Disparities in next generation sequencing in a population-based community cohort of patients with advanced non-small cell lung cancer.

Abstract

6563 Background: The use of next generation sequencing (NGS) in patients with advanced non-small cell lung cancer (NSCLC) is increasing. This study explored disparities in the use of NGS testing. Methods: This retrospective observational study utilized Flatiron Health’s longitudinal, demographically and geographically diverse database containing electronic health record data from 191 oncology practices across the U.S. We identified patients diagnosed with advanced (stages IIIB/IV or recurrent) non-squamous NSCLC who received first line treatment and either NGS testing or standard biomarker testing (e.g., EGFR, ALK) alone. NGS included any multi-gene panel testing > 30 genes. Logistic regression modeled the association between patient characteristics and receipt of NGS testing, accounting for clustering of patients by oncology practice. Results: Among 5,688 adults with advanced NSCLC, 4,813 (84.6%) patients received standard biomarker testing alone and 875 (15.4%) patients received NGS testing. The median age of the sample was 67y (IQR: 41-85), the majority was white (63.6%) vs. black (7.5%) vs. unknown (13.4%), and had a history of smoking (79.9%). Among the youngest patients ( < 45y), 31.5% received NGS compared to 11.3% among the oldest (76-85y; P < .001). Approximately 16% of white patients received testing, compared to 11.4% of black patients (P < .001). Patients with Medicaid received testing less often than commercially insured patients (11.7% vs 17.0%; P = .10). Patients had significantly lower odds of receiving NGS testing if they were older (≥75 vs. < 45 years of age; adjusted OR: 0.21, 95% CI: 0.13-0.34), black vs. white race (aOR: 0.63, 95% CI: 0.44-0.90) or were Medicaid vs. commercially insured (aOR: 0.54, 95% CI: 0.30-0.97). Conclusions: Significant age, race, and insurance-related disparities exist in the receipt of NGS testing among patients with advanced lung cancer in real world clinical practice.