A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
Abstract Background Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. Methods We performed...
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| Format: | Article |
| Language: | English |
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Wiley
2019-03-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2005 |
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| author | Samuel Cykert Eugenia Eng Paul Walker Matthew A. Manning Linda B. Robertson Rohan Arya Nora S. Jones Dwight E. Heron |
| author_facet | Samuel Cykert Eugenia Eng Paul Walker Matthew A. Manning Linda B. Robertson Rohan Arya Nora S. Jones Dwight E. Heron |
| author_sort | Samuel Cykert |
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| description | Abstract Background Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. Methods 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 were eligible. Intervention components included: (1) a real‐time warning system derived from electronic health records, (2) race‐specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. Results 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 baseline, 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, treatment site, cancer stage, gender, comorbid illness, and income‐odds ratio (OR) 0.66 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 ratio for the adjusted analysis was 2.1 (95% CI 0.41‐10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. Conclusion A system‐based intervention tested in five cancer centers reduced racial gaps and improved care for all. |
| format | Article |
| id | doaj-art-64ae051cc52b4fdab8789de5d4344e79 |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-64ae051cc52b4fdab8789de5d4344e792025-01-31T08:47:43ZengWileyCancer Medicine2045-76342019-03-01831095110210.1002/cam4.2005A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centersSamuel Cykert0Eugenia Eng1Paul Walker2Matthew A. Manning3Linda B. Robertson4Rohan Arya5Nora S. Jones6Dwight E. Heron7Division of General Medicine and Clinical Epidemiology The Center for Health Promotion and Disease Prevention The Lineberger Cancer Center The University of North Carolina School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North CarolinaDepartment of Health Behavior The Gilling's School of Global Public Health Chapel Hill North CarolinaLeo Jenkins Cancer Center Brody School of Medicine ‐ East Carolina University Greenville North CarolinaCone Health Cancer Center Greensboro North CarolinaUPMC Hillman Cancer Center Pittsburgh PennsylvaniaPalmetto Health and the University of South Carolina School of Medicine Columbia South CarolinaThe Partnership Project Greensboro North CarolinaDepartment of Radiation Oncology UPMC Hillman Cancer Center Pittsburgh PennsylvaniaAbstract Background Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. Methods 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 were eligible. Intervention components included: (1) a real‐time warning system derived from electronic health records, (2) race‐specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. Results 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 baseline, 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, treatment site, cancer stage, gender, comorbid illness, and income‐odds ratio (OR) 0.66 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 ratio for the adjusted analysis was 2.1 (95% CI 0.41‐10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. Conclusion A system‐based intervention tested in five cancer centers reduced racial gaps and improved care for all.https://doi.org/10.1002/cam4.2005cancer disparitieshealth equityinterventionpragmatic trialsystems change |
| spellingShingle | Samuel Cykert Eugenia Eng Paul Walker Matthew A. Manning Linda B. Robertson Rohan Arya Nora S. Jones Dwight E. Heron A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers Cancer Medicine cancer disparities health equity intervention pragmatic trial systems change |
| title | A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers |
| title_full | A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers |
| title_fullStr | A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers |
| title_full_unstemmed | A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers |
| title_short | A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers |
| title_sort | system based intervention to reduce black white disparities in the treatment of early stage lung cancer a pragmatic trial at five cancer centers |
| topic | cancer disparities health equity intervention pragmatic trial systems change |
| url | https://doi.org/10.1002/cam4.2005 |
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