Cancer
Disparities in Utilization of Immune Checkpoint Inhibitor Therapy among Older Patients with Advanced Non-Small Cell Lung Cancer: A SEER-Medicare Analysis Danting Yang* Danting Yang Shama D. Karanth Hyung-Suk Yoon Jae Jeong Yang Lusine Yaghjyan Dejana Braithwaite
Background and purpose: Socioeconomic and racial/ethnic disparities exist in access to care among patients with non-small cell lung cancer (NSCLC) in the United States. Immune checkpoint inhibitor (ICI) therapy has emerged as a promising treatment option for advanced NSCLC (aNSCLC). In this study, we investigate the associations of race/ethnicity with ICI therapy utilization among older patients with aNSCLC.
Methods: This retrospective study used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. The cohort included patients (aged 66 years or older) diagnosed with aNSCLC (stage III/IV) between March 2015 to December 2017, followed through December 2019. Race/ethnicity was categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, and Other. ICI therapy utilization was determined by identifying any usage of the following ICI agents (Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab, Ipilimumab, and Cemiplimab-rwlc) from the Medicare database. Multivariable logistic regression models assessed the association between race/ethnicity and ICI therapy utilization (yes, no). Effect measure modification analyses were conducted by sex, socioeconomic status, and comorbidity.
Results: The final sample included 26,836 patients, 76.2% were NH-White, 10.1% NH-Black, 5.7% Hispanic, and 8.0% Other. The overall ICI therapy utilization rate was 17.8%, varying across ethnicities: NH-Black 14.1%, Hispanic 16.3%, NH-White 18.4%, and Other 18.5%. In comparison to NH-White patients, NH-Black patients were 15% less likely to receive ICI therapy (adjusted odds Ratio: 0.85, 95% CI: 0.75, 0.96). Furthermore, the association between race/ethnicity and utilization of ICI therapy was modified by comorbidity status, sex, and socio-economic status (SES).
Conclusion: NH-Black patients with aNSCLC were less likely to receive ICI therapy than their NH-White counterparts.
