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.
The ASCO Post Staff
Etienne Brain, MD, PhD, of the Institut Curie, discusses phase III findings from the Unicancer ASTER 70s trial, in which patients aged 70 or older with estrogen receptor–positive, HER2-negative breast cancer and a high genomic grade index received adjuvant endocrine therapy with or without chemotherapy. The data did not find a statistically significant overall survival benefit with this treatment after surgery (Abstract 500).
The ASCO Post Staff
Shilpa Gupta, MD, of the Cleveland Clinic Foundation, discusses an updated consensus definition for standard therapy and clinical trial eligibility for patients with metastatic urothelial cancer who are platinum-ineligible, criteria that are proposed to guide treatment recommendations for this population. This may be especially important now that the U.S. Food and Drug Administration has restricted the use of first-line pembrolizumab to those who are considered platinum-ineligible (Abstract 4577).
The ASCO Post Staff
Andrew D. Zelenetz, MD, PhD, of Memorial Sloan Kettering Cancer Center, and Michael L. Wang, MD, of The University of Texas MD Anderson Cancer Center, discuss primary results from the phase III SHINE study, which showed that ibrutinib, in combination with bendamustine/rituximab and rituximab maintenance, may set a new benchmark for patients aged 65 or older with mantle cell lymphoma. With a median progression-free survival of 6.7 years, the ibrutinib combination is more beneficial than currently used chemoimmunotherapy (approximately 1.5–3.5 years) (Abstract LBA7502).
Paul G. Richardson, MD, of Dana-Farber Cancer Institute, discusses phase III findings from the DETERMINATION trial, which showed that, for patients with newly diagnosed multiple myeloma, lenalidomide, bortezomib, and dexamethasone (RVd) with or without autologous stem cell transplant (ASCT) and lenalidomide maintenance to disease progression resulted in the longest median progression-free survival reported for each approach, and a highly significant difference in progression-free survival in favor of early transplant. While overall response rates were similar, rates of MRD favored early transplant also, but toxicity was greater and quality of life was transiently but significantly diminished. No overall survival advantage has been observed to date (Abstract LBA4).
The ASCO Post Staff
Pamela L. Kunz, MD, of the Yale University School of Medicine, discusses new findings from the ECOG-ACRIN E2211 trial, which showed the longest progression-free survival and highest response rates with temozolomide plus capecitabine reported to date for patients with pancreatic neuroendocrine tumors. The presence of a deficiency of MGMT, the drug-resistance gene, was associated with greater odds of an objective response (Abstract 4004).