. Surgical resection is the standard-of-care for patients with early stage lung cancer, and multiple published studies have shown that improvements in resection rates translate into improvements in overall survival. African Americans (AAs) with early stage, non-small cell lung cancer (NSCLC) are significantly less likely than European Americans (EAs) to undergo resection, even when controlling for age, comorbidity, tumor stage, socioeconomic status, insurance status, and surgical consultation. This racial disparity is particularly pronounced in South Carolina (SC). Investigators at the National Cancer Institute-designated Medical University of South Carolina Hollings Cancer Center (MUSC HCC) hypothesize that a dynamic, [statewide], patient navigation intervention will reduce potential barriers to surgical cancer care and improve resection rates among AAs with early stage NSCLC. The patient navigation intervention will be tested in a two-arm, cluster- randomized trial comparing the intervention versus [usual care] in a sample of 200 AAs in SC with Stage I or II NSCLC. Study participants will be recruited from six geographically diverse study sites within a [statewide] cancer Clinical Trials Network (CTN) coordinated by MUSC, and participants will be cluster-randomized by CTN site. The investigators will further evaluate the modifying effects of income and urban-rural residence on the relationships between the intervention and the main study outcome (receipt of surgery), as well as [receipt of surgical consultation], time to resection, [time to death (survival)], health-related quality of life, state anxiety, perceived self-efficacy in patient-physician interaction, trust in physicians, and satisfaction with the treatment decision made. The proposed research is highly significant for many reasons. First, lung cancer is the leading cause of cancer death in the United States (US) and SC. Second, less than half of AAs in SC with early stage NSCLC undergo surgical resection, and the median survival of AAs with early stage NSCLC is consistently lower than that of EAs. Third, SC has a large AA population (approximately 30%), has urban as well as large rural geographic areas, and has wide income distributions. A [statewide] patient navigation intervention to enhance access to surgical therapy for AAs with NSCLC could lead to significant improvements in care and reductions in racial disparities in lung cancer outcomes [across wide geographic and socioeconomic strata] in SC, as well as in other communities across the US.

Public Health Relevance

. Lung cancer is the leading cause of cancer deaths in the US;however, while surgical resection is the optimal treatment for localized, early stage lung cancer, less than half of the African Americans (AAs) diagnosed with this disease undergo surgical resection. This study will test whether a [statewide] patient navigation intervention improves receipt of surgical resection, [receipt of surgical consultation], reduces time to surgery and [improves survival] in AAs with early stage disease, and it may uncover modifiable root causes underlying underuse of lung cancer surgery among AAs. The patient navigation intervention may prove to be a practical but powerful strategy for use by other health care providers, institutions, and communities seeking to reduce persistent racial disparities in lung cancer surgery and outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD005892-02
Application #
8448104
Study Section
Special Emphasis Panel (ZMD1-MLS (01))
Program Officer
Dankwa-Mullan, Irene
Project Start
2012-04-01
Project End
2016-12-31
Budget Start
2013-01-01
Budget End
2013-12-31
Support Year
2
Fiscal Year
2013
Total Cost
$344,781
Indirect Cost
$111,031
Name
Medical University of South Carolina
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425