Previous research has indicated that African American patients with potentially curable lung or breast cancer are less likely to receive or complete standard treatments compared with Caucasian patients, which leads to inequalities in racial mortality rates. The Accountability for Cancer Care Through Undoing Racism and Equity Study examined systematic changes to reduced treatment disparities in cancer care. The researchers presented the study at the ASCO Annual Meeting.
Electronic health records from two cancer centers were used to collect baseline data between 2007 and 2011, and the intervention cohort enrollment was then initiated in 2013. The study’s primary outcomes were a composite consisting of receipt of surgical resection or stereotactic radiosurgery for early stage lung cancer, surgery for early stage breast cancer, completion of at least 80% of the prescribed adjuvant radiation after lumpectomy, and completion of at least 80% of prescribed adjuvant breast cancer chemotherapy.
The study’s intervention included
- A real-time warning system to signal missed appointments or unmet milestones in expected care
- Race-specific data feedback on treatment adherence
- A nurse navigator trained in race-specific barriers
- Quarterly healthy equity training for staff.
Center 1 included 2,532 patients at baseline and 147 received the intervention, whereas center 2 included 5,265 patients at baseline and 126 received the intervention.
At center 1, no significant improvements were indicated for the intervention cohort: 81% of Caucasian patients completed therapy at baseline compared with 85% during the intervention (p = 0.41), whereas 80% of African American patients completed therapy at baseline compared with 87% during intervention (p = 0.28).
At center 2, a significant racial disparity was observed at baseline and resolved with intervention: 91% of Caucasian patients completed therapy at baseline compared with 96% during the intervention (p = 0.21), whereas 81% of African American patients completed therapy at baseline compared with 92% during intervention (p = 0.07). The probability of treatment completion at baseline was 78% for African American patients compared with 89% for Caucasian patients (p < 0.001), whereas the probability of treatment completion after the intervention was 97% and 99%, respectively (p = 0.22).
The researchers concluded, “A multimodal intervention improved overall treatment completion rates. While there was a racial disparity in one center prior to 2011, there were no racial differences in treatment completion in either center among intervention patients.”