A recent intervention at five cancer centers successfully minimized racial gaps in treatment for non-small cell lung cancer (NSCLC) patients.
The five-year pragmatic trial included patients aged 18‚Äď85 years diagnosed with early stage lung cancer. The intervention approach was three-tiered and included a real‚Äźtime warning system derived from electronic health records (EHRs), race‚Äźspecific feedback to clinical teams on treatment completion rates, and a nurse navigator with regular access to the warning systems. Researchers compared data for current patients to those of retrospective and concurrent controls.
“With digital data readily available through EHRs it’s very doable to build a system like this that signals disparities in care for both blacks and whites,” study author Samuel Cykert, MD, of the University of North Carolina at Chapel Hill, told MedPage Today. “It’s very feasible to have real-time actionable data and have one person responsible for the data without requiring extra hiring or bells and whistles.”
Of the 2,841 early stage lung cancer patients in the retrospective group, 16% were black, and of the 360 in the intervention group, 32% were black. Crude treatment rates among the retrospective cohort were 78% for white patients and 69% for black patients (P < 0.001). Researchers confirmed treatment difference by race using a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income and came to an odds ratio (OR) of 0.66 for black patients (95% CI 0.51‚Äź0.85, P = 0.001). In contrast, among the intervention cohort, crude treatment rates were 96.5% and 95% for black and white patients, respectively (P = 0.56); adjusted OR for black versus white patients was 2.1 (95% CI 0.41‚Äź10.4, P = 0.39).
‚ÄúApplication of this system‚Äźbased, pragmatic approach to other cancer treatment disparities at a health system level could have positive effects on treatment completion, treatment equity, and overall outcomes,‚ÄĚ the study authors concluded.
Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503)
Source: Cancer Medicine