Community Health Workers Leading Social Needs Intervention

“How can you begin to think about a clinical trial when you can’t get food on the table?” The impact on clinical trial education and accrual.

 

By Dr. Sohiel Deshpande

 

Key Points: 

• Diversity in cancer clinical trials remains a global concern.
• Multilevel etiologies exist for this issue, but addressing health-related social needs is a crucial first step that we should take.
• A holistic approach with the help of community partners can help improve outcomes for all involved.

 

There is a worldwide concern that participants in clinical trials are not diverse enough to represent the patient population we encounter in our clinics. This can lead to difficulty translating and applying outcomes from these trials to the general population. ​1–4​  Dr. Manali Patel highlighted the point that systemic barriers related to lack of adequate access, awareness amongst participants, and similarly amongst health workers, coupled with issues like racism, are all contributing to disparities in care. 

 

She then discussed the Addressing Latinx CANcer Care Equity (ALCANCE) randomized controlled trial. This study in Monterey County showed that community health worker-led interventions increased patient knowledge about precision medicine amongst an underserved population, highlighting the value of academic-community partnerships in advancing health equity [5].  

 

Dr. Patel expressed the importance of prioritizing screening for and addressing health-related social needs. Multiple studies have shown that health-related social needs play an essential role in the outcomes of cancer patients [6, 7].​ Routine screenings for food insecurity, financial assistance, arranging medical and charitable transportation, legal aid, college and vocational education, and developing safety plans would provide a holistic, patient-centered approach to health.  

 

Tools like ‘The Hunger Vital Sign’ are simple and short screening tools for food insecurity. Once identified, patient navigation showed improved health-related quality of life [8]. Interventions like these ultimately help build relationships and improve trust with the community, which can improve clinical trial education and accrual.  

 

References: 

​​1. Duma N, Aguilera JV, Paludo J, et al. Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. J Oncol Pract. 2018;14(1):e1-e10. doi:10.1200/JOP.2017.025288 

​2. Sirugo G, Williams SM, Tishkoff SA. The Missing Diversity in Human Genetic Studies. Cell. 2019;177(1):26-31. doi:10.1016/J.CELL.2019.02.048 

​3. Nazha B, Mishra M, Pentz R, Owonikoko TK. Enrollment of Racial Minorities in Clinical Trials: Old Problem Assumes New Urgency in the Age of Immunotherapy. American Society of Clinical Oncology Educational Book. 2019;(39):3-10. doi:10.1200/EDBK_100021 

​4. Ajewole VB, Akindele O, Abajue U, Ndulue O, Marshall JJ, Mossi YT. Cancer Disparities and Black American Representation in Clinical Trials Leading to the Approval of Oral Chemotherapy Drugs in the United States Between 2009 and 2019. JCO Oncol Pract. 2021;17(5):e623-e628. doi:10.1200/OP.20.01108 

​5. Wood EH, Rodriguez GM, Villicana G, et al. The effect of a multilevel community health worker–led intervention on patient knowledge of precision medicine: A randomized clinical trial. https://doi.org/101200/OP20231911_suppl211. 2023;19(11_suppl):211-211. doi:10.1200/OP.2023.19.11_SUPPL.211 

​6. Patel MI, Lopez AM, Blackstock W, et al. Cancer disparities and health equity: A policy statement from the american society of clinical oncology. Journal of Clinical Oncology. 2020;38(29):3439-3448. doi:10.1200/JCO.20.00642/ASSET/IMAGES/LARGE/JCO.20.00642T2.JPEG 

​7. Graboyes EM, Lee SC, Lindau ST, et al. Interventions addressing health-related social needs among patients with cancer. JNCI: Journal of the National Cancer Institute. 2024;116(4):497-505. doi:10.1093/JNCI/DJAD269 

​8. Parks CA, Carpenter LR, Sullivan KR, et al. A Scoping Review of Food Insecurity and Related Factors among Cancer Survivors. Nutrients 2022, Vol 14, Page 2723. 2022;14(13):2723. doi:10.3390/NU14132723 

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Author Bio:

Dr. Sohiel Deshpande is an internal Medicine resident at Mercy Catholic Medical Center Pennsylvania and an incoming Hematology and Medical Oncology Fellow at Thomas Jefferson University Hospital.  

 

No Conflicts of Interest