Active Multimodal Intervention Reduced Racial Disparities in Delivery of Timely Lung Cancer Surgery

It is well-known that racial disparities in the treatment of lung cancer exist and have been persistent for more than 20 years; specifically, African Americans are less likely to receive timely and potentially curative surgery compared with non-Hispanic whites. To address racial inequities in lung cancer surgery, the multisite prospective Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial was initiated that was guided by a diverse partnership involving academic researchers, a nonprofit community-based organization, and 2 cancer centers. The study used multicomponent interventions, including real-time electronic health record (EHR) monitoring to identify patients not receiving recommended care, a nurse navigator who reviewed and addressed EHR alerts daily, and race-specific feedback provided to clinical teams. The current analysis evaluated the effect of ACCURE intervention on timely receipt of lung cancer surgery among black and white patients, tested among community-based patients in typical care settings.

Two cohorts were analyzed in this collaborative study: (1) a retrospective cohort at 5 cancer centers collected prior to the ACCURE intervention, and (2) a prospective cohort enrolled in the ACCURE intervention. Outcomes were mean time from clinical suspicion of lung cancer to surgery and proportion of patients who received surgery within 56 days, stratified by race.

A total of 1320 patients underwent surgery in the retrospective arm (black, n = 160), and 254 patients underwent surgery in the intervention arm (black, n = 85). Median time to surgery was significantly less in the intervention cohort compared with the retrospective cohort: <56 days to surgery was 65.6% in the black patients and 76.5% in the white patients (P <.01) in the retrospective arm, and <56 days to surgery was 89.4% in the black patients and 92.9% in the white patients (P = .12). Following ACCURE intervention, a significantly higher proportion of black (89.41% vs 65.6%; P <.001) and white (92.9% vs 76.5%; P <.001) patients received surgery within 8 weeks compared with the retrospective cohort (65.6% of black patients vs 76.5% of white patients; P <.001).

These results indicate that a combination of real-time EHR monitoring, nurse navigation, and race-based feedback eliminated time to treatment disparities for surgery within 8 weeks for both black and white patients, and improved equity in the delivery of timely lung cancer surgery for both black and white patients with early-stage lung cancer.

Source: Stein JN, et al. J Clin Oncol. 2021;39(suppl 15):Abstract 101.