New studies show that system-level changes in how cancer treatments are delivered can also close the black-and-white gap in survival from early-stage lung and breast cancer. By identifying and addressing the obstacles that prevent patients from completing radiation therapy for cancer, the intervention improves the 5-year survival rate for all patients and closes the survival gap between black and white patients. bottom. The findings will be presented today at the Annual Meeting of the American Society for Radiation Oncology (ASTRO).
Accountability (ACCURE) clinical trials of cancer treatment by revoking racism and impartiality cancer Completion and survival of treatment in black and white patient populations. “Thousands of studies have examined racial disparities in health care, but until recently, few have conducted interventions to close those disparities,” said radiation oncologist and cone health oncology. Dr. Matthew A. Manning, Director of Medicine, said. Greensboro, North Carolina. “This study shows that it is possible.”
The ACCURE approach has made several changes to the way patients are supported while receiving cancer treatment. There were four components to this process. (1) Electronic health records with automatic alerts that flag milestones for missed appointments and expected care. (2) A nurse navigator trained on race-specific barriers to help patients overcome obstacles to care when alerts are reported. (3) Doctor’s champion. Provide racial feedback to the medical team regarding the completion of treatment. (4) Regular health inequalities education and training sessions for staff.
Previously published results show that ACCURE intervention significantly reduced the disparity in treatment completion rates between black and white patients undergoing curative radiation therapy or surgery for early-stage breast or lung cancer. In a new study, researchers looked at whether increasing completion rates could improve outcomes, paying particular attention to whether interventions reduced racial disparities in cancer survival. They compared the 5-year survival rates of 1,413 patients with stage 0, I, and II lungs. breast cancer The patients treated after the intervention were 2,016 patients who were treated before the system change.
Prior to the intervention, black patients with breast cancer had a 5-year survival rate of 89%, while white patients had a 5-year survival rate of 91%. After system-level changes began, the 5-year survival rates for both groups increased to 94%. Among patients treated for early-stage lung cancer, survival increased from 37% to 54% in black patients and from 43% to 56% in white patients.
“Historically, black and white patients had different survival rates after treatment, but that difference has disappeared,” said Dr. Manning. “This intervention has closed the gap in overall survival.”
Blacks face the highest cancer mortality and shortest cancer survival rates of any racial / ethnic group in the United States. According to the American Cancer Association, the black population is also facing “a greater obstacle to cancer prevention, detection, treatment and survival.” The ACCURE team identifies and addresses specific obstacles facing the patient population, such as restricted access to transportation and the difficulty of taking time off from work without penalties, and how disabilities vary by race. By deliberately investigating what to do, he said, he was able to reduce the negative effects of these barriers. Dr. Manning.
“The bottom line is that patients may not come back to us because we don’t know what’s going on unless we ask what happens when we miss an appointment or milestone. We can deal with barriers. We can provide transportation and letters to patients for work. We can overcome many barriers inside and outside the medical institution, Only if you know what it is. “
Dr. Manning’s hospital previously led a pilot study that found that offering a free ride-sharing program to transfer patients to radiation therapy sessions reduced the no-show rate in vulnerable populations.
Samuel Cykert, MD, a professor of medicine at the University of North Carolina at Chapel and principal investigator of the study, said the success of the ACCURE study was to focus on structural and institutional changes rather than individual changes to combat inequality. Said it was the key to. “The responsibility for the change lies with the system, not the individual patient. For example, if a child misses a treatment day due to having a caring child, people cannot help it. Intervention also cares in health. Indicates a delay in the system itself, which occurs even if the patient does not miss an appointment. “
“The clinic can provide a safety net by establishing ways to flag these disorders and delays and taking steps to help patients return to and complete treatment. That’s all in this trial. Made a difference, “said Dr. Cykert.
Investigators were instructed by the basic work of the Greensboro Health Disparity Community (a long-standing community-led partnership between medical, academic, and community representatives) in designing interventions, an assistant professor of public health education. Christina Young, MPH, MCHES said. Project Manager for the University of North Carolina Greensboro and ACCURE exams.
“The main concepts that drive ACCURE: transparency, accountability and enhanced communication arose from this collaboration and workshop on racial equality needed by providers and staff,” said Yongue. “These pillars were essential to building trust with our research participants, especially the historically marginalized black patients. Health care.. Without this confidence, clinical results would not have been possible. “
Going forward, the ACCURE team is looking at other applications of intervention, such as addressing pregnancy / maternal care disparities. “We have shown that it is possible to close the gap in the completion of cancer treatment and that this change may close the downstream cancer survival gap,” Dr. Manning said. “But we think the application could be wider.”
American Society of Radiation Oncology
Quote: Intervention was obtained from https://medicalxpress.com/news/2021-10-intervention-black-white-gaps- on October 25, 2021 for early-stage breast and lung cancer (October 25, 2021). Eliminate black and white gaps in survival from Survival-early-stage.html
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