Educational and Equity Implications of Biomarker Testing and Targeted Therapy Access in NSCLC: Insights from the NIH All of Us Research Program

Precision oncology in non-small cell lung cancer (NSCLC) depends on biomarker testing and access to targeted therapies. However, disparities in testing and treatment highlight critical educational needs for patients, providers, and health systems. Using the NIH All of Us Research Program (2017-2022), we identified 287 patients with advanced NSCLC who received first-line carboplatin-based chemotherapy or targeted therapy. Social determinants of health (SDoH) including education, employment, retirement, and disability were evaluated as predictors of biomarker testing and targeted therapy receipt. Only 18% of patients had documented biomarker testing despite 45% minority representation in the All of Us cohort. Patients with any college education had significantly higher odds of receiving targeted therapy (OR 2.43, 95% CI 1.23-4.97), while retired patients were less likely to receive targeted therapy (OR 0.35, 95% CI 0.18-0.68). Disability was associated with increased biomarker testing (OR 2.82, 95% CI 1.19-6.51). Although TTD was longer for targeted therapies, incomplete biomarker documentation limited interpretation of outcomes. Findings underscore the need for enhanced cancer education strategies to improve biomarker literacy, guideline adherence, and equitable access to targeted therapy. Educational outreach should focus on retirees and patients with lower educational attainment, while provider training and system-level improvements are needed to strengthen precision oncology delivery.