Real-Time Intervention Model Reduces Racial Disparity in Cancer Treatment

In a study published in The Journal of the National Medical Association, researchers showed that a pragmatic system-based intervention can significantly reduce disparities in treatment and outcomes for black patients with early-stage lung cancer and breast cancer.

The ACCURE Pragmatic Quality Improvement trial aimed to address the disparities between black and white patients undergoing treatment of early-stage cancers.

The intervention consisted of a real-time registry derived from electronic health records (EHRs) of participants to signal missed appointments or unmet care milestones, a nurse navigator, optional health equity training sessions for staff, and clinical feedback. Patients with early-stage breast or lung cancer aged 18 to 85 years old were enrolled at 2 cancer centers between April 2013 and March 2015. Control completion rates included data from patients seen between January 2007 and December 2012 with these diagnoses.

Overall, 302 patients from Cone Health and University of Pittsburgh Medical Center’s Hillman Cancer Center participated in the trial. In both retrospective and concurrent control groups, there were significant differences in treatment between black and white patients. Prior to the intervention implementation, treatment completion rates were 87.3% for white patients versus 79.8% for black patients.

These racial treatment disparities often exist due to implicit bias among health care providers, the study authors noted. Previous studies conducted by the researchers suggest that some clinicians may be unwilling to take risks with patients who are different from them.

“A black and white patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, yet white patients were more likely to receive surgery and get their cancer treated,” co-principal investigator Samuel Cykert, MD, professor of medicine at the UNC School of Medicine, said in a press release about the study.

In the intervention process, the real-time warning system notified the navigators when a patient missed an appointment or treatment milestone, which allowed the navigator to reengage the patient in care. The intervention model was developed by the researchers in partnership with Greensboro Health Disparities Collaborative with the goals to create elements of real-time transparency, race-specific accountability, and enhanced patient-centered communication.

With the intervention implemented, the study showed that treatment completion increased to 89.5% for white patients and 88.4% for black patients, according to the researchers.

“This treatment model can be applied to most any chronic disease,” Matthew Manning, MD, interim chief of oncology for Cone Health, who helped support the ACCURE trial, said in the press release. “It builds a more culturally competent care delivery system that would benefit all chronic diseases.”

References

Cykert S, Eng E, Manning M, et al. A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial. Journal of the National Medical Association. 2019. Doi: https://doi.org/10.1016/j.jnma.2019.03.001

UNC-Led ACCURE Trial Remedies Racial Disparities in Treatment for Early-Stage Lung and Breast Cancer Patients. UNC Health Care. http://news.unchealthcare.org/news/2019/may/unc-led-accure-trial-remedies-racial-disparities-in-treatment-for-early-stage-lung-and-breast-cancer-patients. Accessed May 13, 2019.