Racial Disparities Persist in Curative Treatment for Early-Stage NSCLC Among Medicare Beneficiaries

Despite many initiatives, racial disparities in curative treatment persist among Medicare beneficiaries diagnosed with early-stage non–small cell lung cancer (NSCLC) from 2005 to 2019, with little improvement over the past 30 years, according to a recent study published in JAMA Network Open.¹

Early-Stage NSCLC Curative Treatment Trends

Lower rates of lung cancer surgery among Black vs White Medicare beneficiaries were first identified in the early 1990s. Despite public attention and interventions, these disparities persisted through the early 2000s.²

Over the past 2 decades, treatment options for early-stage NSCLC have expanded to include both surgery and radiotherapy, with stereotactic body radiotherapy (SBRT) emerging as a standard of care.¹ Whether racial disparities persisted in this evolving treatment landscape, however, remained unclear. To address this, researchers assessed trends in racial disparities in the receipt of curative treatment for early-stage NSCLC, including both surgery and radiotherapy, and evaluated whether adoption of newer therapies occurred equally across racial groups.

Using Surveillance, Epidemiology, and End Results-Medicare-linked data, they analyzed these outcomes among Medicare fee-for-service beneficiaries who received a diagnosis of early-stage NSCLC during 3 time periods: 2005-2007, 2010-2012, and 2017-2019. The analysis was restricted to non-Hispanic Black and non-Hispanic White patients aged between 66 to 85 years at diagnosis. They also compared findings with prior work on patients diagnosed between 1992 and 2002.

Racial Gaps Persist in NSCLC Surgery Despite Gains in Radiotherapy

The study included 28,287 patients, with a mean (SD) age of 75.1 (5.3) years. Regarding race, 92.5% of patients were White and 7.5% were Black. The researchers found that Black patients were more likely to have 3 or more comorbidities (37.7% vs 28.6%; standardized mean difference [SMD], 0.20), meet frailty criteria (12.3% vs 7.2%; SMD, 0.23), and have been hospitalized in the year before diagnosis (33.3% vs 28.0%; SMD, 0.11).

Overall, 82.3% of patients received curative therapy. Across time intervals, 68.2% to 72.2% of Black patients received curative therapy vs 82.0% to 84.9% of White patients. These differences persisted after adjusting for demographic and clinical characteristics, with 73.9% for Black patients and 83.3% for White patients in 2005-2007, followed by 76.3% and 85.2%, respectively, in 2011-2013 and 78.4% and 86.8% in 2017-2019 (all P < .001).

Disparities were most pronounced for surgical treatment, as Black patients consistently had lower surgical resection rates. The rates were 52.3% for Black patients and 65.9% for White patients in 2005-2007, followed by 48.3% and 61.0% in 2011-2013 and 43.7% and 53.1% in 2017-2019 (all P < .001).

In contrast, radiotherapy use increased for all patients over time, with minimal racial disparities. Specifically, radiotherapy use rose from 17.0% among Black patients and 20.7% among White patients in 2005-2007 to 32.6% for both groups in 2017-2019.

Regarding SBRT, disparities were present but smaller. SBRT adoption initially revealed racial gaps, with 39.6% of Black patients receiving SBRT vs 51.6% of White patients in 2011-2013, but these differences narrowed by 2017-2019, increasing to 65.6% and 71.7%, respectively (P = .11). However, the receipt of preferred surgery was similar between Black and White patients, with no significant differences in any of the 3 time frames.

Limitations and Future Directions

The researchers acknowledged several of the study’s limitations, one being that it was limited to insured patients, potentially underestimating disparities in the broader population. They also described treatment decisions as “highly nuanced and personalized” and said they may involve factors not captured in the data, including a patient’s financial situation, level of social support, and cultural beliefs.

However, the researchers expressed confidence in their findings and used them to suggest areas for further research.

“This study suggests that racial disparities in the receipt of curative treatment for early-stage NSCLC among Medicare beneficiaries have persisted since the 1990s…” they concluded. “Further work must explore factors that can address and mitigate these disparities.”

References

1. Lynch OF, Lee DH, Soulos PR, Yu JB, Herrin J, Gross CP. Early-stage lung cancer treatment disparities by race among Medicare beneficiaries. JAMA Netw Open. 2026;9(3):e2559845. doi:10.1001/jamanetworkopen.2025.59845
2. Gross CP, Smith BD, Wolf E, Andersen M. Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer. 2008;112(4):900-908. doi:10.1002/cncr.23228