Published on July 12, 2021
Can Targeted Interventions Reduce Racial Disparities in Healthcare?
Racial disparities persist in cancer care, but results from two studies presented virtually at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting showed that targeted interventions can reduce disparities and improve outcomes for all patients.
In the first study, researchers at the Abramson Cancer Center (ACC) at the University of Pennsylvania in Philadelphia, led by ACC director Robert H. Vonderheide, MD, developed a five-year plan to increase enrollment of Black patients in clinical trials. The initiative was based on community outreach and engagement.
Before the initiative, in 2014, Black or African American individuals accounted for only 11% of the patients at the ACC, although they accounted for 19% of the local population and 17% of cancer cases in the area, Dr. Vonderheide explained in his presentation. The percentages of Black participants in treatment clinical trials, non-therapeutic interventional trials, and non-interventional trials were 12%, 8%, and 13%, respectively, he said. Non-therapeutic interventional trials do not provide a treatment to patients, but are designed to study factors that advance the understanding of cancer, such as collecting tissue samples. Non-interventional trials are designed to assess the safety and tolerability of a treatment.
Dr. Vonderheide and colleagues established a program at the ACC to close the gaps in Black patient participation in trials. Their strategies included developing new marketing strategies for cancer clinical trials; creating plans for each treatment protocol to facilitate enrollment of Black patients; and partnering with faith-based organizations serving Black communities to conduct informational events about clinical trials. The ACC redesigned communications about trials, creating brochures, videos, websites, and social media campaigns in which Black cancer patients shared their stories about their treatment experiences.
The ACC initiative also addressed barriers such as transportation by offering patients rides to ACC through the program Ride Health. In addition, the ACC provided patient education by nurse navigators regarding cancer and clinical trials and developed an improved informed consent process.
The researchers reviewed their patient metrics five years later, in 2018, and found an increase to 16% in the proportion of Black patients at ACC. The percentages of Black patients participating in treatment trials, non-therapeutic interventional trials, and non-interventional trials increased to 24%, 33%, and 23%, respectively.
Next steps for ACC include the use of community ambassadors who will conduct peer-to-peer education with caregivers, survivors, and lay educators to spread the word about clinical trials in their communities, Dr. Vonderheide said. Other plans include combining COVID-19 outreach with cancer outreach and a partnership with the Lazarex Cancer Foundation, a nonprofit organization that helps cancer patients with the costs of clinical trial participation, he added.
“Full inclusion of minority participants in cancer clinical trials is mission-critical in our community and across the nation,” he emphasized.
Targeted Interventions Benefit All Patients
Several decades of research show that Black patients with early-stage lung cancer are less likely than non-Hispanic white patients to undergo potentially curative surgery, according to Jacob Newton Stein, MD, of the University of North Carolina at Chapel Hill.
“In lung cancer, delays in surgery really do lead to harm,” Dr. Stein said in a virtual presentation at the ASCO meeting.
However, a targeted intervention based on community engagement and partnership resulted in not only in the elimination of the disparity in lung cancer surgery rates, but also improvement in time to surgery for early-stage lung cancer patients of all races, Dr. Stein said.
An intervention known as ACCURE (Accountability for Cancer Care through Undoing Racism and Equity) involved use of a patient registry and real-time electronic health record monitoring to identify patients who missed key milestones in care, such as referrals for surgery, Dr. Stein explained. A nurse navigator checked the registry regularly, communicated with patients and doctors to address barriers to care, and incorporated feedback.
The researchers analyzed data on time to surgery in Black and non-Hispanic white patients at five cancer centers from time periods both before and during the ACCURE intervention. They compared the records of a total of 1,320 patients who underwent surgery before the intervention, 160 of whom were Black, and 254 patients who underwent surgery after the intervention, 85 of whom were Black.
“The intervention worked,” with dramatic results, said Dr. Stein. Among the patients assessed during the period before the intervention, 69% of Black patients and 79% of white patients underwent surgery in less than 60 days, which was a significant difference. During the intervention period, 89% of Black patients and 95% of white patients underwent surgery within 60 days, and the difference was no longer significant. Additionally, “after the intervention, the average number of days to surgery dropped from 42 days to 26 days across the entire patient population, and 93% of all patients had surgery within 60 days,” said Dr. Stein.
“When we take a system-based approach with a patient-centered focus, everyone benefits,” he said. “Partnership with the community was essential for intervention development,” he added.
The studies highlight the importance of community-facing patient navigation as a way to reduce disparities, said Christopher S. Lathan, MD, director of the cancer care equity program at the Dana-Farber Cancer Institute in Boston, who provided an additional perspective on both studies.
Dr. Lathan praised the authors of the studies for using community-based patient navigation to address disparities. Community-based patient navigation “promotes access to timely cancer diagnosis and treatment by helping diverse populations overcome barriers to care,” he said. These barriers include racial and socioeconomic disparities, language and cultural differences, lack of communication and information, and fear and distrust in the healthcare system, he explained.
“People tend to trust their clinicians if they have a good relationship with them,” he said. “These interventions demonstrate how to turn words into impact.”
Both studies were supported in part by the National Institutes of Health. Dr. Vonderheide disclosed that he is the inventor of a licensed patent regarding cancer vaccine antigens and that he receives royalties from Children’s Hospital Boston for a licensed research-only monoclonal antibody. Dr. Stein had no financial conflicts to disclose.
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