A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers

Samuel Cykert, Eugenia Eng, Paul Walker, Matthew A Manning, Linda B Robertson, Rohan Arya, Nora S Jones, Dwight E Heron, Samuel Cykert, Eugenia Eng, Paul Walker, Matthew A Manning, Linda B Robertson, Rohan Arya, Nora S Jones, Dwight E Heron

Abstract

Background: Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non-small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients.

Methods: We performed a 5-year pragmatic, trial at five cancer centers using a system-based intervention. Patients diagnosed with early stage lung cancer, aged 18-85 were eligible. Intervention components included: (1) a real-time warning system derived from electronic health records, (2) race-specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment.

Results: There were 2841 early stage lung cancer patients (16% Black) in the retrospective group and 360 (32% Black) in the intervention group. For the retrospective baseline, crude treatment rates were 78% for White patients vs 69% for Black patients (P < 0.001); difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income-odds ratio (OR) 0.66 for Black patients (95% CI 0.51-0.85, P = 0.001). Within the intervention cohort, the crude rate was 96.5% for Black vs 95% for White patients (P = 0.56). Odds ratio for the adjusted analysis was 2.1 (95% CI 0.41-10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention.

Conclusion: A system-based intervention tested in five cancer centers reduced racial gaps and improved care for all.

Trial registration: ClinicalTrials.gov NCT01954641 NCT01687738.

Keywords: cancer disparities; health equity; intervention; pragmatic trial; systems change.

Conflict of interest statement

Cykert has no actual or potential conflicts of interest to report; Eng has no actual or potential conflicts of interest to report; Walker has no actual or potential conflicts of interest to report; Manning has no actual or potential conflicts of interest to report; Robertson has no actual or potential conflicts of interest to report; Arya has no actual or potential conflicts of interest to report; Jones has no actual or potential conflicts of interest to report; Heron has no actual or potential conflicts of interest to report.

© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
CONSORT Diagram—patient enrollment and progression: a system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: a pragmatic trial at five cancer centers

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Source: PubMed

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