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

Abstract

8068 Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality in California. Black patients experience the highest mortality rates (39 per 100,000) compared to Non-Hispanic White (NHW) (34 per 100,000), Asian/Pacific Islanders (A/PI) (23 per 100,000), and Hispanic patients (17 per 100,000). The most modifiable factor contributing to these differences is the receipt of guideline-concordant treatment (GCT), with surgical resection or radiation therapy recommended for all medically operable patients with stage I-II NSCLC. Despite rigorous clinical evidence supporting these guidelines, a higher proportion of Non-Hispanic Black (NHB) and Hispanic patients do not receive GCT compared to NHW patients. This study analyzed differences in receipt of GCT across racial and ethnic groups, leveraging data from a robust, population-based cohort of all early-stage NSCLC cases diagnosed in Los Angeles County. Methods: Patients diagnosed with early-stage NSCLC (tumors <4cm, no lymph node involvement, and no metastases) between 2012-2022 were identified from the Los Angeles County Cancer Surveillance Program. Using a logistic regression model, we evaluated the association between race and ethnicity and receipt of guideline concordant treatment, adjusting for confounders including age, sex, socioeconomic status, insurance type, marital status, and tumor size. Outcomes were defined as receipt of GCT (surgery or radiation only), while non-GCT included no treatment or any combination of multiple treatments. Results: A total of 2,033 patients with early-stage NSCLC were identified of which 57.2% were NHW, 8.9% were NHB, 14.8% were Hispanic, and 18.2% were A/PI. Patients with early-stage NSCLC were on average 70.3 years of age, majority female (63.7%), and had an average tumor size of 1.9 cm. While most patients (85.6%) received GCT, NHB patients had the highest proportion of non-GCT treatment (21.1%) followed by Hispanic patients (16.9%). NHB patients had significantly higher oddsof not receiving GCT compared to NHW patients (OR: 1.62, 95% CI: 1.05-2.46; p<0.05). No statistically significant differences in GCT receipt were observed for A/PI or Hispanic patients compared to NHW patients. Conclusions: 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 decision to receive GCT and a physician’s decision to recommend and adhere to GCT guidelines is needed to understand the complexity of treatment decision-making.