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Published on September 26, 2016

Research closes racial gap and improves treatment rates for early stage lung cancer

Simple steps put in place at Cone Health eliminated the disparity between black and white patients when it came to treating lung cancer.


Training staff to better understand subtle cultural differences and removing barriers to care can essentially eliminate racial differences in how lung cancer is treated. The measures also help more people of all races complete lung cancer treatment. Cone Health radiation oncologist Matt Manning, MD, presented

Matt Manning, MD

research this morning into bridging the racial gap in cancer care at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO) in Boston.

Studies have shown that African-Americans with early stage lung cancer are not being treated as aggressively as white patients. This contributes to their higher death rates from the disease than white Americans. “The history of racial inequality in health care has been long standing. Health disparity has been defined, studied and accepted for decades. Yet these chasms continue to harm large groups of patients,” said Manning, lead author of the study. “Our findings show that by changing a few processes, we can essentially eliminate racial disparity while improving care for all races.

The Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial is a National Institute of Health-sponsored project designed to reduce racial disparities and increase treatment for early stage lung and breast cancer, especially among African-Americans. ACCURE was the result of more than a decade of work by the Greensboro Health Disparities Collaborative and the Partnership Project, which are community organizations dedicated to addressing racial disparity in health care.

Working with the University of North Carolina-Chapel Hill and the University of Pittsburgh Medical Center, Cone Health focused on providing better ways to support patients. This included using electronic health records to signal the care team whenever a patient missed an appointment or an anticipated milestone in care. Nurse navigators underwent training to explore subtle cultural biases that cause many people not to complete their treatment. “Sometimes it takes a little extra time to ask sensitive questions to understand the concerns, and the ACCURE nurse navigators were trained to identify and overcome these barriers to help patients feel comfortable completing treatment,” adds Manning.

The ACCURE study tracked 2,537 patients with stage I or II lung cancer between 2013 and 2015.  Of these patients, 100 were enrolled in the intervention trial. Researchers looked at rates of receiving two lung cancer treatments with good cure rates, stereotactic body radiation therapy (SBRT) and surgical resection (R). Rates among study participants were measured against other patient records at the cancer centers involved in the trial. Records for all patients treated between 2007 and 2011 served as a baseline. Records for all patients treated between 2014 and 2015 served as a control group. Researchers conducted multivariate analyses to control for Charlson comorbidity score, prognosis (i.e., disease stage I or II) and patient age.

Treatment rates for both R and SBRT increased for all in the trial. Among those patients, 96 percent received R or SBRT for early stage lung cancer, compared to rates of 64 to 76 percent for the baseline group and 85 to 87 percent for the control group.

The techniques eliminated the racial disparity in treatment rates for this group of patients. Rates of receiving treatments that could potentially cure them were 96 percent for both black and white patients in the study compared to baseline rates of 64 percent for black and 76 percent for white patients

Treatment rates also increased for the control group of all patients at the cancer centers (i.e., including those not enrolled in the trial). Researchers attributed this finding to a likely spillover effect, where even patients who were not enrolled in the trial may have benefitted from staff training and other structural or cultural changes at the center.

 “The ACCURE trial represents one of the first studies to demonstrate a way to eliminate racial disparity in cancer treatment,” says Manning. “The results suggest that treatment inequity can be closed, not just for African-Americans with early stage lung cancer, but for other underserved populations and other types of cancer.”

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