The trial remedies racial disparities in the treatment of early stage lung and breast cancer

May 10, 2019 | | Say something
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IMAGE: This is the opinion of Dr. Samuel Cykert. Plus

Credit: UNC School of Medicine

CHAPEL HILL, NC – Results of a study published in the Journal of the National Medical Associationn show that an intervention based on a pragmatic system within cancer treatment centers can almost eliminate existing disparities in treatment and outcomes for black patients with early stage lung and breast cancer. The rates of completion of treatment before this intervention were 87.3 percent for white patients, compared to 79.8 percent for black patients. With the intervention implemented, the completion of treatment increased to 89.5 percent for white patients and 88.4 percent for black patients.

"These results are promising for all cancer treatment centers," said Samuel Cykert, MD, professor of medicine at the UNC School of Medicine and a research co-author on the trial.

This trial is similar to another trial led by Cykert that reduced treatment disparities for patients with early-stage lung cancer, while this study focuses more on patients with breast cancer. The results of the previous work were published in the journal. Cancer medicine in February.

Before these trials, Cykert and his colleagues conducted studies in 2005 and 2009 to discover why there are racial disparities in the treatment of cancer. They found multiple reasons that contribute to the overall reduction in treatment.

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"We found what appears to be an implicit bias with some clinicians that made them less willing to take the same risks with patients who were different from them," Cykert said. "A black and white patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, but white patients were more likely to receive surgery and have their cancer treated."

Cykert says that, in addition, they found that black cancer patients who did not have a regular source of care, as a result of poor clinical communication, did not end up looking for an adequate diagnosis or treatment. This finding highlights the need for systems that fully follow the trajectory of patient care. Instead of blaming the patient for incomplete care, recognition of these barriers allows the cancer team to be responsible for the resumption of commitment and complete communication to promote the completion of standard treatments.

"With that knowledge, we wanted to build a system that would pinpoint these lapses in real-time care or communication to help us keep track of patients who would otherwise leave the network," Cykert said.

The intervention consisted of several parts: a real-time warning system derived from electronic health records, race-specific feedback for clinical teams on treatment completion rates, optional health equity training sessions for staff and a navigator nurse specially trained in racial equity to participate with patients throughout the treatment.

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The real-time warning system notified the navigators of the nurse when a patient did not attend an appointment or treatment. Then, the navigator approached the patient to reconnect and return it to attention. Nursing navigators were encouraged to familiarize themselves with patients and build trust in case of a missed appointment, a lack of communication between the doctor and the patient, or another circumstance that created a potential barrier to care.

Cykert, who is a member of the UNC Lineberger Comprehensive Cancer Center, says he and his colleagues devised the intervention model in partnership with the Greensboro Health Disparities Collaborative, an academic and community partnership with experience in participatory community-based research. Its objectives were to create elements of transparency in real time, specific responsibility for the race and better communication centered on the patient.

"I think it's revolutionary that we have devised an intervention to address the way the health care system creates disparities," said Kari Thatcher, co-chair of the Greensboro Health Disparities Collaborative. "We have made systemic changes that close the disparity gap and we have improved medical care for all races involved." Terence "TC" Muhammad, co-chair of the Collaborative, said: "This is the result of a real collaboration between researchers, health care providers and community members who helped shape an action plan to achieve real change."

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One of the participating institutions, Cone Health Cancer Center in Greensboro, NC, is now working to permanently implement this intervention in cancer care for all patients.

"This treatment model can be applied to most chronic diseases," said Matthew Manning, MD, interim chief of oncology at Cone Health, who helped endorse the ACCURE trial. "It creates a more culturally competent care delivery system that would benefit all chronic diseases."

The study team recruited 302 patients aged 18 to 85 from Cone Health and the Hillman Cancer Center at the University of Pittsburgh Medical Center in this prospective trial sponsored by the National Cancer Institute. Cykert was a co-director investigator with Geni Eng, DrPH, at the Gillings School of Global Public Health of the UNC, a national expert on participatory community research.

Researchers are in the process of presenting a grant proposal with the National Cancer Institute to implement this intervention to cover entire populations of cancer centers rather than studying only patients.

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