Black patients lag behind whites in getting treatment for potentially curable non-small cell lung cancer. Compared with white patients, blacks also have lower surgical rates for lung cancer, possibly owing to denial or mistrust, and they're more likely to be lost to follow-up. A multifaceted intervention, which included identifying missed appointments and follow-ups by nurse navigators, improved care in both black and white patients according to a recent five-year study.

Black and white patients with newly diagnosed stage I and stage II lung cancer were recruited at multiple cancer centers through programs sponsored by the American Cancer Society and the National Cancer Institute. The centers' electronic health records (EHRs) were programmed to send real-time warnings about missed appointments for tests, treatments, and procedures, or when patients did not reach an expected milestone in care. Nurse navigators accessed these EHR data daily and acted on the warnings by contacting patients and helping with barriers to treatment, such as lack of transportation, financial difficulties, mistrust, miscommunication, or religious concerns. A physician champion at each cancer center kept clinical staff informed about the study and provided race-specific quarterly reports on all patients.

As a result of the intervention, treatment rates (surgery or radiation) increased in both groups. Before the intervention, treatment rates were 78% for white patients and 69% for black patients. After the intervention, rates rose to 95% for white patients and 96.5% for black patients.

"Application of this system-based, pragmatic approach to other cancer treatment disparities at a health system level could have positive effects on treatment completion, treatment equity, and overall outcomes," write the researchers.-Carol Potera

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