Association of Area-level Broadband Access and Non-Small Cell Lung Cancer Diagnosis and Guideline-Concordant Care in the US

BACKGROUND: Access to broadband is a social driver of health facilitating healthcare access and reducing travel-related burdens. This study examined associations between area-level broadband access and non-small cell lung cancer (NSCLC) stage at diagnosis, receipt of timely treatment, and guideline-concordant treatment (GCT) before and during the COVID-19 pandemic in the US. METHODS: Patients aged ≥18 years with newly diagnosed NSCLC (2018-2022) were identified from the National Cancer Database. Residential ZIP code-level broadband access, collected from the American Community Survey (2018-2022), was categorized into quartiles. Multivariable logistic regression models examined associations between broadband quartiles and stage at diagnosis, time-to-treatment initiation (TTI), and GCT, stratified by metropolitan status and pandemic period, adjusting for sociodemographic and clinical characteristics. RESULTS: Among 525,114 patients, compared with those in the lowest broadband quartile, patients in the highest quartile had higher odds of early-stage diagnosis before and during the pandemic (adjusted odds ratio [AOR]=1.18, 95% confidence interval [CI]=1.13-1.22; AOR=1.21, 95%CI=1.17-1.24), timely treatment (AOR=1.13, 95%CI=1.09-1.17; AOR=1.14, 95%CI=1.11-1.18), and GCT (AOR=1.14, 95%CI=1.10-1.19; AOR=1.11, 95%CI=1.07-1.15), with significant positive trends across broadband quartiles. In non-metropolitan areas, significant associations with timely treatment and GCT emerged only during the pandemic. CONCLUSION: Higher area-level broadband access was associated with better NSCLC outcomes, especially in non-metropolitan areas during the pandemic. Although broadband access may partly reflect socioeconomic conditions, it may also independently support cancer care access. IMPACT: Increased broadband access, combined with telehealth waivers during the pandemic may have supported greater access to and continuity of high-quality cancer care, particularly among patients in non-metropolitan areas.