Disparities in Surgical Recommendation for Stage I Non-Small Cell Lung Cancer

Objectives: Sociodemographic disparities in lung cancer prevalence, treatment options offered, and outcomes have been well documented. In stage I non-small cell lung cancer (NSCLC), the standard of care is surgical resection. This study explores disparities in surgical recommendations in stage I NSCLC, when surgery is considered curative. Materials and Methods: Patients diagnosed with primary stage I NSCLC from 2007 to 2016 were identified from the Surveillance, Epidemiology, and End Results database (N=56,534). Associations between sociodemographic variables and surgical recommendation were assessed using multivariable logistic regression models. Survival impact was investigated using Cox-proportional hazards regression and propensity matching techniques. Results: Of the 76.9% patients recommended surgery, 95% underwent surgery. Recommended surgery was inversely associated with increasing age (P<0.01), non-Hispanic Black race (adjusted odds ratio [ORadj] 0.64, 95% confidence interval [CI]: 0.59-0.70), Hispanic ethnicity (OR(adj)0.75, 95% CI: 0.67-0.84), nonprivate/Medicare insurance (Medicaid: OR(adj)0.55, 95% CI: 0.51-0.60; insured with unknown plan: OR(adj)0.74, 95% CI: 0.69-0.79; uninsured: OR(adj)0.45, 95% CI: 0.36-0.55), and single status (OR(adj)0.66, 95% CI: 0.63-0.70). Patients who were not recommended surgery were at increased risk of death compared with those who were recommended. Conclusion: In a cohort of NSCLC patients, nonclinical factors identified a subgroup of patients who were less likely to be recommended surgery.