Trends in initial primary treatment approach and biomarker testing across social determinants of health in early-stage non-small cell lung cancer

Abstract

Aim: To evaluate the impact of a comprehensive set of social determinants of health (SDOH) on treatments, timing, and key biomarker testing for early-stage non-small cell lung cancer (NSCLC). Methods: Patients with the first diagnosis of stage I–III NSCLC from 1 January 2015 to 15 October 2023 and treated at community health systems in the United States were eligible for this retrospective database study. We summarized initial primary treatment and time-to-treatment initiation (TTI) by Social Vulnerability Index (SVI), primary care provider (PCP) shortage areas, household income, and insurance type. Data cutoff was 15 October 2024. Results: Of 8501 patients with stage I–III NSCLC, 32% underwent surgery-only and 14% also received neoadjuvant and/or adjuvant therapy. Greater percentages underwent surgery (with/without neoadjuvant/adjuvant therapy) in counties with lowest SVI/vulnerability, highest median income, and no PCP shortage, and among those with private healthcare insurance (vs. Medicare/Medicaid). Median (range) TTI for any NSCLC-related treatment after diagnosis was 41 days (0–1846); TTI increased across treatment strategies by increasing SVI/vulnerability and decreasing household income. Annual rates of programmed death-ligand 1/EGFR mutation testing rose from 60%/51% in 2020 to 84%/82% in 2023, with greatest rates in counties with no PCP shortage. Conclusions: Disparities in early-stage NSCLC treatment by SDOH factors call for efforts to improve access to timely care for NSCLC.