Identifying and offering solutions for obstacles that kept people from completing radiation therapy for early-stage breast cancer and lung cancer improved outcomes and seemed to eliminate the difference in 5-year survival rates between Black and white people, according to the ACCURE study.
The research was presented on Oct. 25, 2021, at the 2021 American Society for Radiation Oncology (ASTRO) Annual Meeting. Read the abstract of “Overall Survival From a Prospective Multi-Institutional Trial to Resolve Black-White Disparities in the Treatment of Early Stage Breast and Lung Cancer.”
Historical differences in breast cancer diagnoses and mortality
It has long been known that breast cancer diagnoses and mortality rates were different among women of different races and ethnicities.
In 1980, for example, white women were much more likely to be diagnosed with breast cancer than Black women.
Throughout the 1980s, breast cancer diagnoses increased in both Black women and white women, likely due to an increase in screening mammograms.
Rates of breast cancer in white women decreased from 1999 to 2004, possibly because fewer women used hormone replacement therapy (HRT), after a study linked HRT with an increase in breast cancer risk.
Rates of breast cancer in Black women increased dramatically in the late 1970s and 1980s. Since that time, rates have consistently inched up, and recent research has found that rates of breast cancer in Black women and white women are now fairly equal.
Black women and white women had similar breast cancer mortality rates from 1975 to 1981. Breast cancer mortality rates increased for both groups of women from the mid-1970s to the early 1990s. Still, this increase was nearly 5 times higher for Black women.
Since 1990, breast cancer mortality has been decreasing for white women. But for Black women, breast cancer mortality didn’t start to decrease until 1993, and the decrease was smaller than it was for white women.
Various organizations and groups have started a number of programs and initiatives to address these disparities in breast cancer outcomes.
About the study
Called ACCURE (Accountability for Cancer Care through Undoing Racism and Equity), the study included 1,413 people diagnosed with stage 0, I, and II lung or breast cancer between 2013 to 2015 and 2,016 people diagnosed between 2007 to 2011. Overall:
- 1,279 white people were diagnosed with breast cancer between 2007 and 2011
- 362 Black people were diagnosed with breast cancer between 2007 and 2011
- 871 white people were diagnosed with breast cancer between 2013 and 2015
- 282 Black people were diagnosed with breast cancer between 2013 and 2015
- 304 white people were diagnosed with lung cancer between 2007 and 2011
- 71 Black people were diagnosed with lung cancer between 2007 and 2011
- 206 white people were diagnosed with lung cancer between 2013 and 2015
- 54 Black people were diagnosed with lung cancer between 2013 and 2015
Earlier research suggested that Black people with early-stage breast or lung cancer were less likely to complete radiation therapy than white people, which contributed to worse survival rates.
So after identifying the issues that stopped people from completing radiation therapy, the researchers implemented changes to the support system for people undergoing treatment. The changes began with people diagnosed between 2013 and 2015.
The changes included:
- automatic alerts in the electronic health record system if a person missed an appointment or didn’t meet a milestone in expected care
- adding a nurse navigator trained in race-specific barriers to help people overcome obstacles to care if there was an alert in the electronic health record
- adding what was called a physician champion, a doctor who would offer race-related feedback about treatment completion to the healthcare teams
- conducting regular health equity education training sessions for healthcare staff members
Earlier results from the ACCURE study found these changes reduced the differences in radiation therapy completion rates between Black people and white people receiving treatment for early-stage breast and lung cancer. For this analysis, the researchers wanted to know if the increase in radiation therapy completion rates led to better 5-year survival rates.
The researchers compared the 5-year survival rates for people diagnosed between 2007 and 2011 with people diagnosed between 2013 and 2015.
Five-year survival rates were:
- 91.36% for white people diagnosed with early-stage breast cancer between 2007 and 2011
- 89.44% for Black people diagnosed with early-stage breast cancer between 2007 and 2011
- 43.39% for white people diagnosed with early-stage lung cancer between 2007 and 2011
- 36.62% for Black people diagnosed with early-stage lung cancer between 2007 and 2011
- 93.92% for white people diagnosed with early-stage breast cancer between 2013 and 2015
- 93.96% for Black people diagnosed with early-stage breast cancer between 2013 and 2015
- 55.64% for white people diagnosed with early-stage lung cancer between 2013 and 2015
- 53.54% for Black people diagnosed with early-stage lung cancer between 2013 and 2015
The results show that the changes to the treatment support system improved outcomes for all the people in the study and virtually eliminated the differences in survival rates between white and Black people.
“Historically, Black and white patients had different survival rates after treatment, but that difference disappeared,” said lead author Matthew Manning, M.D., radiation oncologist and chief of oncology at Cone Health in North Carolina, in a statement. “We are now able to say that this intervention eliminated disparities in overall survival.
“The bottom line is, unless we ask what happens when an appointment or milestone is missed, we just don't know what's going on, and the patient may never come back to us,” Dr. Manning continued. “If we do ask, we often have systems in place that can address those barriers. We can provide transportation or provide a letter for the patient for work. We can overcome many barriers, both internal and external to our healthcare institutions, but only if we know what they are. Thousands of studies have looked at racial disparities in healthcare, but until recently, very few studies have implemented interventions to eliminate those disparities. This study shows that it can be done.”
What this means for you
This study strongly suggests that some of the racial differences in early-stage breast cancer outcomes may be overcome by offering more support for people undergoing radiation therapy treatment.
As this study shows, it’s very important to complete all your radiation therapy treatments. Still, traditional whole-breast radiation therapy after surgery for early-stage breast cancer is usually given as one treatment per day, 5 days a week, for 5 to 7 weeks. This daily commitment can be very difficult for some people, especially if they live far away from a treatment center or can’t take that much time off work. Newer, accelerated radiation schedules put the same radiation dose into a 3- to 5-week schedule. But this is still a big commitment.
So what can you do if your facility doesn’t offer the same support as the ACCURE study did?
When you’re planning your treatment, be very honest with your doctor about how difficult it may be for you to complete the full course of radiation therapy. You may be eligible for an accelerated radiation schedule. Ask if the facility offers transportation to radiation therapy appointments. If not, ask if there are ride-to-treatment services, such as the American Cancer Society’s Road to Recovery program, available in your area.
If taking time off work every day will be hard for you, ask your doctor if your appointments can be set at a time when you’re not working. If that’s not possible, ask if your doctor or nurse navigator can talk to your employer.
If you’re experiencing troubling side effects from radiation therapy, talk to your doctor right away. Skin side effects are the most common, and there are steps you can take to soothe and help heal any irritation.
If you’re having trouble paying for your care, talk to your doctor or a hospital social worker about assistance programs in your area.
If you have to skip an appointment, call your healthcare team right away and tell them why. They can reschedule you and help you overcome any barriers you may be facing.
There is only one of you, and you deserve the best care possible.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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