Manali I. Patel, MD, MPH, on Equitable, Value-Based Care: The Effectiveness of Community Health Worker–Led Interventions
2022 ASCO Annual Meeting
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).
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.
Richard Finn, MD, of the Geffen School of Medicine at UCLA and the Jonsson Comprehensive Cancer Center, discusses analyses from the PALOMA-2 trial on overall survival with first-line palbociclib plus letrozole vs placebo plus letrozole in women with ER-positive/HER2-negative advanced breast cancer. The study met its primary endpoint of improving progression-free survival but not the secondary endpoint of overall survival. Although patients receiving palbociclib plus letrozole had numerically longer overall survival than those receiving placebo plus letrozole, the results were not statistically significant (Abstract LBA1003).
Clifford A. Hudis, MD, of the American Society of Clinical Oncology, and Karen E. Knudsen, PhD, MBA, of the American Cancer Society, discuss their collaboration, pooling their research and education resources to help empower patients with cancer and their families. Within 48 hours, Drs. Hudis and Knudsen were able to gear up a rapid response to the crisis in Ukraine, forming a clinical corps of volunteers to post information online in multiple languages, which helped patients navigate their care in the war-torn region. To date, 300 European cancer organizations have joined their efforts.
Georgina V. Long, MD, PhD, of the Melanoma Institute Australia, The University of Sydney, discusses phase III findings from the KEYNOTE-716 study. The trial showed that compared with placebo, adjuvant pembrolizumab significantly improved distant metastasis–free survival in patients with resected stage IIB and IIC melanoma. The findings also suggest a continued reduction in the risk of recurrence and a favorable benefit-risk profile (Abstract LBA9500).
Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Takayuki Yoshino, PhD, MD, of the National Cancer Center Hospital East, Japan, discuss results from the PARADIGM trial, the first prospective study to test the superiority of panitumumab vs bevacizumab in combination with standard doublet first-line chemotherapy for patients with RAS wild-type and left-sided metastatic colorectal cancer. The study showed that panitumumab improved overall survival in combination with mFOLFOX6, which may establish a standard first-line combination regimen for this population (Abstract LBA1).
Sriram Yennu, MD, of The University of Texas MD Anderson Cancer Center, discusses the placebo response in patients with advanced cancer and cancer-related fatigue. His latest findings show that open-labeled placebo was efficacious in reducing cancer-related fatigue and improving quality of life in fatigued patients with advanced cancer at the end of 1 week. The improvement in fatigue was maintained for 4 weeks (Abstract 12006).