Sociodemographic inequalities in non-small cell lung cancer (NSCLC) novel treatments: a national population-based cohort study

BACKGROUND: Sociodemographic inequalities impact patients with non-small cell lung cancer (NSCLC). Advances in novel therapeutics have increased treatment options; however, for advanced disease, prognosis remains poor and inequalities in care are recognised to exist, requiring further characterisation. This population-based study aimed to describe the associations between markers of sociodemographic characteristics and novel anticancer therapy utilisation for a stage IV NSCLC population in a publicly funded healthcare system. METHODS: A retrospective cohort of 73 640 patients with histologically confirmed stage IV NSCLC between 1 January 2017 and 31 December 2021 was identified from the English national cancer registry and linked to the Systemic Anti-Cancer Therapy database. Multivariable logistic regression evaluated likelihood of novel therapy utilisation across sociodemographic characteristics and for pre-COVID-19 and peri-COVID-19 time periods. RESULTS: Patients resident in the most deprived quintile had the lowest likelihood of novel therapy receipt. Patients ≥70 years old had reduced likelihood of receipt (OR: 0.79, CI 0.73 to 0.86), as did patients recorded as ethnicity 'unknown' (OR: 0.85, CI 0.75 to 0.97). Likelihood of utilisation increased from 2017 to 2019 and decreased in 2020 and 2021. Pre-COVID-19 and peri-COVID-19 analysis identified reduced sociodemographic inequalities from 2020, but variation across therapy subgroups. CONCLUSION: Even in the National Health Service (NHS) in England, where cancer medication access is free, inequalities in NSCLC novel therapies utilisation persisted in 2017-2021, despite more treatment options and greater clinician familiarity. There is evidence of decreasing utilisation during this study period. These findings are important to ensure equitable access to novel therapies and require further study of future trends and impact on real-world survival.