A Lay Health Worker–Led Symptom Intervention and Acute Care Use in Older Adults With Cancer

Importance Undertreated cancer symptoms are common among older adults, yet effective early identification and intervention remain limited. Objective To determine whether lay health worker–led symptom assessment reduces acute care use among older adults with cancer. Design, Setting, and Participants Multisite randomized clinical trial across 43 oncology clinics in California and Arizona conducted 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. Interventions Participants were randomized 1:1 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), with planned enrollment of 200 in both groups. The lay health workers reviewed assessments with advanced practice practitioners who conducted interventions for symptoms rated 4 or greater or that increased by 2 points or more. Main Outcomes and Measures Outcomes were determined a priori. The primary outcome was emergency department (ED) use and hospitalizations. Secondary outcomes were total costs, hospice, and, among decedents, acute care within 30 days of death and facility deaths. Results Among 416 patients, the median age was 82 (range, 75-99) years; 219 (52.6%) were male; 171 (41.1%) had stage 4 disease; and 27 (6.4%) had recurrent disease. The mean risk adjustment factor score was 2.70 (SD, 1.77). Symptom assessment participants had 53% lower odds of ED use (61 [30.5%] vs 103 [47.7%] had ≥1 ED visit; adjusted odds ratio [OR], 0.47; 95% CI, 0.32-0.71), 68% lower odds of hospitalization (37 [18.5%] vs 86 [39.8%] had ≥1 hospitalization; OR, 0.32; 95% CI, 0.20-0.51), and lower mean total costs by $12 000 per participant ( P = .01) than control group participants. Among 142 deceased participants (71 in each group), symptom assessment participants had 68% lower odds of ED use within 30 days of death (OR, 0.32; 95% CI, 0.12-0.88) and 75% lower odds of acute care facility death (OR, 0.25; 95% CI, 0.08-0.77). Conclusions and Relevance A lay health worker–led symptom assessment intervention may be a scalable approach to reduce acute care use. Trial Registration ClinicalTrials.gov Identifier: NCT04463992