Dr. Samuel Cykert spent his career asking why Black patients with curable cancer were still dying at higher rates than white patients with the same diagnosis, and then doing something about it. As a Professor Emeritus of Medicine at the University of North Carolina Chapel Hill and a founding member of the Greensboro Health Disparities Collaborative, he helped design and lead ACCURE, the Accountability for Cancer Care through Undoing Racism and Equity intervention, a system-based approach that nearly eliminated racial disparities in cancer treatment completion for breast and lung cancer patients across multiple institutions.
His research began with a deceptively simple observation. Getting into the cancer care system was not enough. What happened after diagnosis, whether a patient actually completed treatment, was where the gap between Black and white patients was widest and least studied. Cykert sat down with Rolling Out Health IQ to explain what the data revealed, what the community demanded, and what it felt like when the numbers proved the system worked.
Black Americans are diagnosed with cancer at similar rates to white Americans yet outcomes are consistently worse. What is driving that gap?
Going back decades, most of it comes down to the same set of factors. Access to care is part of it, both in terms of insurance and income, but also geography. Whether there are aggressive cancer specialists close enough to reach, and whether those specialists are using state-of-the-art approaches, makes a real difference.
But in years of research, even when controlling for social determinants of health, there tends to be less aggressive care for Black individuals. A paper published in 2010 on lung cancer showed that Black patients with two or more significant comorbid illnesses almost never went to lung cancer surgery even when their cancer was curable, whereas similar white patients still did. A lot of that comes down to implicit bias.
How much of the disparity is about access to diagnosis versus what happens after a patient is already in the system?
Being in the system does not assure completion of cancer care. In research from the early 2000s, cancer registries tracked when a patient got surgery or started chemotherapy but did not account for whether they finished chemotherapy. A Columbia University researcher demonstrated that in breast cancer chemotherapy, Black patients started therapy but did not finish it at much higher rates than white patients. Completion is actually the area that most needed focus, and it required a three-step framework. First, overcoming social determinants like money, insurance, and transportation. Second, getting access to appropriate diagnostic tests. Third, actually completing that treatment in a timely and aggressive way.
Walk us through what the ACCURE intervention is and what problem it was designed to solve.
Working with the community through the Greensboro Health Disparities Collaborative, the intervention was built around three things the community identified as essential. The first was real-time transparency. Retrospective data showing disparities five years later is too late for the patient who already died. So every patient with a cancer diagnosis went into a real-time registry built from electronic health records. If a patient missed an appointment, a warning came up immediately. If a patient was keeping their appointments but not reaching expected milestones of care, a second warning came up. The system asked the clinical team whether care was intentionally going that slowly, and if not, it accelerated.
The second was accountability. Clinical teams saw their own data on treatment completion broken down by race. When a 10% gap showed up between Black and white patients, the team was asked to identify why. At one site, they discovered a transportation problem affecting patients from a specific area, built a transportation system to address it, and that system still exists today.
The third was communication. A nurse navigator maintained contact with each patient at least twice in the first month after diagnosis and at least once monthly after that. When barriers came up, whether money, childcare, food insecurity, or mistrust, the navigator knew the community resources and the health system resources and could address them in real time. Calling a patient noncompliant for missing an appointment is blaming the patient. The navigator’s job was to find out what the actual problem was and fix it.
Why was community partnership non-negotiable from the beginning?
Top-down solutions have limits, even when the people designing them have genuine empathy. Without lived experience, there are barriers that simply would not have come up in the design process. The Greensboro Health Disparities Collaborative reviewed every element of the intervention, approved each step, and validated whether the solutions being built actually addressed the barriers community members identified. That partnership gave the work both richness and credibility that it could not have had otherwise.
Showing clinical teams their own racial data sounds like it could create defensiveness. How did you navigate that?
At the beginning there was real anger. Clinicians pushed back and said their patients were sicker, that the data was wrong. The research team controlled for severity of illness in the analysis so that argument could be addressed directly. But beyond the data, the framing mattered enormously. The message to clinicians was that they were idealistic, that the disparities were not happening on purpose, and that the system, not the individual physician, was what needed to change. By removing blame and focusing on building better systems, the team earned enough trust to get clinicians to work with them.
How significant was the navigator role in the final results?
Extremely significant. The navigator was not just a scheduling coordinator. The relationship built through regular contact meant that when something went wrong, the navigator already had a connection with the patient. That made it possible to have honest conversations about what was actually getting in the way, and to bring in real solutions rather than simply rescheduling an appointment. The navigator also worked alongside a physician champion to address clinical inertia when the milestone warnings triggered, engaging the clinical team to move faster when things were going slowly on the system side.
What did it feel like to see the data come in?
In the lung cancer work across five centers with 360 patients, the initial baseline showed 80% of white patients completing care for curable lung cancer and 70% of Black patients completing care. A 10% gap. With the intervention in place, completion rates reached 96% and 95% respectively. People argue that improving outcomes for one group means making things worse for another. The data proved that is not true. When you build a system that works, it works for everyone.
What is the first step for health systems and policymakers who want to build toward this?
Start with a registry and a navigator. Even without fully automated warning systems, a registry that tracks every cancer patient and a trained navigator who understands milestones and maintains regular contact with patients can produce meaningful results. The programming for one cancer type can be done for less than $100,000 and maintained for around $10,000 a year. The navigator cost is a staffing question based on patient volume. Those two investments, a registry and a human being with a relationship, are the foundation of the whole system.
What do you want people to understand about where this work is headed next?
The ACCURE intervention was built for early-stage breast and lung cancer, which are curable. But new biological treatments are now extending survival significantly for cancers like pancreatic cancer and advanced lung cancer. To access those treatments, patients need biomarker testing at the time of biopsy. Early data suggests people of color are already being shortchanged in getting that testing done. The same system of transparency, accountability, and communication that worked for treatment completion would work just as powerfully for biomarker testing and access to biologics. The implications for the long term are significant.
Dr. Samuel Cykert is a Professor Emeritus of Medicine at the University of North Carolina Chapel Hill and a founding member of the Greensboro Health Disparities Collaborative. To learn more about the ACCURE intervention and the collaborative’s ongoing work to eliminate racial disparities in cancer care, visit greensborohealth.org