Racial and socioeconomic disparities in molecular testing and targeted therapy utilization among patients with advanced non-small cell lung cancer: A National Cancer Database analysis.

Abstract

e13733 Background: Despite advances in precision medicine for non-small cell lung cancer (NSCLC), disparities in access to molecular testing and targeted therapies persist. This study evaluates the association between sociodemographic factors and molecular testing rates, as well as subsequent targeted therapy utilization in advanced NSCLC. Methods: We conducted a retrospective observational cohort study using the National Cancer Database (2014-2022). Patients with stage IIIB-IV NSCLC were included. Multivariable logistic regression assessed the relationship between patient characteristics and likelihood of receiving molecular testing and targeted therapy. Results: Among 124,865 eligible patients, molecular testing rates varied significantly by race (White: 72.3%, Black: 65.8%, Asian: 78.4%, p < 0.001) and insurance status (Private: 75.6%, Medicare: 68.9%, Medicaid: 63.2%, Uninsured: 52.1%, p < 0.001). Academic centers had higher testing rates compared to community centers (76.5% vs 61.2%, p < 0.001). After adjusting for clinical factors, Black race (aOR 0.78, 95% CI 0.72-0.85), Medicaid insurance (aOR 0.65, 95% CI 0.59-0.72), and treatment at community centers (aOR 0.71, 95% CI 0.66-0.77) were independently associated with lower odds of molecular testing. Among patients with actionable mutations, similar disparities were observed in targeted therapy utilization. Rural patients had significantly longer time from diagnosis to molecular testing results (median 28 vs 21 days, p < 0.001). Conclusions: Significant disparities exist in access to precision medicine for advanced NSCLC, with race, insurance status, and treatment facility type being key determinants. Implementation of universal testing protocols and expansion of precision medicine access in community settings may help address these disparities. Multivariable analysis of factors associated with molecular testing in advanced NSCLC. Factor Adjusted OR (95% CI) P-Value Race/Ethnicity  White Reference  Black 0.78 (0.72-0.85) <0.001  Asian 1.24 (1.15-1.34) <0.001  Hispanic 0.85 (0.78-0.93) 0.002 Insurance Status  Private Reference  Medicare 0.82 (0.76-0.88) <0.001  Medicaid 0.65 (0.59-0.72) <0.001  Uninsured 0.48 (0.42-0.55) <0.001 Facility Type  Academic Reference  Community 0.71 (0.66-0.77) <0.001 Geographic Location  Urban Reference  Rural 0.84 (0.77-0.91) <0.001 Age  <65 years Reference  ≥65 years 0.89 (0.83-0.95) 0.001 Multivariable logistic regression analysis examining factors associated with receipt of molecular testing among 124,865 patients with stage IIIB-IV NSCLC. OR = Odds Ratio; CI = Confidence Interval.