Racial and ethnic disparities in receipt of guideline-concordant treatment for early-stage non-small cell lung cancer

PURPOSE: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality in California, with Non-Hispanic Black (NHB) patients experiencing the highest mortality rates. Disparities in receipt of guideline-concordant treatment (GCT) contribute to these outcomes. This population-based study analyzed racial and ethnic differences in GCT receipt among early-stage NSCLC patients. METHODS: Patients diagnosed with early-stage NSCLC (tumors ≤ 4 cm, no lymph node involvement, and no distant metastases) between 2012 and 2022 were identified from the Los Angeles County Cancer Surveillance Program. Logistic regression evaluated associations between race/ethnicity and receipt of GCT (surgery or radiation only vs. no treatment or multiple treatments), adjusting for potential confounders. RESULTS: In our sample (n = 2,857), the average age was 69.6 years, 63.2% were female, mean tumor size was 1.9 cm, and the cohort was 57.3% Non-Hispanic White (NHW), 8.9% NHB, 14.2% Hispanic, and 18.8% Asian/Pacific Islander (API). While most patients (87.4%) received GCT, NHB and Hispanic patients had higher rates of non-GCT treatment (18.0% and 15.8%, respectively; p < 0.001). NHB patients had significantly higher odds of not receiving GCT compared with NHW patients (OR: 1.55, 95% CI: 1.07-2.26; p < 0.05). No significant differences were observed for API or Hispanic patients. CONCLUSION: Addressing disparities in GCT for patients diagnosed with early-stage NSCLC is critical to improving survival outcomes. Future studies identifying factors influencing a patient's and physician's decision to receive, recommend, and adhere to GCT guidelines are needed to understand the complexity of treatment decision-making.