In a study reported in JCO Oncology Practice, Manali I. Patel, MD, MPH, and colleagues found that a lay health worker­–led intervention was associated with improved documentation of goals of care, increased clinical trial participation, and increased use of palliative care in a population of predominantly minority and low-income adults with cancer.

Manali I. Patel, MD, MPH

As stated by the investigators, “New approaches are needed to overcome low supportive care and clinical trial participation among low-income and minority adults with cancer. The objective of this project was to determine whether a lay health worker intervention was associated with improvements in supportive care and trial participation.”

Study Details

The study enrolled 66 union members newly diagnosed with cancer into a 6-month lay health worker–led intervention from October 2016 to February 2017. Outcomes were compared with a cohort of 72 union members newly diagnosed in the 6 months preceding the intervention period. The intervention included two full-time equivalent health advocates under nurse supervision who contacted patients weekly by telephone to discuss goals of care, symptoms, and possibility of clinical trial participation. The primary outcome measure was goals of care (ie, understanding and discussing values and cancer care, preferences with clinicians, identifying a surrogate decision-maker, and completing and filing an advance directive); the outcome was considered met if an oncology clinician documented patients’ goals of care in a clinical note in the electronic health record within 6 months of diagnosis.

For the intervention vs control group: mean age was 56 vs 55 years; 24% vs 25% were Hispanic/Latino, 45% vs 46% were Black/African American, 24% vs 25% were Asian/Pacific Islander, and 16% vs 15% were White; mean annual household income was $23,436 vs $21,984; and disease stage at diagnosis was III or IV (37% vs 38%) in 72% vs 74%.

Key Findings

At 6 months, significantly more intervention group patients had clinician-documented goals of care (94% v 26%, P < .001), including entry of advance directives in the electronic health record (83% vs 17%, P < .001).

More patients in the intervention group participated in cancer clinical trials (72% vs 22%, P < .001) and received palliative care (45% vs 15%, P < .001) and hospice care (44% vs 7%, P < .001).

Death occurred within 6 months in 22% vs 31% of patients (P = .30). Among those who died, more patients in the intervention group received palliative care (100% vs 14%, P = .03) and hospice care (100% vs 23%, P < .001) before death.

Health-related quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) survey (total score = 0–108, with higher score indicating better health-related quality of life) only in the intervention group. The mean health-related quality-of-life total score at baseline was 73.2. At 4 months post-enrollment in the intervention, the mean total health-related quality-of-life score increased by 3.98 points (P < .001). The increase represented improvements in emotional and social or family well-being domains (all P < .001). Scores for physical and functional well-being domains were unchanged from baseline.

The investigators concluded, “Lay health worker–led interventions may improve supportive care and clinical trial participation among low-income and minority populations with cancer.”

Dr. Patel, of the Division of Oncology, Stanford University, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. For full disclosures of the study authors, visit ascopubs.org.