Samuel Cykert1, Eugenia Eng2, Matthew A Manning3, Linda B Robertson4, Dwight E Heron5, Nora S Jones6, Jennifer C Schaal6, Alexandra Lightfoot7, Haibo Zhou8, Christina Yongue9, Ziya Gizlice10. 1. The University of North Carolina School of Medicine, 145 N Medical Drive CB# 7165, Chapel Hill, NC 27599, USA. Electronic address: samuel_cykert@med.unc.edu. 2. Department of Health Behavior, The Gilling's School of Global Public Health, 360 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA. 3. Cone Health Cancer Center, 501 N Elam Ave, Greensboro, NC 27403, USA. 4. UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine 5150 Centre Avenue POB2 Cancer Pavilion, Room 438 Pittsburgh, PA 15232, USA. 5. Department of Radiation Oncology UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine5230 Centre Ave. Pittsburgh, PA 15232, USA. 6. The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA. 7. Department of Health Behavior, The Gilling's School of Global Public Health 1700 Martin Luther King, Jr. Boulevard CB #7426, Chapel Hill, NC 27599, USA. 8. Department of Biostatistics, The Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 3104C McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC 27599, USA. 9. Department of Public Health Education, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170, USA. 10. Biostatistical Support Unit, The Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill NC 27599, USA.
Abstract
BACKGROUND: Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS: A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS: The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION: A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.
BACKGROUND: Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS: A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS: The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION: A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.
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