Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based upon patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC.

The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into 3 treatment groups: primary resection (SUR), nonstandard treatments (chemotherapy with or without radiation) (NST), and no therapy (NoT). The SES of patients who made up the treatment groups was assessed and the 5-year survival of all groups was analyzed.

The cohort included 69,168 patients with stage I NSCLC. Each of these patients had between 0 and 5 SES risk factors. The factors associated with no surgery were: low income, nonwhite race, low high school graduation rate, Medicaid or no insurance, rural residence, and distance <12.5 miles from treatment facility. Patients with multiple SES risk factors have a linearly increasing odds of undergoing NST and a quadratically increasing odds of undergoing NoT (up to OR=4.7; 95% CI 3.44-6.30 for those with 5 factors). SUR was associated with significantly longer 5-year survival (71.8%) compared to NST (22.7%) and NoT (21.8%), (p<0.0001).

SES factors increase the risk of undergoing guideline discordant therapy for Stage I NSCLC. As the number of SES factors increases, the odds of NoT rises quadratically while the odds of NST rises constantly. The SUR group had significantly longer survival than NST and NoT groups.