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A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers

BACKGROUND: Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. METHODS: We performed a 5‐yea...

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Autores principales: Cykert, Samuel, Eng, Eugenia, Walker, Paul, Manning, Matthew A., Robertson, Linda B., Arya, Rohan, Jones, Nora S., Heron, Dwight E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434214/
https://www.ncbi.nlm.nih.gov/pubmed/30714689
http://dx.doi.org/10.1002/cam4.2005
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author Cykert, Samuel
Eng, Eugenia
Walker, Paul
Manning, Matthew A.
Robertson, Linda B.
Arya, Rohan
Jones, Nora S.
Heron, Dwight E.
author_facet Cykert, Samuel
Eng, Eugenia
Walker, Paul
Manning, Matthew A.
Robertson, Linda B.
Arya, Rohan
Jones, Nora S.
Heron, Dwight E.
author_sort Cykert, Samuel
collection PubMed
description BACKGROUND: Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. METHODS: We performed a 5‐year pragmatic, trial at five cancer centers using a system‐based intervention. Patients diagnosed with early stage lung cancer, aged 18‐85 were eligible. Intervention components included: (1) a real‐time warning system derived from electronic health records, (2) race‐specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. RESULTS: There were 2841 early stage lung cancer patients (16% Black) in the retrospective group and 360 (32% Black) in the intervention group. For the retrospective baseline, crude treatment rates were 78% for White patients vs 69% for Black patients (P < 0.001); difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income‐odds ratio (OR) 0.66 for Black patients (95% CI 0.51‐0.85, P = 0.001). Within the intervention cohort, the crude rate was 96.5% for Black vs 95% for White patients (P = 0.56). Odds ratio for the adjusted analysis was 2.1 (95% CI 0.41‐10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. CONCLUSION: A system‐based intervention tested in five cancer centers reduced racial gaps and improved care for all.
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spelling pubmed-64342142019-04-15 A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers Cykert, Samuel Eng, Eugenia Walker, Paul Manning, Matthew A. Robertson, Linda B. Arya, Rohan Jones, Nora S. Heron, Dwight E. Cancer Med Clinical Cancer Research BACKGROUND: Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. METHODS: We performed a 5‐year pragmatic, trial at five cancer centers using a system‐based intervention. Patients diagnosed with early stage lung cancer, aged 18‐85 were eligible. Intervention components included: (1) a real‐time warning system derived from electronic health records, (2) race‐specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. RESULTS: There were 2841 early stage lung cancer patients (16% Black) in the retrospective group and 360 (32% Black) in the intervention group. For the retrospective baseline, crude treatment rates were 78% for White patients vs 69% for Black patients (P < 0.001); difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income‐odds ratio (OR) 0.66 for Black patients (95% CI 0.51‐0.85, P = 0.001). Within the intervention cohort, the crude rate was 96.5% for Black vs 95% for White patients (P = 0.56). Odds ratio for the adjusted analysis was 2.1 (95% CI 0.41‐10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. CONCLUSION: A system‐based intervention tested in five cancer centers reduced racial gaps and improved care for all. John Wiley and Sons Inc. 2019-02-04 /pmc/articles/PMC6434214/ /pubmed/30714689 http://dx.doi.org/10.1002/cam4.2005 Text en © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Cancer Research
Cykert, Samuel
Eng, Eugenia
Walker, Paul
Manning, Matthew A.
Robertson, Linda B.
Arya, Rohan
Jones, Nora S.
Heron, Dwight E.
A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title_full A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title_fullStr A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title_full_unstemmed A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title_short A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers
title_sort system‐based intervention to reduce black‐white disparities in the treatment of early stage lung cancer: a pragmatic trial at five cancer centers
topic Clinical Cancer Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434214/
https://www.ncbi.nlm.nih.gov/pubmed/30714689
http://dx.doi.org/10.1002/cam4.2005
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