Federal housing assistance and treatment receipt for non-small cell lung cancer patients in the US.

201 Background: Federal housing assistance (HA)—which limits household spending on rent and utilities—has been linked with earlier stage non-small cell lung cancer (NSCLC) diagnosis. However, prior research has not examined association of HA with the receipt of cancer treatment. Methods: Patients aged 66-95 years who were newly diagnosed with NSCLC between 2007 and 2019 and survived at least 3 months after diagnosis were selected from the linked SEER-Medicare Housing and Urban Development data. HA was defined as continuous enrollment in any housing program from 6 months before, to 3 months after diagnosis. Patients with NSCLC without HA were identified as controls using 3:1 propensity score matching on demographic and clinical characteristics. Medicare claims data were used to identify receipt of surgery, radiation, and chemotherapy within 3 months of diagnosis. Predicted probabilities of treatment receipt were estimated using multivariable logistic regression models, stratified by stage and adjusted for all matching variables. Median time to first treatment initiation (TTI) was also estimated by stage. Results: The sample included 3,836 patients with HA at diagnosis and 11,508 matched controls. Small variations in treatment patterns between patients with and without HA were observed across treatment types and stage, although differences were not statistically significant (Table). Among patients with stage I disease, approximately one-third received surgery (39.1% with HA vs. 34.8% without), and about 10% received chemotherapy (10.1% vs. 8.9%) within 3 months of diagnosis. For those with stage III/IV, < 10% underwent surgery, about 3%-14% received immunotherapy, while approximately 40% received chemotherapy. Radiation use ranged from approximately 25% in stage I to > 40% in Stage III, with minimal differences by HA status. Median TTI ranged from approximately 48 days for patients with Stage II to 44 days for patients with Stage IV and were similar by HA status. Conclusions: Supporting housing affordability through federal housing assistance may, in itself, not be sufficient to increase rates of NSCLC treatment. Future studies are warranted to examine associations of housing assistance with care coordination and receipt of timely guideline-concordant care. Predicted probabilities of treatment receipt among patients with NSCLC, with vs. without HA. Surgery Radiation Chemotherapy Immunotherapy HA No HA HA No HA HA No HA HA No HA Stage I 39.1 34.8 25.1 27.5 10.1 8.9 1.0 0.0 II 29.7 25.9 31.9 33.0 24.4 24.3 0.7 0.9 III 9.4 9.6 41.8 41.1 40.1 39.7 5.9 3.2 IV 4.4 4.2 34.2 34.5 43.8 43.8 13.8 12.7 Note: The analysis of immunotherapy includes data from 2015 to 2019. Models adjusted for age, sex, race and ethnicity, marital status, SEER registry, year of diagnosis, Yost index, dual Medicaid enrollment, rural/urban residence, Medicare entitlement reason, and Charlson comorbidity index.