Overall Survival From a Prospective Multi-Institutional Trial to Resolve Black-White Disparities in the Treatment of Early Stage Breast and Lung Cancer

Purpose/Objective(s) Black patients with curable lung or breast cancer complete treatment less often than similar white patients contributing to worse survival. ACCURE was a system-based intervention trial shown to eliminate black-white disparities in treatment completion and improved completion for all. The current study investigates how the ACCURE intervention influenced survival disparity. Materials/Methods We previously reported a prospective multi-institutional trial using a system-based intervention. Patients diagnosed with early-stage breast and lung cancer, aged 18 to 85 were eligible. Enrollment spanned from 2013 until 2015. Intervention components included: (1) a real time warning system derived from electronic health records, (2) feedback to clinical teams on cancer treatment according to race, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary study outcome was receipt of curative treatment. The current study compares 5-year survival according to race for eligible patients from the tumor registry during the study period with comparison to historical controls. The ACCURE study treatment for early-stage lung cancer included resection or stereotactic body radiotherapy (SBRT) and survivals are now reported separately. Results There were a total of 1,413 patients with stages 0, I & II lung and breast cancer diagnosed in 2013-2015 who were compared to 2,016 patients treated in 2007-2011. The table shows statistically significant improved survival for black and white breast cancer patients and white lung cancer patients over time, while the racial gap in survival was reduced for lung and breast cancer. The 5-year observed survivals for white (2150) versus black (644) breast patients increased from 91% vs. 89% (P = NS) to 94% for both. The 5-year observed survival for white (510) and black (125) lung narrowed from 43% and 37% (P = NS) to 56% and 54%. Subgroup analysis of lung cancer patients showed 5-year survival for surgery was 78.5% and 70.1% for white and black patients (P = NS) while survival for SBRT was 41.9% and 50% for white and black patients (P = NS). Conclusion A systems-based intervention reduced racial gaps in treatment completion and improved care for all. This study suggests that equity in treatment may be associated with elimination of survival disparities during the ACCURE study. In the lung cancer sub-group, the higher survival of white lung cancer patients undergoing surgery and black patients undergoing SBRT may suggest some continued disparity in patient selection for lung resection. Further analysis of comorbid conditions and other important factors will shed light on the full survival impact of the intervention.