Community intervention benefits low-income minority people with cancer


Patel MI, et al. Abstract 6500. Presented to: ASCO Annual Meeting; June 3-7, 2022; Chicago.

Disclosures: Patel does not report any relevant financial information.

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Minority and low-income populations are less involved in their cancer care, have lower health-related quality of life, and experience more acute care visits and higher total costs of care than their affluent and white counterparts .

However, incorporating community intervention into health care delivery for these underserved populations can lead to significant improvement in these measures, according to a study presented at the ASCO annual meeting.

Quote from Manali I. Patel, MD, MPH, MS.

The intervention, LEAPS, uses trained community health workers to facilitate discussions between patients and clinicians about cancer care, particularly regarding advance care planning and symptom burden. These community health workers also play an important role in connecting patients to community resources to overcome the social determinants of health.

“What’s exciting about this plan is that these community health advocates are actually embedded in clinics and working closely with patients to navigate their cancer treatment,” Manali I. PatelMD, MPH, MS, assistant professor of medicine in the division of oncology at Stanford University School of Medicine, said in an interview with Healio. “This is a very unique collaboration.”

Patel spoke with Healio about the barriers to quality health care in this population, the promising results of his study, and the potential future use of community health advocates in cancer.

Helio: How did you develop this action?

patel: We have created a tiered response with an employer union health plan, which is basically a situation where the union, Unite Here, is partnered with a health plan. Unite Here Health provides benefits to people who otherwise would not have benefits in their jobs and professions. These are mainly hourly workers who work for hotels, casinos or restaurants. The union has a trust fund that sets up health benefits for these people. Thus, the health plan has a vested interest in improving value-based care for its members.

This collaboration has been going on for 10 years. In these clinics, they have nurses, nurse practitioners, pharmacists, and clinicians. However, as part of the care team, they employed community health advocates. These advocates were involved in various aspects of care delivery, but primarily in the area of ​​chronic disease – diabetes, heart failure, blood pressure management and primary care. There was nothing in the cancer space.

I first met them after giving a presentation on using community health workers to help patients plan care in advance and assess symptoms. At the time, I had no data on the cost of care, but the impact on patient experience was part of the reason they contacted me. They wanted to study what we could do in the area of ​​cancer for their health plan members.

Healio: How did you conduct the study?

Patel: In collaboration with United Here Health, we conducted a randomized, controlled trial of LEAPS in Atlantic City, New Jersey, and Chicago. We randomly assigned 160 union members enrolled in the employer-union health plan and newly diagnosed with hematological cancers and solid tumors to usual care or the 6-month LEAPS intervention. Intervention group members were assigned to a community health advocate who had been trained by my team in advance care planning and symptom management. Additionally, they were pre-screened for any barriers they might have faced from a social or economic standpoint. Also, as part of usual care, we really wanted people to seek out the clinicians who provided the best care, even if they weren’t the least expensive. We knew there were some providers in Atlantic City who seemed to do better than others, so we would waive copayments for those seeking care at those facilities.

The only thing the control group did not receive was advance care planning and symptom management.

Healio: What did you find?

patel: Over time, compared to the control group, the intervention group tended to have better health-related quality of life at 4 months and then again at 12 months. There was more activation and engagement in their care. This was part of the intervention – we trained these community health advocates to help patients be more active, engaged and confident in taking charge of their healthcare. They also helped patients feel more confident about engaging and following up with their clinicians regarding their treatment plans.

We found greater activation in the intervention group and significant reductions in hospitalizations. The number of emergency room visits was lower, but the difference was not statistically significant. However, this translated to an almost 50% reduction in hospitalizations in the intervention group. In the intervention group, the overall cost at 12 months was about $70,000 versus about $150,000 in the control group. It shows that what may explain these differences is that patient activation is associated with reductions in unnecessary healthcare utilization.

Another advantage lies in the assessment of symptoms. Most of the studies we’ve done in my group have shown that if you identify and address patients’ symptoms after they’ve been diagnosed with cancer, you can potentially not only improve their health-related quality of life, but also reduce the need to go to the hospital. for uncontrolled symptoms.

This intervention is also proactive. We do not expect patients to need these services. They get them before they need them. It takes time and money, and the fact that Unite Here Health is invested in it is exciting. They invested in this long before we knew there would be a cost reduction. Now we have shown that the return on investment does not pay for itself.

Helio: What are your future research projects in this area?

patel: We are committed to training Unite Here Health advocates across the United States. In July, we are planning training for most health advocates to engage these people. Then we plan to replicate a larger study with this group. My group will also do a cluster randomized study of 24 clinics.

Healio: Is there anything else you would bewould like to mention?

patel: I didn’t expect to see these kinds of results, and I don’t think United Here Health did either. I couldn’t be more grateful to have been involved in this community-based approach – United Here Health was involved in the design of this intervention, as well as the members of the Community Advisory Board. I think community involvement leads to an effective approach, because the community itself knows where to focus these efforts. They were critical in telling me what they wanted us to design for them. So we started with a bit of a half-baked idea of ​​what we thought we could do, and then together we really worked through the process. Did it take a decade? Yes, but so many patients have benefited from the work we have done. I think you have to make some sort of upfront investment to do the hard work at the start, so you can reap the benefits at the end.

For more information:

Manali I. PatelMD, MPH, MS, can be contacted at Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94304; email: [email protected]


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