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Immunotherapy is one of the newer treatment options for improving survivability in patients diagnosed with lung cancer. However, a recent study reports that lower-income and less educated people are less likely to receive these novel drugs, contributing to cancer treatment disparities.

Lung cancer is among the leading causes of death in U.S. men and women. Approximately 85% of all lung cancer cases are non-small cell lung cancer (NSCLC). This type of cancer is often diagnosed at an advanced stage, when treating the condition is quite challenging. 

Traditionally, doctors have treated NSCLC with cytotoxic drugs. However, in 2015, the US FDA approved immunotherapy agents for the management of NSCLC. This therapy has proven to be effective at prolonging life for this group of patients. However, it is quite expensive, thus adding to health disparities. 

This study, published in the journal Scientific Reports, explores how socioeconomic disparities affect immunotherapy utilization and aims to quantify these disparities. 

Socioeconomic Status and Education Level Both Contribute to Lung Cancer Treatment Disparities

This retrospective study used data from the 2016 National Cancer Database (NCDB) Participant Use File (PUF). It is the largest clinical registry in the world, with over 34 million cancer records. The study included adults aged 40–89 years diagnosed with stage III or IV NSCLC in the years 2015 and 2016. These were patients who did not receive surgery. The study included the data of 100,298 individuals. The study then divided the patients into various income and education categories using data related to zip codes. 

The study found that 9% of all the patients received immunotherapy. It also found that about one-fifth of the patients lived in the areas with the highest education status, while only about 7% of Black patients lived in those areas. The study found that those with lower socioeconomic status and education levels were 29% less likely to receive immunotherapy. When stratified by race, the association between lower income and education and lower chances of receiving immunotherapy was observed in White patients, while in Blacks, a statistical association was only seen between lower education and lower immunotherapy receipt.

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The Bottom Line

The study shows disparities in healthcare delivery, with those living in low-income areas and those with less education receiving less care. However, the study has several limitations. It used area-level education and income measures, which may not represent individual patients’ circumstances. It also did not consider the specific kinds of immunotherapy regimens. Additionally, such large-scale data may have some inconsistencies in defining variables like race/ethnicity. Nevertheless, the study highlights the presence of social inequities related to cancer care, something to keep in mind when developing cancer treatment interventions aimed at improving patient survival.


Gupta, A., Omeogu, C., Islam, J. Y., Joshi, A., Zhang, D., Braithwaite, D., Karanth, S. D., Tailor, T. D., Clarke, J. M., & Akinyemiju, T. (2023). Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database. Scientific Reports, 13(1), 8190. https://doi.org/10.1038/s41598-023-35216-2