Disparities in receipt of guideline concordant treatment for early-stage non-small cell lung cancer (NSCLC) patients in California.

Abstract

160 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 nonadherence to GCT and treatment delay in California NSCLC patients by sociodemographic characteristics and geography. Methods: 53,746 patients diagnosed with stage I/II NSCLC (2000-2015) in the California Cancer Registry were included in our study. We classified GCT according to NCCN guidelines and treatment delay as >60 days after diagnosis. We report proportion of nonadherence to GCT and treatment delay overall, in 5-year periods and by patient race/ethnicity, socioeconomic status, payer, and marital status. Hotspot analysis is underway to identify regions at increased risk for nonadherence to GCT and treatment delay by patient residential census tract. Results: Overall, 55.9% of patients received GCT, 14.1% of patients received no treatment, and nonadherence to GCT increased over time. Among those who received treatment, 26.7% experienced a treatment delay. Nonadherence to GCT and delay was more frequent in patients who were black or Hispanic, unmarried, had public insurance, and were of lower socioeconomic status. Based on preliminary analyses, we expect nonadherence to GCT and treatment delay to be non-uniformly distributed across California neighborhoods. Conclusions: Nonadherence to GCT and treatment delay 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.