to usual care. Many had multiple needs, with 63% reporting informational; 55%, psychosocial; and 53%, practical needs, such as paying for and getting to and from treatment.

“Women with informational or psychosocial needs were more likely to receive help” (relative risk [RR] = 1.77, 95% CI = 1.51–1.90; and RR = 1.37; 95% CI = 1.06–1.61, respectively), the researchers reported. While 76% reported receiving specific help from the programs, only 7% of women in the intervention group and 4% in the usual care group with practical needs reported receiving help from a program.

The authors noted that the rates for treatment and use of assistance programs were “were significantly higher than national and previously reported rates, suggesting a possible healthy volunteer bias or Hawthorne effect.” ■

Bickell NA, et al: J Oncol Pract. September 10, 2013 (early release online).