Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the U.S. In 2013, the U.S. Preventive Services Task Force began recommending lung cancer screening, which has resulted in earlier stage diagnosis for many tobacco users. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. The objective of this study is to describe receipt of timely GCT in California NSCLC patients by sociodemographic characteristics and geography. Methods: We studied 23,080 patients diagnosed with stage I/II NSCLC (2006-2015) in the California Cancer Registry. We classified treatment received as: undertreated, GCT, or over-treated according to NCCN guidelines, and timeliness (treatment began ≤ 45 days after diagnosis) among patients who received GCT. We describe the population according to treatment received, and timeliness by detailed race/ethnicity, stage of diagnosis, sex, age, insurance type, marital status, cancer approved program, and neighborhood socioeconomic status. We calculated absolute and relative inequalities in GCT and timeliness between race/ethnic groups. Hotspot analyses were conducted to identify regions at increased risk for under-treatment/overtreatment, and treatment delay by patient residential census tract. Results: Overall, 69.95% of patients received GCT, 14.53% were undertreated and 15.55% over-treated. Among patients who received GCT, 56.78% began treatment within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We detected moderate absolute inequalities in receipt of GCT and timely care; no relative inequalities were observed. Cold and hot spots for under- and over-treatment and timeliness were identified within Metropolitan areas across California. Conclusion: Under-treatment and delayed treatment for early stage lung cancer disproportionately affect priority populations. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment of lung cancer is critical.
Citation Format: Chelsea A Obrochta, Atsushi Nara, James Murphy, Caroline A Thompson. Sociodemographic and geographic disparities in treatment for early-stage non-small cell lung cancer (NSCLC) patients in California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D077.