Lung Cancer Care Disparities For Black Patients Persist Despite Medicare Coverage

Dr. Olivia Lynch, a postdoctoral fellow in the National Clinician Scholars Program at Yale University, highlighted findings from a study of more than 28,000 Medicare beneficiaries with early-stage non-small cell lung cancer.

About 82% of patients received curative treatment, defined as surgery or radiation. However, Black patients were consistently 8 to 9 percentage points less likely than White patients to receive these treatments, even after adjusting for clinical factors. These disparities have persisted for decades, pointing to ongoing structural barriers in care.

The gap was largely driven by lower rates of surgery among Black patients. Surgery remains the primary curative option. Differences in access to surgical specialists, referral pathways and health system resources may contribute. Importantly, all patients had Medicare coverage, indicating that insurance alone does not ensure equitable access to treatment.

The study also found that use of stereotactic body radiation therapy (SBRT) increased over time, but disparities appeared early in its adoption before narrowing as it became standard.

Findings suggest the biggest gaps occur before treatment begins, particularly in referrals and access to specialists. Efforts such as improving referral pathways, expanding access to surgical care and addressing barriers like transportation and care coordination may help more patients receive potentially curative treatment.

Your study analyzed treatment patterns for more than 28,000 Medicare beneficiaries with early-stage non-small cell lung cancer. What were the most important findings that patients and caregivers should understand from this research?

The main takeaway is that racial disparities in potentially curative treatment for early-stage lung cancer are still present today, even among patients who all have Medicare coverage. In our study, as you said, we looked at more than 28,000 older adults with early-stage — that’s Stage 1 or 2 — non-small cell lung cancer, and about 82% overall received curative treatment, which in our study meant surgery or radiation. These are the two modalities used for early-stage lung cancer treatment these days. However, Black patients were consistently less likely than White patients to receive these treatments across all three time periods that we studied. Even after adjusting for differences in age, comorbidities and other clinical factors, Black patients were still about 8 to 9 percentage points less likely to receive curative therapy. So this gap has persisted for decades with very little improvement. Our study group, led by Carrie Gross, our senior author, investigated the same question using data from the 1980s and ’90s and found the same thing: these racial disparities in receipt of curative treatment for early-stage lung cancer. So the findings really highlight that these disparities have persisted and that structural barriers in the health care system are still affecting whether patients receive potentially life-saving cancer treatment.

The study found that Black patients were consistently less likely than White patients to receive curative treatment. What factors do you believe are contributing to this persistent gap?

We looked at two different types of treatments, as I mentioned earlier: surgery and radiation therapy, which are the two categories of modalities used in early-stage lung cancer treatment. We looked at them together, but we also looked at them separately. Our study suggested that the disparity we saw overall was largely driven by differences in access to surgery, which remains the primary curative treatment for early-stage lung cancer.

Black patients were consistently much less likely to undergo surgery than White patients across all of the time periods, and that’s where we saw the greatest gap. I think a lot of factors could contribute to this. First of all, access to surgical specialists can be very variable, and prior research has shown that areas with fewer surgeons have lower surgical treatment rates overall — fewer surgeons, less surgery. There could also be system-level barriers. Differences in referral pathways to surgeons, variations in health care resources and structural inequities in the health care system are all likely factoring into this finding. Treatment decisions in lung cancer are also very complex and influenced by factors we’re not able to capture in the data source we used. For example, we controlled for comorbidities and frailty, but those are not perfect measurements. Social support, transportation and patient-clinician communication are also not captured in our data, and those may differ across patient populations and contribute to the disparities.

Because the analysis focused on Medicare beneficiaries, all patients in the study had insurance coverage. What does this tell us about the barriers that may still exist beyond insurance?

You are hitting on one of the most important aspects of the study, which is that everyone in the study had Medicare insurance. Disparities in treatment cannot be explained simply by differences in insurance coverage. Instead, these results suggest that other barriers in the health care system are contributing — access to specialists, referral patterns, availability of surgical services and differences in health care resources in a given area. Insurance coverage is obviously important, but our findings really show that coverage alone is not enough to ensure equitable access to cancer treatment.

The study also looked at the adoption of stereotactic body radiation therapy. What did your team observe about how new technologies like SBRT were implemented across different patient populations?

This is an important finding of our study. SBRT, or stereotactic body radiation therapy, has become an important treatment option for early-stage lung cancer, particularly during the years our study investigated. At the very beginning of our study, nobody was getting SBRT. By the end, many people were receiving it. We were able to capture what it looked like as it was being implemented. As expected, we saw that over time, the use of SBRT increased dramatically across all patient populations, reflecting its growing role as a core treatment for early-stage lung cancer.

However, we did observe that racial disparities emerged as the technology was first being adopted. In the first-time interval, no one was really receiving SBRT, so we didn’t see differences between populations. In the second interval, when SBRT became more widely used, Black patients were significantly less likely than White patients to receive it. By the third time period, as it became more standard, that disparity narrowed. That narrowing is encouraging, but it also shows that new technologies are especially vulnerable to disparities early on and may reach some populations before others.

Your findings suggest that disparities may occur earlier in the care process, before patients even reach surgery. Where in the treatment pathway do you think the biggest gaps are emerging?

Our results suggest that the largest gaps likely occur before patients receive any treatment, particularly in the steps leading up to surgery. For example, disparities may arise in referrals to thoracic surgeons, access to specialized cancer centers or the availability of surgical services in certain communities. Interestingly, when patients did undergo surgery, the type of surgery they received, such as lobectomy — the standard procedure we looked at — was similar across racial groups. That suggests the disparity is less about what treatment patients receive once they reach specialists and more about whether they reach those treatments in the first place.

Based on your research, what steps could health systems, clinicians or policy makers take to help ensure that more patients with early-stage lung cancer receive potentially curative treatment?

I think your question highlights that this inequity operates at multiple levels within the health care system — from policy to health systems to the clinician-patient relationship. As clinicians, we need to examine whether we are offering all treatment options equitably across patient populations. At the health system level, advocacy and policy changes are critical. System-level improvements across the care pathway will be key. One important step is ensuring that patients with early-stage lung cancer are evaluated by multidisciplinary teams, including thoracic surgeons and oncologists, so all treatment options are considered.

Health systems also need to improve referral pathways and expand access to surgical services, especially in areas with fewer specialists. Finally, there are factors not captured in large data sets — such as social support, transportation and care coordination — that influence treatment access. Programs like patient navigation services, transportation support and care coordination may help address these structural barriers. Reducing disparities in cancer care will require coordinated efforts across health systems, policy makers, clinicians and patients.

The transcript has been edited for clarity and conciseness.

References

1. “Racial disparities in the receipt of curative treatment for early-stage non–small cell lung cancer among Medicare beneficiaries” by Dr. J. D. Ramsey, et al., JAMA Network Open
2. Patel A. Gaps in lung cancer treatment persist, Yale study finds. Yale School of Medicine. March 2, 2026. https://medicine.yale.edu/news-article/gaps-in-lung-cancer-treatment-persist-yale-study-finds/

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