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Intervention for Racial Disparities in Time to Lung Cancer Surgery: ACCURE Trial


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In an analysis from the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial reported in the Journal of Clinical Oncology, Marjory Charlot, MD, MPH, MSc, and colleagues found that the ACCURE intervention reduced the disparity between Black and White patients in time to surgery after diagnosis of early-stage non–small cell lung cancer (NSCLC).

Marjory Charlot, MD, MPH, MSc

Marjory Charlot, MD, MPH, MSc

Study Details

The analysis included 2,363 patients diagnosed with stage I or II NSCLC. The ACCURE intervention group consisted of 263 patients (85 Black and 178 White) enrolled between April 2013 and December 2016 at five U.S. cancer centers. Comparisons were made with a concurrent control group consisting of 302 patients (37 Black and 265 White) not enrolled in the trial who were diagnosed in 2014 and 2015 and received surgery at two of the participating study sites, and a retrospective control group of 1,798 patients (271 Black and 1,527 White) diagnosed and treated from January 2007 to December 2012, prior to the intervention period.

In brief, the ACCURE intervention consists of:

  • A real-time warning system to identify unmet care milestones
  • Race-specific feedback on lung cancer treatment rates
  • Patient navigation.

The primary outcome measure was surgery within 8 weeks of diagnosis. Risk ratios were adjusted for clinical and demographic factors.

Key Findings

In the intervention group, 87.1% of Black patients and 85.4% of White patients (P = .13) received surgery within 8 weeks (risk ratio [RR] = 1.02, 95% confidence interval [CI] = 0.80–1.15, P= .79). Median time to surgery was 28 vs 21 days (P = .33).

In the concurrent control group, rates of surgery within 8 weeks were 64.9% for Black patients and 73.2% for White patients (P = .29, RR = 0.91, 95% CI = 0.73–1.13, P = .40). Median time to surgery was 35 vs 33 days (P = .83).

In the retrospective control group, rates of surgery within 8 weeks were 58.7% for Black patients and 75.0% for White patients (P < .01, RR = 0.76, 95% CI = 0.69–0.85, P < .01). Median time to surgery was 43 vs 32 days (P < .01).

Black patients in the intervention group were more significantly more likely to undergo surgery within 8 weeks than Black patients in the concurrent (RR = 1.30, P = .04) and retrospective control groups (RR = 1.43, P < .01) and White patients in the retrospective control group (RR = 1.11, P = .02).

White patients in the intervention group were also significantly more likely to receive surgery within 8 weeks than White patients in the concurrent (RR = 1.13, P = .02) and retrospective control groups (RR = 1.10, P = .01).

The investigators concluded: “Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.”

Dr. Charlot, of the Division of Oncology, The University of North Carolina at Chapel Hill, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the University of North Carolina Simmons Scholar program, a National Cancer Institute–funded Cancer Health Disparities Training grant, and others. For full disclosures of the study authors, visit ascopubs.org.

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®.
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