Intervention Illustrates Ways to Reduce Racial Disparities in Lung Cancer Care

February 11, 2019

A set of simple interventions succeeded in reducing disparities in lung cancer care between black and white patients across five cancer centers.

A set of simple interventions succeeded in reducing disparities in lung cancer care between black and white patients across five cancer centers, according to a new study.

Lung surgery resection is the generally recommended curative treatment for early-stage non–small-cell lung cancer (NSCLC), though some patients can undergo stereotactic radiation. “Despite the high mortality and progressive physical limitations that decisions against treatment portend, black patients undergo surgery less often than similar white patients,” wrote study authors led by Samuel Cykert, MD, of the University of North Carolina Lineberger Cancer Center in Chapel Hill. “Studies spanning decades show persistence of surgical disparities with similar gaps emerging for radiation.”

The authors conducted a 5-year study across 5 cancer centers, aimed at reducing such disparities. They included a total of 2,841 early-stage lung cancer patients, 16% of whom were black, in a retrospective cohort, as well as 360 patients, 32% of whom were black, in an intervention group; they were compared with a concurrent control group of 597 patients at 2 of the 5 centers who were not consented for the study. The intervention included a real-time warning system based on electronic health records (EHRs), designed to deliver alerts when an appointment or treatment milestone was missed; race-specific feedback given to clinical teams based on treatment completion rates; and a nurse navigator who regularly accessed the warning system. The results were published in Cancer Medicine.

In the retrospective group, the overall rate of surgery or radiation with curative intent was 76%, regardless of race. This improved to 96% in the intervention group, and 83% in the concurrent group (P < .001).

Among black patients, the treatment rate was 69% in the retrospective cohort and 96% in the intervention group; the rate was 79% in the concurrent control group. Among white patients, the rate was 78% in the retrospective group, 96% in the intervention group, and 84% in the concurrent control group.

An adjusted analysis revealed an odds ratio (OR) for receiving treatment in the retrospective group of 0.66 for black patients (95% CI, 0.51–0.85; P = .001) compared with white patients. In the intervention group, there was no such difference, with an adjusted OR of 2.1 (95% CI, 0.41–10.4; P = .39). There was also no difference with regard specifically to surgery or to radiation.

“A multifaceted intervention tested in five cancer centers using the transparency of race‐specific data feedback, real‐time warnings derived from EHRs, and patient‐centered navigation improved care for both black and white patients, while reducing racial differences,” the authors concluded. “Application of this system‐based, pragmatic approach to other cancer treatment disparities at a health system level could have positive effects on treatment completion, treatment equity, and overall outcomes.”