System-Based Intervention Cuts Racial Disparities in Cancer Care

A system-based intervention reduced racial disparities among black and white cancer patients.

By Jessica Kent

May 14, 2019 - A pragmatic, system-based intervention decreased racial disparities in cancer treatment and outcomes for black patients with early-stage breast cancer.

In a five-year study conducted at the University of North Carolina (UNC) School of Medicine, researchers were able to increase treatment completion rates among black patients to more closely match those of white patients. Before the intervention, treatment completion rates were 87.3 percent for white patients, and 79.8 percent for black patients.

After the intervention, treatment completion rates increased to 89.5 percent for white patients and 88.4 percent for black patients.

The intervention system consisted of multiple parts, including a real-time warning system derived from EHR data. The system would warn nurse navigators when a patient missed an appointment or treatment milestone. The navigator would then reach out to patients and bring them back into care, encouraging them through circumstances that presented potential barriers to treatment.

The intervention also included race-specific feedback to clinical teams on treatment completion rates, as well as optional health equity training sessions for staff.

Prior to this study, the research team conducted trials in 2005 and 2009 that aimed to discover why racial disparities exist in cancer care.

“We found what seems to be implicit bias with some clinicians that made them less willing to take the same risks with patients that were different from them,” said Samuel Cykert MD, professor of medicine at the UNC School of Medicine and co-principal investigator of the study.

“A black and a white patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, yet white patients were more likely to receive the surgery and get their cancer treated.”

These previous studies also showed that black cancer patients who didn’t have a regular source of care because of poor clinical communication did not pursue adequate diagnosis or treatment, which illustrates the need for systems to follow the trajectory of patient care more fully and communicate with patients to support completion of cancer treatment.

“With that knowledge, we wanted to build a system that pointed out these lapses in care or communication in real time to help us keep track of patients who would otherwise drop off the grid,” said Cykert.

The current study also builds on previous research conducted by the team, in which the group reduced treatment disparities for patients with early-stage lung cancer. The study, published in the journal Cancer Medicine in February 2019, showed that a similar multi-part intervention was able to improve cancer care for both black and white patients.

The former study also showed that disparities among black patients were strongly related to a lack of communication between patients and clinicians.

“The reasons for cancer treatment disparities go beyond socioeconomic status, age, and health status,” the UNC team wrote at the time.

“When considering only black patients, this study found that lack of a regular source of care was associated with lower surgical rates suggesting that black patients, possibly experiencing denial or mistrust, were more likely lost to follow‐up.”

For the current study, UNC School of Medicine researchers developed the intervention model in partnership with the Greensboro Health Disparities Collaborative. Together, their goals were to create elements of real-time transparency, race-specific accountability, and improved patient-centered communication.

“I think it is revolutionary that we have devised an intervention to address the way that the health care system creates disparities,” said Kari Thatcher, co-chair of Greensboro Health Disparities Collaborative. “We have made systemic changes that close the disparity gap and have improved healthcare for all races involved.”

Cone Health Cancer Center in Greensboro, North Carolina, one of the participating institutions in the study, is working toward implementing this intervention model into cancer care for all its patients.

“This treatment model can be applied to most any chronic disease,” said Matthew Manning, MD, interim chief of oncology for Cone Health, who helped support the ACCURE trial. “It builds a more culturally competent care delivery system that would benefit all chronic diseases.”

Researchers are currently in the process of submitting a grant proposal to the National Cancer Institute to implement this intervention to cover whole cancer populations, rather than just study patients alone. The team is confident that their intervention could reduce cancer care disparities across organizations.

“These results show promise for all cancer treatment centers,” Cykert concluded.

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