Antiracism intervention reduces disparities in timely lung cancer surgery
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The racial gap in timely surgery between Black and white patients with early-stage lung cancer improved after an antiracism intervention, according to study results published in Journal of Clinical Oncology.
The Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) study — a first-of-its-kind pragmatic trial — included an intervention that addressed systemic racism and reduced the treatment disparity between Black and white patients with early-stage non-small cell lung cancer.
“This research is a secondary analysis of the ACCURE study that was designed to address racial inequities in early-stage lung and breast cancer treatments,” Marjory Charlot, MD, MPH, MSc, oncologist in the division of oncology at The University of North Carolina at Chapel Hill, told Healio. “The primary study successfully demonstrated that this multifaceted antiracism intervention eliminated the treatment gap between Black and white patients.
“The Greensboro Health Disparities Collaborative — a community-academic-medical partnership with expertise in community-based participatory research and racial analyses — initiated and executed this research project,” Charlot added. “I was fortunate to be mentored by one of the members, Samuel Cykert, MD, and have since become a member of this collaborative, as well. Learning about the study, and as a thoracic oncologist conducting health services and health equity research, I was interested in understanding the impact of ACCURE on time to lung cancer treatment since the existing data suggests delayed treatment impacts survival.”
Methods
The secondary analysis of the ACCURE study included 2,363 patients with early-stage NSCLC receiving treatment across five cancer centers.
Charlot and colleagues sought to examine the effect on the overall timeliness of lung cancer surgery and racial disparities in receipt of timely surgery among 263 patients included in an intervention group that consisted of a real-time warning system to identify unmet care milestones, race-specific feedback on lung cancer treatment rates and patient navigation.
Researchers compared patients in the intervention group with 1,798 patients included in a retrospective control group and 302 patients in a concurrent control group.
Surgery within 8 weeks of lung cancer diagnosis served as the primary outcome.
Key findings
Results showed 87.1% of Black patients and 85.4% of white patients included in the intervention group underwent surgery within 8 weeks of lung cancer diagnosis, compared with only 58.7% of Black patients vs. 75% of white patients included in the retrospective group (P < .01) and 64.9% vs. 73.2% of those in the concurrent control group.
Black patients in the intervention group appeared more likely to receive timely lung cancer surgery than Black patients in the retrospective (RR = 1.43; 95% CI, 1.26-1.64) and concurrent (RR = 1.3; 95% CI, 1.01-1.64) control groups. White patients in the intervention group also had a higher likelihood of timely surgery than their counterparts in the retrospective (RR = 1.1; 95% CI, 1.02-1.18) and control groups (RR = 1.13; 95% CI, 1.02-1.25).
Implications
“Measuring racial inequities and providing race-specific feedback to providers and patient navigators are components of a system change intervention that demonstrates near elimination of racial disparities in the treatment of early-stage lung cancer and timely surgery for lung cancer,” Charlot said.
“If we want to move the needle on racial inequities in care, we must measure it, communicate results to providers within the system and help patients navigate these systems to obtain the highest quality of care,” she added. “Dissemination of the results and, hopefully, implementation of ACCURE-like interventions across cancer centers are key to ensure that equity is centered in quality initiatives so that all individuals facing care have the opportunity to receive the highest quality of cancer care and live their best lives either with or beyond cancer.”
For more information:
Marjory Charlot, MD, MPH, MSc, can be reached at The University of North Carolina at Chapel Hill, Houpt Office Building, 3rd Floor, Campus Box 7305, 170 Manning Drive, Chapel Hill, NC 27599; email: mcharlot@med.unc.edu.
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