Breast Cancer Coverage from Every Angle

Can Systems-Based Intervention Reduce Racial Gaps in Treatment of Breast Cancer?

By: Vanessa A. Carter, BS
Posted: Friday, November 12, 2021

Matthew Manning, MD, FASTRO, of Cone Health Cancer Center, Greensboro, North Carolina, and colleagues conducted the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial to attempt to reduce treatment and survival disparities among Black and White patients with breast and lung cancers. Their results, which were presented during the 2021 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 53), demonstrated improved 5-year overall survival rates, suggesting that systems-based intervention may also reduce race-related survival disparities.

“Thousands of studies have looked at racial disparities in health care, but until recently, very few studies have implemented interventions to eliminate those disparities,” said Dr. Manning in an ASTRO press release. “This study shows that it can be done.”

The ACCURE approach had four key components: (1) an electronic health record with automatic alerts to flag missed appointments or unmet milestones in expected care; (2) a nurse navigator trained in race-specific barriers to help patients overcome obstacles to care when alerts are flagged; (3) a physician champion, to engage health-care teams with race-related feedback on treatment completion; and (4) regular health-equity education training sessions for staff.

Previous results demonstrated that ACCURE improved treatment completion rates between Black and White patients who received surgery or radiation therapy for early-stage lung or breast cancer. This new trial enrolled 1,413 participants with stage 0, I, and II breast and lung cancers diagnosed from 2013 to 2015 and compared them with 2,016 patients treated before the intervention from 2007 to 2011.

Before the intervention was implemented, the 5-year survival rates for White and Black patients with breast cancer were 89% and 81%, respectively. Of note, both increased to about 94% after the systems-based changes occurred, which was significant among Black patients (P = .044). Additionally, the survival rates for White patients with lung cancer significantly increased from 43% to 56% (P = .006), whereas the rates for Black patients increased from 37% to 54%.

Disclosure: For full disclosures of the study authors, visit

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