Latinx and low-income populations experience greater cancer incidence, later stage diagnosis, poorer quality of life, less access to precision medicine (PM), and greater morbidity and mortality than non-minority, more affluent populations. Community-based, culturally tailored approaches are needed to address these disparities. Community Health Worker (CHW) models popular in prevention, have yet to be implemented in precision cancer care. This randomized controlled trial will evaluate the efficacy of a CHW-led intervention among patients with cancer to reduce disparities. The primary outcome is to evaluate the effect on patient knowledge of PM and secondarily on receipt of evidence-based care, patient activation, health-related quality of life, and satisfaction.
A community advisory board and stakeholder interviews informed the design of this ongoing trial. Patients are randomized to usual care (control group) or usual care + the CHW intervention. Participants randomized to the intervention group are assigned to a CHW who educates them on PM, engages them in advance care planning, screens for complications from social determinants of health and connects them to community-based resources. Surveys at baseline, 3-, 6-, and 12-months measure changes in knowledge about PM; patient activation; quality of life; prognosis; prognostic awareness, and satisfaction with decision. Surveys are in English and Spanish.
To date, 55 participants of an anticipated 110 have enrolled. Most are female (n=32, 58.2%), Hispanic (49, 89.1%), and in their late 50s (mean score (SD), 58.7 (12.8)). Most have attained less than a high school education (36, 65.5%) and report annual household incomes less than $35,000 (28, 71.8%). Most common are gastrointestinal (19, 34.5%) cancers diagnosed with stage 4 disease (25, 45.5%). Only 1 patient had an advance directive at baseline. Baseline knowledge of PM was low (mean score (SD), 22.8 (20.0)).
Interventions to increase knowledge and access to precision cancer care are needed.