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

Why It Matters

The enduring treatment gap signals systemic inequities that threaten outcomes for a vulnerable Medicare population and underscores the need for targeted health‑equity interventions.

Key Takeaways

• Black Medicare patients receive fewer curative surgeries than Whites
• Surgical gap widened from 2005 to 2019
• Radiotherapy use equalized across races by 2019
• SBRT adoption gap narrowed but remains
• Black patients show higher comorbidities and frailty

Pulse Analysis

Early‑stage non‑small cell lung cancer (NSCLC) remains one of the few cancers where curative intent—surgery or high‑dose radiotherapy—can dramatically improve survival. Over the past two decades, the therapeutic landscape has expanded with minimally invasive surgery and stereotactic body radiotherapy (SBRT) offering alternatives for older, frail patients. Yet, the promise of these advances is unevenly realized; historically, Black patients have faced barriers to surgical care, a trend that recent Medicare data confirms is persisting.

The JAMA Network Open analysis of SEER‑Medicare claims reveals a stark, widening chasm in surgical treatment: Black beneficiaries’ resection rates dropped from 52.3% to 43.7% while White beneficiaries fell from 65.9% to 53.1% over three time periods. Radiotherapy adoption, by contrast, rose uniformly, reaching parity at 32.6% for both races by 2019. SBRT, a newer curative modality, initially lagged for Black patients but narrowed to a non‑significant difference by the latest cohort. These patterns suggest that diffusion of non‑surgical options may be more equitable than surgical pathways, highlighting the role of technology adoption and provider referral patterns.

Persisting gaps point to deeper structural factors—higher comorbidity burdens, frailty, and limited social support among Black patients—combined with unmeasured socioeconomic and cultural influences. Policymakers and health systems must prioritize culturally competent navigation, bias training, and value‑based reimbursement models that incentivize equitable access. Future research should integrate patient‑reported outcomes and socioeconomic data to untangle the drivers of disparity, ensuring that Medicare’s expanding therapeutic arsenal benefits all beneficiaries regardless of race.