System-Based Intervention Designed to Reduce Racial Disparities in Lung Cancer Treatment
Posted: Tuesday, February 19, 2019
Currently, racial disparities in the treatment of early-stage non–small cell lung cancer exist, with black patients significantly less likely to receive treatment than white patients. However, recent findings from a long-term trial published in Cancer Medicine found that implementing a system-based intervention within cancer centers may reduce racial disparities and improve cancer care for all. Moreover, application of this approach among other cancer treatment disparities at a systemic level may improve treatment completion, equity, and overall patient outcomes.
“We wanted to build a system that pointed out these lapses in care or communication in real time to help us keep track of patients who would otherwise drop off the grid,” Samuel Cykert, MD, of the University of North Carolina at Chapel Hill, noted in an institutional press release.
Over the course of 5 years, the authors performed a system-based intervention at 5 cancer centers. A total of 2,841 patients with early-stage lung cancer were recruited from 2 trials using identical interventions and separated into retrospective (16% black patients) and intervention (32% black patients) cohorts. The intervention consisted of three parts: (1) a real-time warning system from electronic health records, which notified nurse navigators if a patient missed an appointment or treatment; (2) race-specific feedback to clinical teams on treatment completion rates; and (3) a nurse navigator to engage with patients throughout treatment.
Baseline treatment rates were 78% for white patients versus 69% for black patients (P < .001) in the retrospective cohort. After the interventions were implemented, the rate of treatment receipt increased for both groups to 96.5% for black patients and 95% for white patients (P = .56). Furthermore, in the retrospective group, the “difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income,” which yielded an odds ratio of 0.66 for black patients when compared with white patients.
Disclosure: The study authors reported no conflicts of interest.