Implementation of Systems-Based Intervention Could Eliminate Racial Disparities in Cancer and Improve Survival Across all Populations

Implementing a systems-based intervention and utilizing transparent data reporting by race may help to eliminate racial disparities in cancer and improve patient outcomes, according to findings from the ACCURE study (NCT01954641) that were presented at the 2021 American Society for Radiation Oncology Annual Meeting (ASTRO).

The ACCURE trial assessed the use of a community-created intervention with the intention of reducing racial disparities and increasing completion of treatment in patients with early-stage breast cancer and lung cancer.

In the breast cancer group, investigators identified a 5-year overall survival (OS) of 89.44% among Black patients who were diagnosed from 2007 to 2011 compared with 93.96% among those who were diagnosed from 2013 to 2015 (P = .044). White patients with breast cancer had 5-year OS rates of 91.36% and 93.92% among those diagnosed from 2007 to 2011 and 2013 to 2015, respectively (P = .026).

Black patients within the lung cancer cohort diagnosed from 2007 to 2011 had a 5-year OS rate of 36.62% and 53.54% for those diagnosed from 2013 to 2015 (P = .056). Within the White cohort, patients who were diagnosed from 2007 to 2011 had a 5-year OS rate of 43.39% and 55.64% in the 2013 to 2015 group (P = .006).

“Community based participatory research at individual institutions is one model to drive health equity. The community can help create the solutions to serve the community rather than well intended scientists or hospital administrators. Transparent Data Reporting by race and accountability of stakeholders for potential disparities can be applied to leverage better outcomes. This study shows that the implementation of systems change can eliminate racial disparities in cancer survival while improving survival for all.” according to Matthew Manning MD, FASTRO, a radiation oncologist and chief of oncology at Cone Health, in a presentation on the findings.

The Greenboro Health Disparities Collaborative has utilized community-based participatory research to better examine and remedy disparities in cancer care. The landmark ACCURE trial deviates from standard observational studies that typically describe disparities to prospective clinical research with the intent to eliminate racial disparities. Manning noted that the research could potentially be used to spur similar grassroots, community-based participatory research efforts.

Manning emphasized the importance of moving away from a focus on individual provider bias and shifting focus to implement new systems capable of preventing disparities and achieving health equity.

“The ACCURE intervention was essentially a system-based intervention trial. We previously published that the ACCURE intervention eliminated Black/White disparities in treatment completion rates, which was the primary endpoint. It also improved the completion of treatment for all patients. This was reported at ASTRO in 2016,” Manning explained.

The ACCURE intervention utilizes a number of tools and introduces new roles within institutions that may work to ease the burden of disparities. Among these tools is the use of a real-time patient registry, an informatic tool that can be used in medical record keeping to flag missed milestones, as well as health equity training that can raise awareness about bias and privilege to a medical team. Similarly, the intervention suggests the use of nurse navigators who are trained to have knowledge of cultural barriers to care and offering patients a sense of personal connection. Additionally, the intervention also includes a physician champion who can be tasked to hold healthcare providers accountable.

The trial included 11413 patients who had been diagnosed with stage 0 to II lung and breast cancer from 2013 to 2015 compared with 2016 patients in the 2007 to 2011 historical cohort. The trial included a total of 769 Black patients and 2660 White patients.

Reference

Manning M, Yongue Y, Garikipati A, et al. Overall survival from a prospective multi-institutional trial to resolve black-white disparities in the treatment of early stage breast and lung cancer. 2021 American Society for Radiation Oncology Annual Meeting; October 25-27, 2021; Virtual. Accessed October 25, 2021. Abstract 53.