A study presented by Manning et al at the 2021 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 53) showed that interventions to help Black patients overcome obstacles to completion of treatment can impact disparities in survival outcomes between Black and White patients with early-stage breast cancer and lung cancer.
More on the ACCURE Trial
The Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) clinical trial found that by identifying and addressing obstacles that prevented patients from finishing radiation treatment, 5-year survival rates improved among Black patients, and were similar to White patients who were not participating in the intervention.
“Thousands of studies have looked at racial disparities in health care, but until recently, very few studies have implemented interventions to eliminate those disparities,” said lead author Matthew A. Manning, MD, a radiation oncologist and Chief of Oncology at Cone Health in Greensboro, North Carolina. “This study shows it can be done.”
The ACCURE approach institutes four main changes to the support system for patients during cancer treatment:
1) An electronic health record with automatic alerts to flag missed appointments or unmet milestones in expected care
2) A nurse navigator trained in race-specific barriers to help patients overcome obstacles to care when alerts are flagged
3) A physician champion to engage health-care teams with race-related feedback on treatment completion
4) Regular health equity education training sessions for staff.
Dr. Manning and his coinvestigators previously reported results from a prospective multi-institutional trial using the systems-based ACCURE intervention in patients diagnosed with early-stage breast and lung cancer aged 18 to 85 years. That study found that patients who had the intervention had increased completion rates for curative radiation therapy or surgery.
Improved Survival Rates
The present study focused on whether the increased completion rates translated to improved outcomes (ie, 5-year survival rates).
The investigators compared 5-year survival rates for 1,413 patients with stage 0, I, and II lung and breast cancers diagnosed from 2013 to 2015 to 2,016 patients treated in 2007 to 2011.
Prior to the intervention, the 5-year survival rate for Black patients with early-stage breast cancer was 89% compared to 91% for White patients. After the system-level intervention was implemented, 5-year survival for both groups was 94%. Among patients with early-stage lung cancer, 5-year survival rates prior to initiating the intervention were 37% for Black patients and 43% for White patients; after the intervention, 5-year survival rates increased to 54% among Black patients and 56% for White patients. A subgroup analysis of patients with lung cancer by kind of treatment showed 5-year survival for those who underwent surgery was 78.5% and 70.1% for White and Black patients, respectively, while survival for those treated with stereotactic body radiotherapy was 41.9% and 50% for White and Black patients, respectively.
“Historically, Black and white patients had different survival rates after treatment, but that difference disappeared. We are now able to say that this intervention eliminated disparities in overall survival,” Dr. Manning stated.
The types of obstacles were addressed by the intervention included ensuring that patients have access to transportation, providing a letter to the patient’s employer that he/she needs time off to have a treatment, and helping arrange childcare.
Principal investigator of the trial, Samuel Cykert, MD, Professor of Medicine at the University of North Carolina School of Medicine, emphasized that structural institutional change is needed to overcome obstacles that lead to disparities in care.
“The intervention … flags delays in care within the health system itself that occur even when patients don’t miss appointments,” Dr. Cykert noted. “The clinic can provide safety nets by instituting a method to flag these obstacles and delays, and by having steps in place to help the patient return to and complete treatment. That made all the difference in with this trial.”
In the future, the ACCURE team plans on addressing disparities in other areas of medical care, including pregnancy/maternal care.
The authors concluded, “A systems-based intervention reduced racial gaps in treatment completion and improved care for all. This study suggests that equity in treatment may be associated with elimination of survival disparities during the ACCURE study. In the lung cancer subgroup, the higher survival of White patients with lung cancer undergoing surgery and Black patients undergoing stereotactic body radiotherapy may suggest some continued disparity in patient selection for lung resection. Further analysis of comorbid conditions and other important factors will shed light on the full survival impact of the intervention.”
Disclosure: For full disclosures of the study authors, visit redjournal.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®.