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Cancer Med. 2019 Feb 4. doi: 10.1002/cam4.2005. [Epub ahead of print]

A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers.

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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.
Leo Jenkins Cancer Center, Brody School of Medicine - East Carolina University, Greenville, North Carolina.
Cone Health Cancer Center, Greensboro, North Carolina.
UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.
Palmetto Health and the University of South Carolina School of Medicine, Columbia, South Carolina.
The Partnership Project, Greensboro, North Carolina.
Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.



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.


cancer disparities; health equity; intervention; pragmatic trial; systems change

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