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

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Rohan Arya (Creator)

Samuel Cykert (Creator)

Eugenia Eng (Creator)

Dwight E. Heron (Creator)

Nora S. Jones (Creator)

Matthew A. Manning (Creator)

Linda B. Robertson (Creator)

Paul Walker (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Background: Advances in early diagnosis and curative treatment have reduced high\r\nmortality rates associated with non-small cell lung cancer. However, racial disparity\r\nin survival persists partly because Black patients receive less curative treatment than\r\nWhite patients.\r\nMethods: 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\r\nwere eligible. Intervention components included: (1) a real-time warning system derived from electronic health records, (2) race-specific feedback to clinical teams on\r\ntreatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of\r\ncurative treatment.\r\nResults: 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\r\nbaseline, 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,\r\ntreatment site, cancer stage, gender, comorbid illness, and income-odds ratio (OR)\r\n0.66 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\r\nratio for the adjusted analysis was 2.1 (95% CI 0.41-10.4, P = 0.39) for Black vs\r\nWhite patients. Between group analyses confirmed treatment parity for the\r\nintervention.\r\nConclusion: A system-based intervention tested in five cancer centers reduced racial\r\ngaps and improved care for all.

Additional Information

Publication

Other

Language: English

Date: 2023

Subjects

cancer disparities, health equity, intervention, pragmatic trial, systems change

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