Community Worker–Led Cancer Care Improves HRQOL in Racial/Ethnic Subgroups

"This CHW-led intervention is an effective strategy that may mitigate the impact of structural racism on ACP and cancer symptom management among low-income and racial and ethnic minoritized populations in community-based outpatient cancer clinics," according to the study authors.

Intervention organized by community health workers (CHW) produced significant improvements in health-related quality of life (HRQOL) among low-income, and racial and ethnic minority populations with cancer compared with usual care on its own, according to findings from a randomized clinical trial (NCT03699748) published in Journal of Clinical Oncology.

At baseline, the HRQOL scores were 74.1±16.5 points and 73.5±15.8 points in the control and CHW intervention groups, respectively. The scores in each respective group were 70.3±16.8 vs 80.7±16.4 points at 4 months and 73.3±15.6 vs 84.4±16.5 points at 12 months. Investigators reported a higher increase in mean HRQOL scores in the intervention group with an expected mean difference of 11.25 points (95% CI, 7.28-15.22) at 4 months and 11.29 points (95% CI, 6.96-15.62) at 12 months.

With respect to patient activation, the intervention group experienced a bigger increase in mean scores from baseline to 4 months (12.77; 95% CI, 9.07-16.46; P <.001) and 12 months (19.63; 95% CI, 15.59-23.67; P <.001) than the control group.

At 4 months compared with baseline, patients in the intervention group were more likely to be in strong agreement that they felt adequately informed about their treatment decision (odds ratio [OR], 3.04; 95% CI, 1.93-4.21), that they made the best possible decision (OR, 2.89; 95% CI, 1.72-4.17), and that their decisions were in accordance with their personal values (OR, 3.93; 95% CI, 2.51-5.23). Additionally, those in the intervention group were more likely to report that they expected to carry out their decisions (OR, 3.21; 95% CI, 2.03-4.23), that they had control over their choices (OR, 2.97; 95% CI, 1.89-4.17), and that they felt satisfied with their decisions (OR, 3.42; 95% CI, 2.24-4.62) compared with the control group (P <.001). Investigators also reported similar trends in the intervention group at 12 months.

“In this randomized clinical trial, a CHW-led advance care planning [ACP], symptom screening, and health-related social needs [HRSN] intervention [LEAPS] improved HRQOL among low-income and racial and ethnic minoritized hourly low-wage workers with solid tumor cancers and hematologic malignancies more than usual cancer care alone,” the study authors wrote. “This CHW-led intervention is an effective strategy that may mitigate the impact of structural racism on ACP and cancer symptom management among low-income and racial and ethnic minoritized populations in community-based outpatient cancer clinics.”

Investigators conducted this trial in collaboration with Unite Here Health in Atlantic City, New Jersey, and Chicago, Illinois. Patients were randomly assigned 1:1 to receive usual care alone or usual care supplemented with a trained CHW program for 12 months. The CHW-based intervention helped patients with ACP, proactively screened for symptoms by telephone, and referred patients to community-based resources for health-related social needs whenever necessary.

The trial’s primary end point was HRQOL. Secondary end points included patient activation, satisfaction with decision, ACP documentation, hospice use, total health care costs, and overall survival.

Patients 18 years and older who were Unite Here Health members with newly diagnosed solid tumor and hematologic malignancies or recurrent disease residing in Atlantic City or elsewhere in New Jersey were eligible for enrollment on the trial.

The trial population consisted of 160 patients, which included 80 each in the control and intervention groups. The median patient age was 58 years. Additionally, 51.8% of patients were female, 51.3% were White, 29.4% were Hispanic, 27.5% were African American or Black, 19.3% were Asian, 1.3% were American Indian or Alaska Native, and 0.6% were Native Hawaiian.

Overall, 79.4% of patients had an annual household income of less than $35,000, and 80.6% reported attaining less than a high school degree. Additionally, 23.1% of patients had breast cancer, and 40.0% had stage IV disease. Investigators reported no meaningful differences in demographic or clinical characteristics between the intervention and control groups.

Patients in the intervention group were more likely to have goals of care documentation compared with those in the control group at 4 months (OR, 9.20; 95% CI, 3.83-20.03; P <.001) and 12 months (OR, 19.72; 95% CI, 8.43-46.12; P <.001). Additionally, there were no statistically significant differences in the probability of emergency department use between the groups at 4 months (OR, 0.75; 95% CI, 0.30-1.88; P = .54) or 12 months (OR, 1.16; 95% CI, 0.54-2.49; P = .70).

Investigators reported a 12-month median total cost of care of $153,980 in the intervention group and $67,655 in the control group with a proportional change in total costs of 0.61 (95% CI, 0.40-0.92; P = .02) between cohorts.

Reference

Patel MI, Kapphahn K, Wood E, et al. Effect of a community health worker–led intervention among low-income and minoritized patients with cancer: a randomized clinical trial. J Clin Oncol. Published online August 25, 2023. doi:10.1200/JCO.23.00309