Results from a pilot feasibility study of a novel community health worker–led intervention delivering stepped palliative care and care navigation for patients with pancreatic ductal adenocarcinoma.

Abstract

12081 Background: Pancreatic Ductal Adenocarcinoma (PDAC) is associated with substantial morbidity, poor quality of life, and poor overall survival. Early palliative care (PC) has been shown to improve quality of life and reduce symptom burden in PDAC, but specialty PC services are often unavailable for this fast-progressing illness, and even then are only utilized by a minority of PDAC patients. To address this challenge, we developed a digitally enhanced CHW-led intervention to deliver stepped PC to patients with PDAC and to report its feasibility and preliminary efficacy. Methods: Adults (aged ≥18 years) with newly diagnosed PDAC (within 2 weeks of diagnosis) were enrolled in a single-arm pilot feasibility study from January to August 2025 (N = 48). The intervention involved early palliative care engagement with targeted escalation (stepping) for patients with untreated symptoms, leading to expedited PC visits, patient education, care navigation, and providing targeted financial resources for patients. The digital component involves using short educational videos and the Twilio SMS to administer the Edmonton Symptom Assessment Scale weekly, with patients with high symptom scores being stepped up to PC visits. The CHW-led intervention was delivered over 12 weeks. Feasibility outcomes were patient engagement with the CHW and completion of the intervention. The acceptability outcome was defined using the AIM-IAM-FIM instrument. Secondary outcomes include symptom burden (NCCN/FACT Hepatobiliary Cancer Symptom Index-18), Advanced Care Planning (ACP) compliance rates, and financial toxicity (measured by the COST instrument). Results: The median age of pts (N = 48) was 69 (IQR 62-76), and 29 (60%) were Hispanic. 25 (52%) had metastatic PDAC, 14 (29.1%) had borderline resectable PDAC, and 9 (18.8%) had resectable PDAC at diagnosis. Four patients died before the intervention was completed, while the remaining patients completed it. Regarding acceptability, 94% strongly agreed that the intervention was acceptable. Themes identified from exit-interviews included the critically important role of the CHW in the process, including appointment scheduling, especially as symptoms worsened. Patient’s symptom burden (median 68 vs. 55, P = 0.02) and rates of financial toxicity (39% vs. 25%, p = 0.01) decreased from baseline to 12 weeks, while 83% of patients completed ACP by 12 weeks. Conclusions: Our digitally-enhanced CHW-led intervention delivering stepped PC was feasible and acceptable to patients with PDAC. The intervention was associated with improvement in symptom burden, reduction in financial toxicity, and higher ACP planning rates. Future prospective comparative studies are needed to understand the intervention’s ability to help manage the morbidity associated with PDAC.