ACCURE Trial: Improving Racial Disparities in Treatment for Patients With Early-Stage Lung and Breast Cancers
Results from a study published by Cykert et al in The Journal of the National Medical Association show that a pragmatic system-based intervention within cancer treatment centers can nearly eliminate existing disparities in treatment and outcomes for black patients with early-stage lung and breast cancer.
“These results show promise for all cancer treatment centers,” said Samuel Cykert, MD, Professor of Medicine at the University of North Carolina School of Medicine and co-principal investigator of the ACCURE trial.
This trial is similar to another led by Dr. Cykert that reduced treatment disparities for patients with early-stage lung cancer, while the ACCURE study focuses more on patients with breast cancer. The results of the previous work were published in the journal Cancer Medicine in February.
Background
Leading up to these trials, Dr. Cykert and his colleagues conducted studies in 2005 and 2009 to find out why racial disparities in cancer treatment exist. They found multiple reasons that contribute to the overall reduction in treatment.
“We found what seems to be implicit bias with some clinicians that made them less willing to take the same risks with patients that were different from them,” Dr. Cykert said. “A black and a white patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, yet white patients were more likely to receive the surgery and get their cancer treated.”
Dr. Cykert said his team additionally found that black patients with cancer who did not have a regular source of care as a result of poor clinical communication did not end up pursuing adequate diagnosis or treatment. This finding highlights the need for systems that fully follow the trajectory of patient care. Rather than blaming the patient for incomplete care, recognition of these barriers allows for the cancer team to be accountable for reengagement and full communication to promote completion of standard treatments.
“With that knowledge, we wanted to build a system that pointed out these lapses in care or communication in real time to help us keep track of patients who would otherwise drop off the grid,” said Dr. Cykert.
Intervention
The intervention consisted of multiple parts: a real-time warning system derived from electronic health records, race-specific feedback to clinical teams on treatment completion rates, optional health equity training sessions for staff, and a nurse navigator specially trained in racial equity to engage with patients throughout treatment.
The real-time warning system notified nurse navigators when a patient missed an appointment or treatment milestone. The navigator then reached out to the patient to reengage and bring them back into care. The nurse navigators were encouraged to become familiar with patients and build trust in case of a missed appointment, miscommunication between doctor and patient, or other circumstance that created a potential barrier to care.
Dr. Cykert said he and his team came up with the intervention model in partnership with the Greensboro Health Disparities Collaborative, an academic-community partnership experienced in community-based participatory research. Their goals were to create elements of real-time transparency, race-specific accountability, and enhanced patient-centered communication.
Results
The study team recruited 302 patients aged 18-85 from Cone Health and University of Pittsburgh Medical Center’s Hillman Cancer.
The treatment completion rates before this intervention were 87.3% for white patients vs 79.8% for black patients. With the intervention in place, treatment completion climbed to 89.5% for white patients and 88.4% for black patients. Odds ratio for black/white disparity within the intervention was 0.98 (95% confidence interval [CI] 0.46–2.1); black completion in the intervention compared favorably to whites in retrospective (OR = 1.6; 95% CI = 0.90–2.9) and concurrent (OR = 1.1; 95% CI = 0.59–2.0) controls.
One of the participating institutions, Cone Health Cancer Center in Greensboro, North Carolina, is now working towards permanently implementing this intervention into its cancer care for all patients.
“This treatment model can be applied to most any chronic disease,” said Matthew Manning, MD, Interim Chief of Oncology for Cone Health, who helped support the ACCURE trial. “It builds a more culturally competent care delivery system that would benefit all chronic diseases.”
Researchers are in the process of submitting a grant proposal with the National Cancer Institute to implement this intervention to cover whole cancer center populations rather than study patients alone.
Disclosure: This study was supported by the National Cancer Institute. For full disclosures of the study authors, visit sciencedirect.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
