Gaps in Lung Cancer Treatment Persist, Yale Study Finds

In recent decades, lung cancer treatment has been transformed—new surgeries, new radiation techniques, and dramatically improved outcomes. But according to new research from Yale, published in JAMA Network Open, one thing has barely changed: who receives curative care.

“The past 30 years have seen tremendous progress in our fundamental understanding of lung cancer and the development of new treatment strategies,” says Cary Gross, MD, professor of medicine (general medicine) at Yale School of Medicine (YSM) and senior author of the study. “As treatment options have expanded, understanding how these advances are implemented across patient populations has become increasingly important.”

For the study, the researchers examined treatment patterns for more than 28,000 Medicare beneficiaries diagnosed with early-stage non-small cell lung cancer between 2005 and 2019. They found that Black patients were consistently less likely than white patients to receive curative treatment—a gap that has persisted with minimal improvement since the early 1990s.

“There’s been a lot of increased attention to disparities in cancer care over the past 20 or 30 years,” says Olivia Lynch, MD, MPH, a postdoctoral research fellow in YSM’s National Clinician Scholars Program and first author of the study. “Given that, we wanted to ask: Have there been improvements in which patient populations receive treatment?”

While overall use of curative treatments increased over time, Black patients remained significantly less likely to receive them, especially surgery, according to Lynch. Importantly, the study focused on Medicare beneficiaries: patients who all had insurance coverage. That design allowed the researchers to rule out lack of insurance as the primary explanation for the gap.

“The findings point to deeper access issues, especially access to surgeons and surgical services,” Lynch says.

The findings also shed light on how new medical technologies can unintentionally widen inequities. The study examined the adoption of stereotactic body radiation therapy (SBRT), a highly targeted and less invasive radiation treatment that became widely available in the early 2010s. During its initial rollout, Black patients were significantly less likely than white patients to receive SBRT—a gap that narrowed only years later.

For Lynch, this pattern raises urgent questions about how medical innovation is implemented.

“If you’re developing cures for cancer, but it’s not getting into the hands of everybody who needs it, then you haven’t succeeded,” she says.

In addition to highlighting gaps in care, the study also helps pinpoint where these differences arise. Black patients who did undergo surgery were equally as likely as white patients to receive the guideline-recommended operation. This suggests that these discrepancies emerge earlier in the care process, before patients ever reach the operating room, according to the researchers.

Ultimately, Lynch hopes the findings push the conversation beyond documenting disparities and toward fixing them at their roots.

“Despite all the effort and attention, we haven’t improved as much as we should have,” she says. "The next step has to ask why—and what we’re going to do differently.”

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