Division of General Medicine and Clinical Epidemiology, The Center for Health Promotion and Disease Prevention, The Lineberger Cancer Center, The University of North Carolina School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Health Behavior, The Gilling's School of Global Public Health, Chapel Hill, North Carolina.
Cancer Med. 2019 Mar;8(3):1095-1102. doi: 10.1002/cam4.2005. Epub 2019 Feb 4.
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.
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.
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.
A system-based intervention tested in five cancer centers reduced racial gaps and improved care for all.
早期诊断和治疗方法的进步降低了与非小细胞肺癌相关的高死亡率。然而，生存方面的种族差异仍然存在，部分原因是黑人群体接受的治疗比白人群体少。
我们在五家癌症中心进行了一项为期五年的实用性试验，采用基于系统的干预措施。符合条件的患者为年龄在 18 岁至 85 岁之间、被诊断为早期肺癌的患者。干预措施包括：（1）源自电子病历的实时警报系统；（2）向临床团队提供关于治疗完成率的种族特异性反馈；（3）一名护士导航员。同意参与的患者与回顾性和同期对照组进行比较。主要结局是接受根治性治疗。
在回顾性组中有 2841 例早期肺癌患者（16%为黑人），干预组中有 360 例（32%为黑人）。在回顾性基线时，白人患者的治疗率为 78%，黑人患者为 69%（P<0.001）；通过调整年龄、治疗部位、癌症分期、性别、合并症和收入的模型证实了种族差异，黑人患者的比值比（OR）为 0.66（95%CI 0.51-0.85，P=0.001）。在干预组中，黑人患者的粗治疗率为 96.5%，白人患者为 95%（P=0.56）。调整分析的 OR 为黑人患者 2.1（95%CI 0.41-10.4，P=0.39）。组间分析证实了干预的治疗平等。
在五家癌症中心测试的基于系统的干预措施减少了种族差距，并改善了所有患者的护理。
