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.

Related Videos

Colorectal Cancer

Michael J. Overman, MD, and Smitha Krishnamurthi, MD, on RAS Wild-Type Metastatic Colorectal Cancer: Refining Treatment Strategy

Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Smitha Krishnamurthi, MD, of the Cleveland Clinic, review three abstracts, all of which enrolled patients with newly diagnosed RAS and BRAF wild-type metastatic colorectal cancer with left-sided primary tumors. The discussion centers on what the study results indicate about the use of an EGFR therapy and weighing the risk to quality of life from rash, in particular (Abstracts LBA3503, LBA3504, LBA3505).

Breast Cancer

Lisa A. Carey, MD, and Hope S. Rugo, MD, on Advanced Breast Cancer: New Data on Sacituzumab Govitecan-hziy vs Treatment of Physician’s Choice

Lisa A. Carey, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and Hope S. Rugo, MD, of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discuss phase III results from the TROPiCS-02 trial. This study showed that sacituzumab govitecan-hziy was more beneficial than single-agent chemotherapy in terms of progression-free survival in heavily pretreated patients with hormone receptor–positive/HER2-negative and unresectable advanced breast cancer (LBA1001).

Gynecologic Cancers

Ursula A. Matulonis, MD, and Ignace Vergote, MD, PhD, on Cervical Cancer: Interim Results on Tisotumab Vedotin-tftv Plus Pembrolizumab

Ursula A. Matulonis, MD, of Dana-Farber Cancer Institute, and Ignace Vergote, MD, PhD, of Belgium’s University Hospitals Leuven, discuss interim safety and efficacy results from a third dose-expansion cohort evaluating first-line tisotumab vedotin-tftv plus pembrolizumab in patients with recurrent or metastatic cervical cancer. Data on the combination showed durable antitumor activity with a manageable safety profile (Abstract 5507).

Hepatobiliary Cancer

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).

Skin Cancer

Georgina V. Long, MD, PhD, on Melanoma: New Data on Pembrolizumab, Dabrafenib, and Trametinib

Georgina V. Long, MD, PhD, of the Melanoma Institute Australia, The University of Sydney, discusses findings from the NeoTrio trial on neoadjuvant pembrolizumab alone, in sequence with, or concurrent with dabrafenib plus trametinib in patients with resectable BRAF-mutant stage III melanoma. The study may help clinicians determine the optimal combination of therapy (Abstract 9503).