Pharmacology

The treatment completion rates before this intervention were 87.3% for white patients versus 79.8%t for black patients. With the intervention in place, treatment completion climbed to 89.5% for white patients and 88.4% for black patients. “These results show promise for all cancer treatment centers;” said Samuel Cykert, MD, professor of medicine at the UNC School of Medicine and co-principal investigator of the trial.

Reduced treatment disparities

This trial is similar to another led by Cykert that reduced treatment disparities for patients with early-stage lung cancer, while this study focuses more on breast cancer patients. The results of the previous work were published in the journal Cancer Medicine in February. Leading up to these trials; Cykert and his colleagues conducted studies in 2005 and 2009 to find out why race disparities in cancer treatment exist. They found multiple reasons that contribute to the overall reduction in treatment.

“They find what seems to be implicit bias with some clinicians that made them less willing to take the same risks with patients that were different from them;” Cykert said. “A black and a white patient of the same age could require the same surgery, have the same comorbidities; have the same income and insurance, yet white patients were more likely to receive the surgery and get their cancer treated.”

Adequate diagnosis or treatment

Cykert says they additionally found that black cancer patients who did not have a regular source of care; as a result of poor clinical communication; did not end up pursuing adequate diagnosis or treatment. This finding highlights the need for systems that fully follow the trajectory of patient care. Rather than blaming the patient for incomplete care; recognition of these barriers allows for the cancer team to be accountable for re-engagement and full communication to promote completion of standard treatments.

“With that knowledge; They want to build a system that pointed out these lapses in care or communication in real time to help us keep track of patients who would otherwise drop off the grid,” said Cykert. The intervention consisted of multiple parts: a real-time warning system derived from electronic health records, race-specific feedback to clinical teams on treatment completion rates; optional health equity training sessions for staff; and a nurse navigator specially trained in racial equity to engage with patients throughout treatment.

Notified nurse navigators

The real-time warning system notified nurse navigators when a patient missed an appointment or treatment milestone. The navigator then reached out to the patient to reengage and bring them back into care. The nurse navigators were encouraged to become familiar with patients and build trust in case of a missed appointment; miscommunication between doctor and patient, or other circumstance that created a potential barrier to care.