Nick Mulcahy

October 05, 2016

BOSTON — Defying a historical disparity, blacks and whites had equal rates of curative treatment completion for early-stage lung cancer in a multi-institutional clinical trial, according to research reported here at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting.

The parity was the result of a patient-support intervention that narrowed historical racial gaps in treatment and, at the same time, raised treatment completion rates for both races, said study lead author, Matthew A. Manning, MD, from the Cone Health Cancer Center in Greensboro, North Carolina.

The rates of receiving potentially curative treatment (stereotactic body radiation therapy [SBRT] or surgical resection) were 96% for both black (n = 25) and white (n = 75) patients in the intervention group. This compared favorably to a 12–percentage point gap in rates for a historical "baseline" group treated in the same institutions from 2007 to 2011 (64% vs 76% for black vs white patients; P < .05).

The study is one of the first to demonstrate that an intervention can eliminate racial disparity in cancer treatment, according to Dr Manning.

The patient-support intervention consisted of four elements: an electronic health record (EHR) system that signalled missed appointments or milestones in care and three race-specific interventions.

Those latter three elements were nurse navigators trained in race-related barriers to care, race-specific treatment feedback to care teams, and quarterly sessions in health equity training for staff.

Which element most influenced the achievement of racial parity?

Dr Manning told Medscape Medical News that the EHR alerts, which served as a "real-time tumor registry," were probably most responsible for the results.

But he also told reporters at a meeting press conference that, in conclusion about the study, "Health systems can eliminate racial disparity with systems change through engagement with community organizations."

Dr Manning said the results are important because, historically, data show that fewer black than white patients undergo curative surgery for early-stage lung cancer, "resulting in higher mortality" (even when controlling for comorbidities and other factors).

The new study is part of the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial, a National Institutes of Health–sponsored multi-institutional project designed to reduce racial disparities and increase treatment utilization for early-stage lung and breast cancer. The 100 patients in the new study are a part of that larger trial, which randomly assigns patients to the ACCURE "navigator" support or usual care.

The ACCURE trial's patient-centric support strategy is "a very creative and forward-looking intervention," said Brian Kavanagh, MD, from the University of Colorado in Aurora, who moderated the press conference.

The primary outcome of the new study was lung resection surgery or SBRT within 4 months of diagnosis.

The study design compared results from the 100 ACCURE patients with those of 2044 patients in the above-mentioned "baseline" group, whose treatment dates back 4 to 8 years ago, as well as 393 "control" patients from the same ACCURE-participant cancer centers (also treated during the ongoing study period). This latter group is necessary to account for any trends or spillover effect from the ACCURE intervention at the various cancer centers.

Table. Race and Treatment Rates (SBRT or Surgical Resection)

Race Baseline: R + SBRT Baseline: R ACCURE: R + SBRT ACCURE: R Control: R + SBRT Control: R
Black (%) 64 55 96a 80a 85a 57
White (%) 76 61 96a 79a 87a 55

R = surgical resection.

a P < .05 compared with baseline.


Dr Manning pointed out that, as separate groups, whites and blacks both had increased rates of potentially curative treatment when compared with recent historical or baseline rates at the ACCURE trial cancer centers.

The fact that the "control" group at the cancer centers also saw an improvement in care during the study period is the result of a likely "spillover" effect at the centers — that the ACCURE navigator sensibilities and teachings may have influenced staff outside the project, he explained.

Study data also show that patients younger than age 70 years were more likely to receive treatment, with either SBRT or resection (odds ratio [OR], 1.9; P < .05), as were those with earlier-stage disease (OR, 3.0; P < .05).

Patients with higher comorbidity scores were less likely to receive resection (OR, 0.66; P < .05) but not SBRT.

Dr Manning and Dr Kavanagh have disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting. Abstract 77. Presented September 26, 2016.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

Follow Medscape Oncology on Twitter: @MedscapeOnc


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