Success in Closing Racial Survival Gap in Lung and Breast Cancer

Roxanne Nelson, RN, BSN

October 28, 2021

CHICAGO — System-level changes to the way cancer care is delivered can help eliminate survival disparities between Black and White patients.

When barriers to completing radiation therapy were identified and addressed in a cohort of patients with early-stage lung and breast cancer, 5-year survival rates improved for all patients and closed the racial disparity gap, researchers reported here at the American Society for Radiation Oncology (ASTRO) 2021 Annual Meeting.

The findings come from the ACCURE clinical trial. This is the first prospective study designed to erase gaps in cancer treatment completion and survival among Black and White patient populations, explained lead author Matthew A. Manning, MD, a radiation oncologist and chief of oncology at Cone Health in Greensboro, North Carolina.

"Thousands of studies have looked at racial disparities in healthcare, but until recently, very few studies have implemented interventions to eliminate those disparities," he said.

"This study shows that the implementation of 'systems-change' can eliminate racial disparities in cancer survival while improving survival for all," he added.

"These results add to a growing body of evidence that healthcare disparities in cancer outcomes are eliminated or minimized by providing supportive, timely, and guideline-directed care," said Lannis Hall, MD, MPH, director of radiation oncology, Siteman Cancer Center, and associate professor of radiation oncology at Washington University School of Medicine, St. Louis, Missouri, who was approached for comment

"This research supports that access to care and timely treatment completion is critical to eliminating healthcare disparities," she told Medscape Medical News. The system-based intervention in this trial was designed to reduce treatment delays and provide a supportive matrix for patients confronting real-world difficulties like transportation issues, childcare complications, and work absence, she explained.

Eliminating Racial Disparities

Previous findings from the ACCURE trial showed that it eliminated Black-White disparities in treatment completion rates, which was the study's primary endpoint. (Cancer Med. 2019;8:1095-1102) "It also improved treatment for all patients," said Manning. "The current study is a follow-up on the survival of eligible patients treated during the ACCURE enrollment as compared to historical data."

ACCURE was a multi-institutional trial designed to test a community-created intervention to reduce racial disparities. The intervention involved multiple changes to the way patients were supported while receiving cancer treatment, and had four components: 

  • an electronic health record with automatic alerts to flag missed appointments or unmet milestones in expected care 

  • a nurse navigator trained in race-specific barriers to help patients overcome obstacles to care when alerts are flagged

  • a physician champion, to engage healthcare teams with race-related feedback on treatment completion

  • regular health equity education training sessions for staff

The cohort was comprised of 1413 patients with lung and breast cancer (stage 0-II) who were diagnosed from 2013-2015, and survival was compared to historical cases — 2016 patients who had been treated from 2007-2011.

The results showed a significant improvement in survival for both Black and White patients with breast and lung cancer over time, and the racial gap in survival was reduced. 

The 5-year survival rate for breast cancer increased from 91% for White patients and 89% in Black patients in historical cases, to 94% for both during the study period.  

For patients with lung cancer, the 5-year survival rate improved from 43% in White patients and 37% in Black patients to 56% and 54%, respectively.

A subgroup analysis showed that patients with lung cancer who underwent surgery had 5-year survival rates of 78.5% for White and 70.1% for Black patients, whereas for those who underwent stereotactic body radiation therapy (SBRT) the rates were 41.9% and 50% respectively.

"We've shown it's possible to eliminate disparities in cancer treatment completion and that this change has the potential to close cancer survival gaps downstream," said Manning. "But we think the application can be much broader." 

The ACCURE study was sponsored by the National Institutes of Health. Manning and Hall have disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 2021 Annual Meeting: Abstract 53. Presented October 25, 2021.

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