Racial and geographic disparities in the use of molecular testing among older Medicare beneficiaries with lung cancer.

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125 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend comprehensive molecular testing for newly diagnosed patients with metastatic non-small cell lung cancer (mNSCLC). However, the uptake of the next-generation sequencing (NGS) tests for NSCLC was low due to lack of insurance coverage. In 2018, the Centers for Medicare & Medicaid Services issued a national coverage determination to cover diagnostic laboratory tests using NGS for Medicare beneficiaries with advanced cancer. It is important to understand the current uptake of the NGS tests among older Medicare beneficiaries with lung cancer and examine the potential racial and geographic disparities in the use of NGS tests. Methods: From the random 20% sample of all Medicare beneficiaries, we selected Medicare beneficiaries who were 66 years and older and newly diagnosed with lung cancer in 2020. We excluded beneficiaries who were ever diagnosed with breast, colorectal, endometrial, lung, or prostate cancer before 2020 and beneficiaries who died in 2020. We further restricted our sample to those with a full year of Medicare Part A and B coverage and no month of Medicare Advantage coverage. We identified molecular testing for our lung cancer cohort using Medicare carrier and outpatient claims. We used two linear probability models to examine the relationship between race and the receipt of any molecular tests among all lung cancer patients (N=9,229), and the relationship between race and the receipt of panel tests among those received any molecular tests (N=1,842). We adjusted for age at the beginning of 2020, sex, Medicaid enrollment (low-income), geographic region, and common pre-existing chronic conditions (Alzheimer’s and related dementia, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, depression, ischemic heart disease, and arthritis). Results: Among 9,229 older lung cancer patients newly diagnosed in 2020, 1,842 (19.96%) of them received molecular tests. Among those 1,842 who received molecular tests, 709 (38.49%) of them received NGS tests, and the rest received single-gene tests only. In our regression analyses, we found Asian patients were 12.5-percentage point more likely to receive any molecular tests compared to White patients. Among those received any tests, Hispanic patients were 16.0-percentage point less likely to receive NGS tests over single-gene tests compared to White patients. We also found those residing in the South and the West were less likely to receive NGS tests over single-gene tests than those residing in the Northeast. Conclusions: Given the guideline recommendation and proportion of new mNSCLC cases among all new lung cancers, there was likely underuse of NGS tests. There were also racial and geographic disparities in the use of NGS tests.