Impact of social determinants of health on treatment patterns and outcomes in metastatic non-small cell lung cancer

Abstract

Background

This study examined the association between social determinants of health (SDOH) and access to first-line therapy, time to treatment (TTT), and overall survival (OS) among patients with metastatic non–small cell lung cancer (mNSCLC).

Methods

This retrospective study used data from the Generating Evidence Excellence research environment, incorporating de-identified U.S. patient-level claims, electronic medical records, and neighborhood-level SDOH data from the American Community Survey. Adults with newly diagnosed mNSCLC were included. Patient characteristics, treatment patterns, and SDOH were analyzed descriptively. Kaplan–Meier methods estimated OS, and multivariable logistic regression evaluated associations between selected SDOH and receipt of first-line treatment.

Results

Among 869 patients, median follow-up was 11.5 months; median age was 67 years; 53% were female, 83% were White, and 10% were Black. Overall, 77% (n = 665) received systemic first-line treatment. Among treated patients, 44% received immunotherapy (IO) plus chemotherapy, 22% chemotherapy alone, 20% other IO regimens, and 14% other treatments. Black patients were less likely than White patients to receive first-line IO (odds ratio 0.47; P = 0.0346). Median TTT was longer among Black patients (49 days) compared with White patients (40 days). Median OS was numerically shorter among Black patients (11.2 months) than White patients (13.6 months), though differences were not statistically significant.

Conclusions

Race was associated with differences in first-line treatment patterns and TTT among patients with mNSCLC. Black patients were less likely to receive IO and experienced longer TTT compared with White patients, highlighting potential disparities in treatment access and timing and supporting continued evaluation of strategies to promote equitable cancer care delivery.