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

Bladder Cancer

Karim Chamie, MD, on Bladder Cancer: Final Results on N-803 and Bacillus Calmette-Guérin

Karim Chamie, MD, of the University of California, Los Angeles, discusses final clinical results on combining the superagonist N-803 with bacillus Calmette-Guérin (BCG) in patients whose carcinoma in situ and high-grade non–muscle-invasive bladder cancers are unresponsive to BCG alone. Of note, cystectomy was avoided in more than 90% of patients with 2 years of follow-up (Abstract 4508).

COVID-19

Jenny S. Guadamuz, PhD, on Racial and Socioeconomic Disparities in Telemedicine Use Among U.S. Patients With Cancer During the COVID-19 Pandemic

Jenny S. Guadamuz, PhD, of Flatiron Health, discusses the use of telemedicine services in community oncology clinics for patients initiating treatments for 21 common cancers during the COVID-19 pandemic. Black, uninsured, non-urban, and less affluent patients were less likely to use telemedicine services. Although telemedicine may expand access to specialty care, the proliferation of these services may widen cancer care disparities if equitable access to these services is not ensured, according to Dr. Guadamuz (Abstract 6511).

Michael J. Overman, MD, and Takayuki Yoshino, PhD, MD, on Colorectal Cancer: Phase III Data on Panitumumab or Bevacizumab Plus mFOLFOX6

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).

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).

Hepatobiliary Cancer
Immunotherapy

Akihiro Ohba, MD, on Biliary Tract Cancer: New Findings on Fam-Trastuzumab Deruxtecan-nxki

Akihiro Ohba, MD, of Japan’s National Cancer Center Hospital, discusses phase II data from the HERB trial on fam-trastuzumab deruxtecan-nxki, which showed activity in patients with HER2-expressing unresectable or recurrent biliary tract cancer (Abstract 4006).

Advertisement

Advertisement




Advertisement