Patel MI, et al. Abstract 6500. Presented at: ASCO Annual Meeting; 3rd-7th June 2022; Chicago.
Disclosure: Patel does not report relevant financial information.
Minority and low-income populations are less involved in their cancer care, experience poorer health-related quality of life, and have more acute care visits and higher overall treatment costs than their affluent and white counterparts.
However, according to a study presented at the ASCO annual meeting, incorporating a community-based intervention into health care for these underserved populations can lead to a significant improvement in those services.
The intervention, LEAPS, employs health workers trained to facilitate patient/clinician conversations about cancer care, particularly in relation to anticipatory treatment planning and symptom burden. These health workers also play an important role in connecting patients with community-based resources to overcome social determinants of health.
“What’s exciting about this plan is that these community health advocates are actually embedded in the clinics and work very closely with patients to guide their cancer care.” Manal I. patelMD, MPH, MS, Assistant Professor of Medicine in the Department of Oncology at Stanford University School of Medicine, said in an interview with Healio. “This is a very unique collaboration.”
Patel spoke to Healio about the barriers to quality healthcare in this population, the promising results of their study, and the potential future engagement of community health advocates in the cancer space.
Unhurt: As did you develop this intervention?
Patel: We have created a tiered intervention with an employers union health plan, which is essentially a situation where the Unite Here union has linked a health plan to it. Unite Here Health offers benefits to individuals who otherwise would not have benefits in their jobs and professions. These are mostly hourly wage earners who work for hotels, casinos or restaurants. The union has a trust fund that provides health care to these people. The health plan therefore has a legitimate interest in improving value-based care for its members.
This collaboration has existed for 10 years. In these clinics they have nurses, orderlies, pharmacists and clinicians. However, they employed community health advocates as part of the nursing team. These advocates supported various aspects of health care, but primarily in the area of chronic diseases – diabetes, heart failure, blood pressure management and primary care. There was nothing in the crab room.
I first encountered them after giving a presentation on the use of community health workers to assist patients with advance care planning and symptom assessment. I didn’t have data on the cost of care at the time, but the impact on patients’ experiences was one of the reasons they reached out to me. They wanted to investigate what we could do in the cancer area for their health insurance members.
Healio: How did you conduct the study?
patel: Together with United Here Health, we conducted a randomized, controlled LEAPS study in Atlantic City, New Jersey and Chicago. We randomly assigned 160 union members who were enrolled in the employers’ union health plan and who had newly diagnosed hematologic and solid tumor cancers to either usual care or the 6-month LEAPS intervention. Those in the intervention group were assigned to a community health advocate who had been trained by my team in advance care planning and symptom management. In addition, they were examined for possible barriers from a social or economic point of view. Additionally, as part of usual care, we really wanted individuals to seek out clinicians who provide the best care, even if it’s not the most cost-effective. We knew there were some providers in Atlantic City that seemed to be doing better than others, so we waived co-payments for those seeking care at those facilities.
The only thing the control group didn’t get was advance planning of care and symptom management.
Healio: What did you find?
Patel: Over time, the intervention group tended to show better health-related quality of life compared to the control group at 4 months and then again at 12 months. There was more activation and engagement in their care. That was part of the intervention – we trained these community health advocates to help patients become more active, engaged and confident about taking responsibility for their healthcare. They also helped patients feel more confident in engaging with and following their doctors regarding their treatment plans.
We found greater activation in the intervention group and a significant reduction in hospital admissions. The number of ED visits was lower, but the difference was not statistically significant. However, this resulted in a nearly 50 percent reduction in hospitalizations in the intervention group. In the intervention group, the total cost at 12 months was about $70,000 versus about $150,000 in the control group. It shows that these differences may be due to the fact that patient activation is associated with reducing unnecessary use of health services.
Another advantage lies in the symptom assessment. Most of the studies we’ve done in my group have shown that if you identify and treat patients’ symptoms after cancer diagnosis, you may not only improve their health-related quality of life, but you may also reduce the need to go to the hospital can account for uncontrolled symptoms.
This intervention is also proactive. We don’t wait for patients to need these services. You get them before you need them. This takes time and money, and the fact that Unite Here Health is investing in this is exciting. They invested in this long before we knew there was going to be a cost reduction. Now we have shown that the return on investment does not pay off.
Unhurt: What plans do you have for future research in this area?
Patel: We participate in training Unite Here health advocates across the United States. In July we are planning a training for most health advocates to engage these people. Then we plan to repeat a larger study with this group. My group will also conduct a randomized cluster study with 24 clinics.
Healio: Is there anything else for you? wantwant to mention?
Patel: I never expected to see results like this, nor do I think United Here Health did. 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 were the community advisory board members. I think community involvement leads to an effective approach because the community itself knows where best to focus this effort. They were critical when they told me what they wanted us to design for them. So we started with a little half-baked idea of what we could do, and then we really worked through the process together. Did it take a decade? Yes, but so many patients have benefited from the work we have put in. I think you need to make some sort of upfront investment for the hard work in the beginning so that you can end up benefiting from it.
For more informations:
Manal I. patelMD, MPH, MS, reachable at Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94304; Email: [email protected]