RACED: The Impact of Navigators and Racial Literacy Training - European Medical Journal

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RACED: The Impact of Navigators and Racial Literacy Training

1 Mins
Oncology
Authors:
* Abna Faustina Sousa Vieira , 1,2 Janaína Santos Paulista , 2 Mateus Fonseca de Gouvêa Franco , 2 Camila Motta Venchiarutti Moniz , 1,2 Maria del Pilar Esteves-Diz , 1,2 Júlio César de Oliveira , 1,2 Ana Claudia Camargo Gonçalves Germani 2
  • 1. Instituto do Câncer do Estado de São Paulo, Brazil
  • 2. Faculdade de Medicina da Universidade de São Paulo, Brazil
*Correspondence to [email protected]
Disclosure:

Vieira has received funding from Bristol Myers Squibb Foundation, through the Cancer Care for Black and Indigenous Brazilians research grant; received consulting fees from Novartis, with payments made to Vieira; received payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Daiichi Sankyo/Lilly, MSD Oncology, and BMS; received support for attending meetings and/or travel from Daiichi Sankyo/Lilly; received participation on a data safety monitoring board or advisory board from Novartis; and received unpaid participation as a member of the Women’s Leadership Committee and the Diversity Committee of the Brazilian Society of Oncology, and as a member of WEEM, UMMAS, and advocacy group for research Projeto Cura. Paulista received payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Becton Dickinson Indústrias Cirúrgicas Ltda, and II Preceptoria para Navegação de Pacientes-IPSEN. Moniz has received grants or contracts from Instituto do Câncer do Estado de São Paulo, and Instituto D’Or de Ensino e Pesquisa, with payments were made to Moniz; received payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from AstraZeneca 2024 – GIRA Project, and Workshop Clinical research Libbs 2024 e 2023; and received participation on a data safety monitoring board or advisory board from AstraZeneca 2025. Medical writing e-review was performed for all authors.

Acknowledgements:

The authors would like to thank many essential contributors to the RACED study: mainly colleagues from the Race.ID research group, the Black nurses hired to navigate all patients, the entire Instituto do Câncer do Estado de São Paulo research team, and everyone who believes in diversity and equity initiatives.

Citation:
Oncol AMJ. ;2[1]:84-86. https://doi.org/10.33590/oncolamj/NNNH9579.
Keywords:
Cancer disparities, institutional racism, intervention, patient navigation, pragmatic clinical trial, racial literacy, systems change, uterine cervical cancer.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

Cervical cancer is the third most prevalent cancer in Brazilian women. Around 17,000 new cases are expected for Brazil’s 2023–2025 triennium.1 The complex multimodal treatment of locally advanced cervical cancer (LACC), which relies on platinum-based chemoradiotherapy (CRT) and brachytherapy (BT), along with the significant healthcare demands of patients with cervical cancer, creates challenges for a universal health system. The Black population experiences the highest cancer mortality rates compared to the general population, partly due to inequalities in social, economic, political, and health areas contexts. Data show that, compared to White women, the mean age-adjusted mortality rates according to race/skin color were 27% higher in Black women. Around 60% of Black patients receive a cervical cancer diagnosis at a locally advanced or advanced stage. The incidence rate among Black women was found to be significantly higher than that of their White counterparts, with a relative risk of incidence nearly 50% higher.2 This disparity cannot be ignored. However, addressing racial and ethnic disparities in oncology care and health outcomes is complex and scarce,3 mainly in low- and middle-income countries. Research into the implementation of complex interventions in care is urgently needed.

METHODS

The authors’ study is based on Public Health Critical Race Praxis.4,5 It is inspired by the Accountability for Cancer through Undoing Racism and Equity (ACCURE) initiative pragmatic trial, composed of three anti-racist actions: (1) oncology navigation with racial literacy, (2) real-time medical record alert system, and (3) race-specific feedback.6,7 The authors’ intervention, in turn, consists of oncology navigation with racial inequities training, and improving interprofessional team knowledge about race and diversity through race-specific feedback. This prospective, single-center, non-randomized clinical trial of anti-racist actions and treatment support will compare prospective patients with a historical control group from the same hospital (Figure 1). The primary endpoint is to increase the completion rate of definitive treatment with CRT+BT for 100 patients with Stage IB2–IVA cervical cancer (convenience sample). The secondary endpoints are to analyze the implementation policy of this strategy and to make an economic assessment of the use of this implementation (the authors hypothesize that such measures reduce both visits to the emergency room due to toxicity, and admissions to wards and ICU). This study has ethics committee approval from the Faculdade de Medicina de São Paulo, Brazil, with the number 85819325.0.0000.0068. Patient inclusion is expected to begin in August 2025. Nurses are receiving training in oncology navigation.8 Racial literacy in healthcare was offered to the entire hospital workforce,9 and this training started on May 14, 2025. As this is a race-conscious trial, the researchers plan to prospectively compare outcomes between the Black/Brown and non-Black/Brown patients in the intervention group. In addition, given Critical Race Praxis, the research team comprises Black women in the creation, design, and throughout the entire study continuum, and the results will support the implementation of racial equity policies,5 in a country where 56% of the population is Black.10

Figure 1: Study design of RACED.
FIGO: International Federation of Gynecology and Obstetrics.

References
Santos MO et al. Estimativa de Incidência de Câncer no Brasil, 2023-2025. Revista Brasileira de Cancerologia 2023;69(1):e-213700. Luiz ODC et al. Racial iniquity in mortality from cervical cancer in Brazil: a time trend study from 2002 to 2021. Cien Saude Colet. 2024;29(3):e05202023. Grant SJ et al. Systematic review of interventions addressing racial and ethnic disparities in cancer care and health outcomes. J Clin Oncol. 2024;42(13):1563-74. Vieira AFS et al. RACED - Reduction of Cervical Cancer Disparities: the impact of navigators and racial literacy training. J Clin Oncol. 2025;43:S16. Ford CL, Airhihenbuwa CO. The public health critical race methodology: praxis for antiracism research. Soc Sci Med. 2010;71(8):1390-8. Cykert S et al. A multi-faceted intervention aimed at Black-white disparities in the treatment of early stage cancers: the ACCURE pragmatic quality improvement trial. J Natl Med Assoc. 2020;112(5):468-77. Cykert S et al. A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: a pragmatic trial at five cancer centers. Cancer Med. 2019;8(3):1095-102. Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(15 Suppl):3539-42. Coleman C et al. Health literacy and systemic racism-using clear communication to reduce health care inequities. JAMA Intern Med. 2023;183(8):753-4. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo 2022: pela primeira vez desde 1991, a maior parte da população do Brasil se declara parda. 2023. Available at: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/38719-censo-2022-pela-primeira-vez-desde-1991-a-maior-parte-da-populacao-do-brasil-se-declara-parda. Last accessed: 18 June 2025.

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