|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
An intervention using lay health workers (LHWs) reduced acute care use and improved end-of-life care use and health care satisfaction among patients with advanced cancer. The findings were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
The randomized clinical trial evaluated the impact of an intervention that used LHWs to discuss patients’ goals of care and to aid in symptom assessment, relative to usual care (control), on acute care use (primary objective) and goals-of-care documentation, health care satisfaction, and end-of-life care use (secondary objectives) among patients with advanced cancer in a community oncology practice (ClinicalTrials.gov Identifier: NCT03154190).
Between August 2016 and February 2020, 128 patients with newly diagnosed, advanced stage, solid and hematologic malignancies who planned to receive care at the practice were randomized to the intervention and control arms (n=64 each). Patients were followed for 12 months and had completed validated satisfaction surveys at randomization and 9 months of follow up.
The mean age of patients was 67 years. Overall, 12% identified as Hispanic/Latino; 51% White, 30% Asian Pacific Islander, 7% Black or African American, 2% Native Hawaiian/American Indian/Alaskan Native, and 10% multiple races/ethnicities. Cancer diagnoses were most often gastrointestinal (30%), other (23%), thoracic (16%), and breast (7%) cancer, and 49% of patients had stage IV disease. Demographic and cancer characteristics were well balanced across the arms.
The study met the primary outcome. Patients in the intervention arm were less likely to use the emergency department (OR, 0.35; 95% CI, 0.17-0.72) and hospital (OR, 0.48; 95% CI, 0.23-0.98) and had a lower average number of emergency department visits (1.05±1.74 vs 1.84±2.55; P =.04) and hospitalizations per year (0.63±1.28 vs 1.26±2.23; P =.04) compared with patients in the control arm.
More patients in the intervention arm had their goals of care documented (94% vs 52%; P <.001) and used hospice (35% vs 14%; P =.004) compared with those in the control arm. No differences in palliative care use were observed (88% vs 77%; P =.09). At 9 months of follow up, patients in the intervention arm reported greater improvements in satisfaction with care compared with patients in the control arm (difference-in-difference: 0.41, 95% CI, 0.22-0.60; P <.001). No difference in survival was observed between the arms.
Among 32 patients who died (n=16 intervention; n=16 control), in the intervention arm, nearly twice as many patients used hospice (81% vs 43%) and fewer used acute care in the last month of life (37% vs 81%; P =.012) than in the control.
“This intervention may be a scalable approach to improve care delivery and experiences for patients after a diagnosis of cancer,” concluded the authors.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.
Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
Patel MI, Smith K, Khateeb S, et al. The effect of a lay health worker intervention on acute care use, patient experiences and end-of-life care: results from a randomized clinical trial. J Clin Oncol. 2021;39(suppl 15; abstr 1508). doi:10.1200/JCO.2021.39.15_suppl.1508