Intervention IP-073: A System-Based Intervention to Reduce Black-White Disparities in the Treatment of Early Stage Lung Cancer

Increased curative treatment completion (defined as lung resection surgery) or full course of stereotactic radiation for Black patients experiencing stage I or stage II, non-small cell lung cancer

Surgical rates alone for Black patients

At baseline, crude treatment rates were 69% for Black patients for all curative treatment and 59% for lung resection surgery alone. In the intervention group, the overall completed treatment rate for Black patients improved to 96.5% while the rate of lung resection surgery improved to 75%. As the primary goal of the study was to prove that care of Black patients could be improved to the care standard of White lung cancer patients and that treatment completion could be optimized for all, logistic regression models were performed to compare treatment improvements for Black patients as well as White patients. Control treatment rates were higher for White patients. However, black patients improved dramatically compared to the White referent group. The data reported supports the effectiveness of the intervention among Black patients alone.

Patient characteristics were summarized using descriptive statistics and compared across study groups and within study groups between races using Chi-square and F-tests for categorical and continuous variables, respectively. Separate analyses were performed for the primary outcome and the secondary outcome. Since we were interested in estimating treatment differences between Blacks and Whites within each study group, a logistic regression model was performed for each outcome.

Yes

Overall treatment for Black and White patients and Black-White treatment differences in a retrospective control group, a concurrent control group, and the intervention group

Surgical rates for Black and White patients in both control groups and the intervention group

Overall treatment rate for surgery/radiation, regardless of race, was 76% for retrospective group, 96% for intervention group, and 83% for concurrent group. For the retrospective baseline, crude treatment rates were 78% for White 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 Blacks (95% CI 0.51 – 0.85, p = 0.001). Within the intervention group, the crude rate was 96.5% for Black vs. 95% for White patients (p = 0.56). OR 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. The White retrospective group was the gold standard comparator at 78% while the Black intervention group had a treatment rate of 96%. In the between group regression model the OR for Black treatment compared to the referent group was 11.9 (2.9-49, p=.001)

Since we were interested in estimating differences between Blacks and Whites within each study group, a logistic regression model was performed for each outcome examining Black compared to White outcomes within each group, controlling for age, income, gender, co-morbidities, clinical stage and site. For the between group analysis, all data from each group of interest were placed into a single model and study group by race combinations were employed to estimate differences by race and group.

Yes