Early-Stage Lung Cancer Treatment Disparities by Race Among Medicare Beneficiaries

Prior work demonstrated racial disparities in lung cancer care for Medicare beneficiaries in the 1990s and early 2000s, with a 13% to 15% difference in receipt of curative therapy between Black and White patients. With the evolving landscape of treatment modalities and the addition of stereotactic body radiotherapy (SBRT) as the standard of care, it is unknown whether disparities have persisted.

To assess temporal trends in racial disparities in the receipt of curative treatment, as well as specific curative modalities, for early-stage NSCLC among Medicare beneficiaries.

This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linkage to identify 28 287 non-Hispanic Black and non-Hispanic White patients aged 66 to 85 years who received a diagnosis of stage I or II NSCLC in 2005 to 2007, 2011 to 2013, and 2017 to 2019. Statistical analysis was performed from November 2024 to April 2025.

Race (non-Hispanic Black compared with non-Hispanic White), as defined in the SEER-Medicare data.

Outcomes included receipt of any curative treatment (surgery or radiotherapy) for all patients, receipt of surgery or radiotherapy, and receipt of preferred treatment (lobectomy or SBRT) among patients receiving surgery or radiotherapy, respectively. Disparities in the data were compared with findings from the 1990s and early 2000s.

Among 28 287 patients (mean [SD] age, 75.1 [5.3] years; 52.4% men; 7.5% Black and 92.5% White), 82.3% (95% CI, 81.8%-82.7%) received curative treatment. Adjusted probabilities of receiving curative treatment were significantly lower for Black compared with White patients in each period: 73.9% (95% CI, 70.6%-77.1%) of Black patients and 83.3% (95% CI, 82.5%-84.1%) of White patients from 2005 to 2007 (difference, -9.4% [95% CI, -12.8% to -6.1%]; P < .001); 76.3% (95% CI, 73.2%-79.4%) of Black patients and 85.2% (95% CI, 84.4%-86.0%) of White patients from 2011 to 2013 (difference, -8.9% [95% CI, -12.1% to -5.8%]; P < .001); and 78.4% (95% CI, 75.3%-81.4%) of Black patients and 86.8% (95% CI, 86.0%-87.5%) of White patients from 2017 to 2019 (difference, -8.4% [95% CI, -11.6% to -5.3%]; P < .001). Disparities were associated primarily with differences in surgical treatment, with 52.3% of Black patients compared with 65.9% of White patients undergoing surgery from 2005 to 2007, 48.3% of Black patients compared with 61.0% of White patients undergoing surgery from 2011 to 2013, and 43.7% of Black patients compared with 53.1% of White patients undergoing surgery from 2015 to 2017 (P < .001 for all). SBRT use increased sharply, and disparities in its use emerged only during the time interval of its initial implementation, from 2011 to 2013 (Black, 39.6%; White, 51.6%; P = .004).

This study suggests that racial disparities in the receipt of curative treatment for early-stage NSCLC among Medicare beneficiaries have persisted since the 1990s, with the most marked differences in the receipt of surgical treatment and significant racial differences in the receipt of SBRT as the therapy emerged. Further work must explore factors that can address and mitigate these disparities.