To the Editor Whether interventions by lay health workers (LHWs) can improve end-of-life care for patients with advanced cancer is a worthy but still uncertain research question. We appreciate the efforts of Patel and colleagues¹ in conducting the EPAC randomized clinical trial and updating the results regarding the long-term effects. We would like to raise a few concerns.

In the initial results of the EPAC trial published in 2018,² the authors mentioned that the LHW employed held a Bachelor of Arts degree and was trained through a curriculum developed by the principal investigator and informed by social cognitive theory. However, in these updated trial results, the participating LHW is described as holding a Bachelor of Science degree. According to the study protocol, the LHW’s work involved conducting 1:1 semistructured discussions within 6 months of the patient’s first oncology appointment, and this work should have been completed by 2015. The updated data suggest a change in the LHW, raising questions about whether a different LHW continued providing services to surviving patients during long-term follow-up. If the LHW’s role in follow-up extends beyond the initial 6 months, it implies that the sustained long-term benefits attributed to the LHW intervention come at a higher human resource cost than described in the Methods. This may affect the evaluation of the LHW’s role in long-term follow-up, particularly regarding cost-effectiveness, and warrants further explanation.