Low-Income, Minority Populations Benefit from Integration of Community-Based Interventions

Interventions that paired community-based health workers with low-income and minority patients with cancer improved quality of life and may be a more effective and sustainable way to ensure cancer care, according to an abstract from the 2021 American Society of Clinical Oncology (ASCO) Quality Care Symposium.

Specifically, patients partnered with community healthcare workers had greater improvement in quality of life, increased engagement in their own care (patient activation), lower acute care use, and emergency department use compared with patients who were not paired healthcare workers.

Manali I. Patel, MD, of Stanford University, and colleagues conducted patient interviews with 160 patients to assess health-related quality of life and patient activation and used claims data to assess healthcare use. Patients were obtained through an employer-union health fund; patients had newly diagnosed hematologic and solid tumor cancers and were randomly assigned to a six-month intervention or to usual care.

The intervention, known as LEAPS (Lay health workers Engage educate and Activate Patients to Share), uses community health workers trained to encourage and support patients to engage in their own cancer care, and discuss advanced care planning and symptom burden with cancer clinicians. The health workers also connect patients with community-based resources to help overcome complications from social determinants of health—the circumstances in which people are born, live, and work, which includes social, economic, and physical factors that have a direct impact on health and healthcare outcomes.

At four months, the intervention group had greater improvements in quality of life compared with usual care (difference in difference: 9.56; P<0.001), greater patient activation (difference in difference 12.43; P<0.001), lower acute care use (P=0.02), and lower emergency department use (P=0.03) than those assigned to usual care.

“The intervention is an example of how collaborations with communities, employers, and health plans can yield novel approaches to overcome inequities in cancer care delivery,” Patel said in a press release. “Such interventions can be expanded to other communities in collaboration with community-based cancer clinics and health plans—such as state-based Medicaid organizations and local employers.”