A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers

Abstract

Background Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. Methods We performed a 5‐year pragmatic, trial at five cancer centers using a system‐based intervention. Patients diagnosed with early stage lung cancer, aged 18‐85 were eligible. Intervention components included: (1) a real‐time warning system derived from electronic health records, (2) race‐specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. Results There were 2841 early stage lung cancer patients (16% Black) in the retrospective group and 360 (32% Black) in the intervention group. For the retrospective baseline, crude treatment rates were 78% for White patients vs 69% for Black patients (P < 0.001); difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income‐odds ratio (OR) 0.66 for Black patients (95% CI 0.51‐0.85, P = 0.001). Within the intervention cohort, the crude rate was 96.5% for Black vs 95% for White patients (P = 0.56). Odds ratio for the adjusted analysis was 2.1 (95% CI 0.41‐10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. Conclusion A system‐based intervention tested in five cancer centers reduced racial gaps and improved care for all.

Cancer health disparities in racial/ethnic minorities in the United States

“… 235 Surgical therapy has improved so that early-stage 3 non-small-cell lung cancer is often amenable to resection, and the persistent lower rate of surgery for AA/B patients might be amenable to system interventions. 236 Limited data exist on attitudes towards treatment, stage at presentation and outcomes of therapy in other diverse populations with lung cancer.…”

Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States

“…Broad multilevel engagement in eliminating the unequal burden of cancer mortality will be essential given the substantial disparities observed in this study and persistence of higher cancer mortality among Blacks compared with Whites since the 1960s ( 32 ). At the point-of-care level, a recent multifaceted intervention with elements of race-specific feedback and patient-centered communication reduced Black–White disparities in access to treatment of early stage lung cancer at 5 cancer centers ( 33 ). In 2016, the American Society of Clinical Oncology approved a strategic plan for increasing racial/ethnic diversity in the oncology workforce, which could potentially bring intercultural responsiveness and expand health-care access among minorities ( 34 ).…”

Healthcare delivery interventions to reduce cancer disparities worldwide

“…In an effort to decrease Black-white disparities in early stage lung cancer, a study at two cancer centers in Pittsburgh and North Carolina used a navigator to proactively reach out to Black patients who missed appointments to identify and resolve barriers to care. The Black-white gap in receipt of curative intent surgery or radiation was eliminated, and treatment rates for Black patient ( n = 144) rose from 69% to 97%[ 42 ]. In Texas, a similar proactive lay navigator model for Hispanic patients ( n = 200) with breast cancer correlated with earlier treatment initiation of 1.9 mo vs 2.4 mo for a historical group ( P = 0.04)[ 43 ].…”