News | Radiation Therapy | September 29, 2016

Intervention Closes Racial Gap, Improves Treatment Rates for Early-stage Lung Cancer

Multi-modality NCI-supported project eliminated disparity in treatment rates for African Americans and improved completion of curative care across all patients

early-stage lung cancer, racial gap, NCI, ACCURE intervention trial, treatment rates, ASTRO 2016

September 29, 2016 — New research suggests enhanced, culturally-competent communication with early-stage lung cancer patients can narrow racial gaps in curative treatment completion and increase treatment rates for all races. The study, part of a project supported by the National Cancer Institute, found that multiple, coordinated modalities of patient support essentially eliminated the inequity in curative treatment and improved completion of care for all patients.

The research was presented at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO), Sept. 25-28 in Boston.

Due to major breakthroughs in lung cancer screening and treatment, many patients with early-stage lung cancer can now be cured with minimal side effects, but disparities negatively impact these potentially high survival rates for vulnerable populations. Many studies have shown, for example, that curative treatment rates for early-stage lung cancer are lower for African American patients than for White patients, which contributes to higher death rates for African Americans.

The Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial is an NIH-sponsored multi-institutional project designed to reduce racial disparities and increase treatment utilization for early-stage lung and breast cancer, especially among African Americans. The ACCURE intervention consists of multiple layers of patient support, including an electronic health record system that signals whenever a patient misses an appointment or anticipated milestone in care; nurse navigators specially trained in race-related barriers to care; presentation of race-specific treatment feedback to care teams; and quarterly health equity training sessions for staff drawing on evidence from community-based participatory research.

Findings are based on data from 100 patients with stage I or II lung cancer enrolled into the prospective randomized trial between 2013 and 2015; of these patients, 25 percent were black, compared to a local population rate of 13 percent. Primary outcomes included rates of receiving two potentially curative lung cancer treatments, 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 (n = 2,044) served as baseline data, and records for all patients treated between 2014 and 2015 (n = 393) 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 surgical resection and SBRT increased for all patients who received the intervention. Among patients in the intervention, 96 percent received resection 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 intervention also eliminated the racial disparity in treatment rates for this cohort. Rates of receiving potentially curative treatment were 96 percent for both African American and White patients in the intervention, compared to a gap in baseline rates of 12 percent (i.e., 64 percent for African American vs. 76 percent for White patients).

“The history of racial inequality in healthcare 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 Matthew A. Manning, M.D., radiation oncologist at Cone Health Cancer Center in Greensboro, North Carolina and lead author of the study. “Our findings show that an evidence-based, strategic intervention can essentially eliminate a racial disparity while improving rates of treatment completion for all races.”

Treatment rates compared to baseline also increased for the control group of all patients at the cancer center (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.

Age and disease stage significantly impacted treatment rates, but comorbidity affected rates of surgical resection only. Patients younger than age 70 were more likely to receive treatment with SBRT or resection (Odds Ratio (OR), 1.9; p < 0.05), as were those with earlier stage disease (OR, 3.0; p < 0.05). Patients with higher comorbidity scores were less likely to receive resection (OR, 0.66; p < 0.05) but not SBRT.

“As we move into an era of population health, the responsibility for incomplete courses of cancer treatment will shift from the individual patient to the healthcare delivery system,” said Manning. “The ACCURE trial represents one of the first studies to demonstrate an intervention to prospectively eliminate racial disparity in cancer treatment. 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.”

For more information: www.astro.org

Related Content

Sponsored Content | Videos | Radiation Therapy | January 18, 2019
Join Chris Toth, president of Varian’s Oncology Systems business, for a look at product introductions for 2018 plus
Novel Technique May Significantly Reduce Breast Biopsies
News | Breast Biopsy Systems | January 17, 2019
A novel technique that uses mammography to determine the biological tissue composition of a tumor could help reduce...
Digital Mammography Increases Breast Cancer Detection
News | Mammography | January 16, 2019
The shift from film to digital mammography increased the detection of breast cancer by 14 percent overall in the United...
MIM Software Inc. Receives FDA 510(k) Clearance for Molecular Radiotherapy Dosimetry
Technology | Nuclear Imaging | January 16, 2019
MIM Software Inc. received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for molecular radiotherapy...
Artificial Intelligence Used in Clinical Practice to Measure Breast Density
News | Artificial Intelligence | January 15, 2019
An artificial intelligence (AI) algorithm measures breast density at the level of an experienced mammographer,...
Machine Learning Uncovers New Insights Into Human Brain Through fMRI
News | Neuro Imaging | January 11, 2019
An interdisciplinary research team led by scientists from the National University of Singapore (NUS) has successfully...
Mobile App Data Collection Shows Promise for Population Health Surveys
News | Population Health | January 10, 2019
Mobile app data collection can bring access to more potential clinical study participants, reduce clinical study...
Hypertension With Progressive Cerebral Small Vessel Disease Increases Cognitive Impairment Risk
News | Magnetic Resonance Imaging (MRI) | January 08, 2019
Patients with high blood pressure and progression of periventricular white matter hyperintensities showed signs of...
Artificial Intelligence Pinpoints Nine Different Abnormalities in Head Scans

A brain scan (left) showing an intraparenchymal hemorrhage in left frontal region and a scan (right) of a subarachnoid hemorrhage in the left parietal region. Both conditions were accurately detected by the Qure.ai tool. Image courtesy of Nature Medicine.

News | Artificial Intelligence | January 07, 2019
The rise in the use of computed tomography (CT) scans in U.S. emergency rooms has been a well-documented trend1 in...
Electronic Brachytherapy Effective in Long-Term Study of 1,000 Early-Stage Breast Cancers
News | Brachytherapy Systems, Women's Healthcare | January 07, 2019
Breast cancer recurrence rates of patients treated with intraoperative radiation therapy (IORT) using the Xoft Axxent...