Disparities in adherence to guideline-concordant care and receipt of immunotherapy for Non-Small cell lung cancer in the United States

Background

Significant progress has been made in reducing lung cancer mortality in the United States, largely due to decreased smoking rates and advancements in treatment, particularly for non-small cell lung cancer (NSCLC). However, lung cancer remains the leading cause of cancer-related deaths, with an estimated 127,010 deaths in 2023. Disparities persist in lung cancer incidence, screening, and treatment, influenced by factors such as race, ethnicity, socioeconomic status, and geography.

Methods

This study analyzed NSCLC treatment patterns in 302,744 patients from the National Cancer Database (NCDB) diagnosed between 2015–2018, focusing on adherence to National Comprehensive Cancer Network (NCCN) guidelines and disparities in immunotherapy receipt.

Results

Overall, 62% of patients received guideline-concordant treatment, though this varied significantly by stage, with only 54% of stage IV patients receiving appropriate care. Disparities in guideline adherence were observed, particularly among non-Hispanic Black patients, elderly individuals, and uninsured or Medicaid-covered patients. Additionally, patients at academic institutions and high-volume facilities were more likely to receive concordant treatment, whereas those at community cancer programs and minority-serving hospitals (MSH) had lower adherence rates. Immunotherapy, increasingly recommended since 2017, was also less accessible to non-Hispanic Black, Hispanic, and Asian patients, those without private insurance, elderly individuals, and patients receiving treatment at MSH institutions.

Conclusions

These findings highlight the need for targeted interventions to address persistent disparities in lung cancer treatment, present from individual to institutional levels, in order to ensure equitable access to recommended treatments and advanced therapies like immunotherapy.