TOPLINE:

A simple phone-based symptom assessment intervention, led by lay health workers, reduced emergency department (ED) visits by more than half and hospitalizations by two thirds among older adults with cancer. The approach also cut total mean healthcare costs by $12,000 per participant.

METHODOLOGY:

• Many older adults with cancer have cancer-related symptoms that go underrecognized and undertreated. Identifying these issues and intervening early remains a challenge.
• To help bridge this gap, researchers explored a low-tech telephone-based strategy that employed just two lay health workers. The researchers conducted a multisite randomized clinical trial across 43 oncology clinics in California and Arizona from November 2020 through October 2023, with 12 months of follow-up among Medicare Advantage beneficiaries aged 75 years or older with newly diagnosed, recurrent, or progressive cancer.
• Participants were randomized into a symptom assessment group (n = 200; usual care with lay health worker-led telephone-based symptom assessments for 12 months using the Edmonton Symptom Assessment System) or a control group (n = 216; usual care alone). Edmonton Symptom Assessment System scores ranged from 0-10, where 0 indicates no symptoms and 10 indicates worst possible symptoms.
• Lay health workers asked patients standard quality-of-life questions over the phone and reviewed assessments with advanced practice practitioners, which happened same day if symptoms were rated at least a 4 or increased by 2 or more points since the previous assessment. Relaying this information in the same day allowed practitioners to provide interventions quickly.
• Primary outcomes included ED use and hospitalizations; secondary outcomes encompassed total costs, hospice use, and among decedents, acute care within 30 days of death and facility deaths.

TAKEAWAY:

• Participants who received symptom assessments were 53% less likely to use the ED (30.5% vs 47.7% with one or more ED visits; odds ratio [OR], 0.47; P  < .001) and 68% less likely to be hospitalized (18.5% vs 39.8% with 1 or more hospitalization; OR, 0.32; P < .001) than control participants.
• Among deceased participants (71 in each group), those in the symptom assessment group had 68% lower odds of ED use within 30 days of death (OR, 0.32) and 75% lower odds of acute care facility death (OR, 0.25).
• The intervention group had significantly lower mean total healthcare costs — $25,345 vs $37,203 — per participant than the control group, for a mean difference of about $12,000 (P  = .01).

IN PRACTICE:

This symptom assessment intervention helped reduce acute care use and costs while also improving end-of-life care outcomes and “may be a scalable approach to reduce acute care use,” the study authors concluded.

“The results are remarkable,” accompanying editorial wrote. “This low-tech, human-administered intervention reaped huge dividends.” The editorialists also noted the benefit of a phone-based strategy for older patients who “often prefer speaking to people — not interacting with software — particularly when they are struggling.”

SOURCE:

The study, led by Manali Patel, MD, MPH, MS, Division of Oncology, Stanford University School of Medicine in Stanford and VA Palo Alto Health Care System in Palo Alto, California, was published online in JAMA, alongside an accompanying editorial.

LIMITATIONS:

While this large study involved multiple clinics and diverse participants, the focus on one Medicare Advantage payer’s network of oncology practices and the use of only two lay health workers could limit generalizability. Implementation outcomes, which may influence adoption and uptake, were not assessed. Different levels of disease severity could have resulted in disparities in mortality rates between groups and produced biased estimates, though this was limited by randomization and mortality rates and baseline mean risk adjustment factor scores were roughly similar between groups, mitigating concerns regarding differences in disease severity.

DISCLOSURES:

Milstein disclosed having stock from Emsana Health and Embold Health, and serving as a trustee at Intermountain Healthcare (uncompensated) and medical director at PBGH (uncompensated). No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.