Stereotactic body radiation therapy for early-stage non-small cell lung cancer in the USA: patterns of adoption and potential healthcare disparities

Abstract

Stereotactic body radiation therapy (SBRT) is a definitive treatment option for early-stage non-small cell lung cancer (NSCLC), but access is not universal. This study evaluated trends in SBRT utilization to identify potential disparities. This was a cancer registry study using the National Cancer Database (NCDB). The NCDB was queried for patients diagnosed with early-stage NSCLC from 2004 to 2016. Patients receiving surgery, chemotherapy, radiation not meeting criteria for SBRT, or other ablative procedures were excluded. SBRT use in treatment facilities over time was evaluated, and patients were analyzed by various socioeconomic factors to determine predictors of SBRT vs no-treatment. Multivariate and Cox regression analyses were performed to determine the extent to which decreased treatment with SBRT may be contributing to worse overall survival. A total of 65,376 patients were included. There was a significant increase in SBRT use from 2004 (n = 80) to 2016 (n = 7948). Patients treated in academic centers were more likely to get SBRT than community programs, but the use in the community has increased in recent years. Covariates associated with decreased use of SBRT included lack of insurance (OR 0.45, p < 0.0001), Hispanic (OR 0.79, p < 0.001), black (OR 0.59, p < 0.0001), or ‘other’ race (OR 0.48 p < 0.0001), and living in a less-educated community (OR 0.83, p < 0.001). On multivariate analysis, use of SBRT was associated with decreased risk of death (HR = 0.48, p < 0.001), and patients treated with SBRT had increased median overall survival compared with patients receiving no treatment (39.6 versus 14.9 months, p < 0.001 by log-rank test). SBRT use is increasing across all treatment facilities but there are notable health disparities based on socioeconomic factors including race that may be contributing to worse survival outcomes.