Community-Based Intervention LEAPS Improves Cancer Care
12/13/2021, Kate O’Rourke, Clinical Oncology News
Interventions that pair community-based health workers with low-income and minority patients with cancer improve quality of life (QOL), reduce use of acute care, and may offer more effective and sustainable ways to foster equitable management of cancer, according to new research.
The study, spearheaded by Manali Patel, MD, an assistant professor of oncology at Stanford University, in California, involved 160 patients with newly diagnosed hematologic and solid tumor cancers, who were members of an employer-union health fund representing hospitality workers in in Atlantic City, N.J. Patients were randomly assigned to receive six months of standard care or an intervention involving community health workers. The intervention, known as “Lay health workers Engage educate and Activate Patients to Share” (LEAPS), uses community health workers trained to encourage and support patients to participate in their own cancer care, and to discuss advance care planning and symptom burden with oncologists. The health workers also connect patients with community-based resources to help overcome complications from social determinants of health.
In the study, three-fourths of the patients were nonwhite or Latino, roughly half were female, and the mean age was 57 years. All patients had household incomes that were at least 200% below the U.S. poverty level. The most common diagnoses were breast cancer (31%) and lung cancer (21%). The majority of patients were diagnosed with late-stage disease.
Presenting the results at the 2021 American Society of Clinical Oncology Quality Care Symposium (abstract 1), Dr. Patel and his co-investigators reported that at four months, patients partnered with community health workers had greater improvements in QOL than the control group, greater changes in patient activation (willingness and ability to take independent action to manage their health care), and lower use of acute care.
Mean scores for health-related QOL decreased from 74.1 at baseline to 70.1 at four months in the control group but increased from 73.4 at baseline to 80.4 at four months in the intervention group (P<0.001).
Mean scores on the patient activation measure increased from 53.4 at baseline to 65.4 at four months in the intervention group. In the control group, scores increased from 53.5 at baseline to 54.6 at four months (P<0.001).
The mean number of visits to the emergency department was 1.25 in the control group and 0.45 in the intervention group (P=0.03). The mean number of hospitalizations was 1.1 in the control group and 0.53 in the intervention group (P=0.02).
Goals of care were documented in 89% of the intervention group and 29% of the control group. Patients were far more likely to have an advance directive if they were in the intervention group (93% vs. 23%).
In a discussion session after the presentation, Marie Bakitas, MD, a professor and the associate director at the Center for Palliative and Supportive Care at the University of Alabama at Birmingham, said the rigor and community engagement that was involved in the early stages of developing the intervention are to be lauded and undoubtedly contributed to the intervention’s effectiveness. She said the study was “highly significant” in that it attempted to reach underrepresented population groups that have fewer resources.