Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery

Abstract

PURPOSE Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non–small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. METHODS We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. RESULTS A total of 2,363 patients with stage I and II non–small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group ( P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group ( P < .01) and 64.9% of Black patients and 73.2% of White patients ( P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). CONCLUSION Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.

Leveraging Digital Technology to Reduce Cancer Care Inequities

“…Moreover, findings from a recently published study using ACCURE data revealed that the ACCURE intervention also addressed racial and ethnic gaps in treatment delays. 35 Critical to the ACCURE intervention was the real-time warning system, which alerted nurse navigators when a patient missed a recommended clinical milestone. This health informatics-enabled tool facilitated improved race-and ethnic-specific transparency and accountability in the delivery of recommended care to patients by prompting the clinical care team to re-engage and support the patient (e.g., address transportation barriers) toward receiving timely treatment when important care milestones were missed.…”

Lung Cancer Disparities Outcomes: The Urgent Need for Narrowing Care Gaps

“…Additional interventions using lay health navigators to decrease disparities in lung cancer care are ongoing. 14 The study by Charlot et al 15 in the article that accompanies this editorial reports the impact of a multilevel intervention, the Accountability for Cancer Care through Undoing Racism (ACCURE), on surgical delays (defined as . 8 weeks from diagnosis) among Black versus White patients with stage I and II nonsmall-cell lung cancer.…”

“…In the article that accompanies this editorial, Charlot et al 15 describe the association of a multilevel intervention, the Accountability for Cancer Care through Undoing Racism, with a reduction in delays in resection among Black patients with stage I and II lung cancer. These results suggest that implementation of real-time notifications of incomplete treatment milestones, physician feedback about racial gaps in treatment rates, and patient navigation may improve lung cancer outcomes among minority patients with early-stage disease.…”

“…The study by Charlot et al 15 in the article that accompanies this editorial reports the impact of a multilevel intervention, the Accountability for Cancer Care through Undoing Racism (ACCURE), on surgical delays (defined as > 8 weeks from diagnosis) among Black versus White patients with stage I and II non–small-cell lung cancer. The study was conducted as a pragmatic trial at five cancer centers and consisted of a multilevel intervention including real-time warning systems for incomplete treatment milestones, feedback regarding lung cancer treatment rates according to race, and patient navigation.…”

Clinical Trial Eligibility Criteria: A Structural Barrier to Diversity in Clinical Trial Enrollment

“…As a recent example, an antiracism system–based intervention was recently demonstrated to eliminate racial disparities in timeliness of lung cancer surgery. 11 The intervention consisted of a real-time warning system using the electronic health record to measure time-sensitive clinical milestones and enhance race-specific transparency in adhering to standards of care, a physician champion who reviewed quarterly reports on race-specific treatment completion rates, and a nurse navigator trained in racial equity analysis who informed the clinical team of care delays and addressed patient barriers to care such as lack of transportation or misinformation. This type of multilevel intervention serves as a model for reducing racial disparities in treatment and could also be applied to clinical trial enrollment.…”