Randomized trial of lay health worker-led symptom intervention and acute care use in older adults with cancer

Undertreated cancer symptoms are common among older adults. A randomized trial across 43 oncology clinics in California and Arizona investigated whether a lay health worker-led symptom assessment reduces acute care use among older adults with cancer. Medicare Advantage beneficiaries aged 75 years or older were randomized to usual care with lay health worker-led, telephone-based symptom assessments for 12 months (n=200) or usual care alone (n=216). Patients in the lay health worker symptom assessment group had significant reductions in any emergency department use (30.5% versus 47.7%; OR 0.47; 95% CI 0.32-0.71)) and any hospitalization (18.5% versus 39.8%; OR 0.32; 95% CI 0.20-0.51) and lower mean total costs by 12,000 per particpant (p=0.01) at 12 months compared to those who received usual care only. The authors conclude that these findings demonstrate effectiveness of a lay health worker-led symptom assessment intervention for older adults with cancer.