Effect of an antiracism intervention on disparities in time to lung cancer surgery.

Authors

Jacob Stein

Jacob Newton Stein

UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC

Jacob Newton Stein , Samuel Cykert , Christina Yongue , Eugenia Eng , Isabella Kathryn Wood , Marjory Charlot

Organizations

UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, UNC Gillings School of Global Public Health, Chapel Hill, NC, University of North Carolina at Chapel Hill, Chapel Hill, NC, The University of North Carolina at Chapel Hill, Chapel Hill, NC

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Racial disparities are well described in the management of early-stage lung cancer, with Black patients less likely to receive potentially curative surgery than non-Hispanic Whites. A multi-site pragmatic trial entitled Accountability for Cancer Care through Undoing Racism and Equity (ACCURE), designed in collaboration with community partners, eliminated racial disparities in lung cancer surgery through a multi-component intervention. The study involved 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. Timeliness of cancer care is an important quality metric. Delays can lead to disease progression, upstaging, and worse survival, and Black patients are more likely to experience longer wait times to lung cancer surgery. Yet interventions to reduce racial disparities in timely delivery of lung cancer surgery have not been well studied. We evaluated the effect of ACCURE on timely receipt of lung cancer surgery. Methods: We analyzed data of a retrospective cohort at five cancer centers gathered prior to the ACCURE intervention and compared results with prospective data collected during the intervention. We calculated mean time from clinical suspicion of lung cancer to surgery and evaluated the proportion of patients who received surgery within 60 days stratified by race. We performed a t-test to compare mean days to surgery and chi2 for the delivery of surgery within 60 days. Results: 1320 patients underwent surgery in the retrospective arm, 160 were Black. 254 patients received surgery in the intervention arm, 85 were Black. Results are summarized in Table. Mean time to surgery in the retrospective cohort was 41.8 days, compared with 25.5 days in the intervention cohort (p<0.01). In the retrospective cohort, 68.8% of Black patients received surgery within 60 days versus 78.9% of White patients (p<0.01). In the intervention, the difference between Blacks and Whites with respect to surgery within 60 days was no longer significant (89.41% of Black patients vs 94.67% of White patients, p=0.12). Conclusions: Racial disparities exist in the delivery of timely lung cancer surgery. The ACCURE intervention improved time to surgery and timeliness of surgery for Black and White patients with early-stage lung cancer. A combination of real-time EHR monitoring, nurse navigation, and race-based feedback markedly reduced racial disparities in timely lung cancer care.

Time to Lung Cancer Surgery.


Black patients
White patients
p value
All patients
p value
Retrospective





 Mean (days)
47.7 (42.2-53.3)
41.0 (39.0-43.0)
p = 0.02
41.8 (34.7-39.9)

 < 60 days
68.8%
78.8%
p < 0.01
77.7%

Intervention





 Mean (days)
28.9 (22.9-34.9)
23.8 (20.7-26.9)
p = 0.10
25.5 (22.6-28.4)
p < 0.01*
 < 60 days
89.4%
94.7%
p = 0.12
92.9%
P < 0.01*

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Clinical Science Symposium

Session Title

Novel Initiatives to Address Disparities in Cancer

Track

Special Sessions

Sub Track

Access to Care

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 101)

DOI

10.1200/JCO.2021.39.15_suppl.101

Abstract #

101

Abstract Disclosures

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