Disparities in stereotactic radiosurgery receipt in patients with brain metastases from non-small cell lung cancer.

PURPOSE: Stereotactic radiosurgery (SRS) is a commonly used alternative to whole-brain radiotherapy for patients with a limited burden of brain metastases from non-small cell lung cancer (NSCLC), but SRS receipt may be influenced by various sociodemographic factors. We sought to describe disparities in SRS receipt among adult patients with brain metastasis from NSCLC in the US.

METHODS

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to characterize disparities in SRS receipt. Analysis focused on adults diagnosed with brain metastases at the time of NSCLC diagnosis. Our outcome was receipt of SRS versus non-SRS radiotherapy. We developed a hierarchical multivariable logistic regression model to identify predictors of SRS receipt.

RESULTS

Medicare beneficiaries living in rural versus urban locations (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.67-0.96, p = 0.019) and with ≥ 3 versus no comorbidities (OR 0.77, 95% CI 0.66-0.91, p = 0.007) had lower odds of SRS receipt. Patient sociodemographic factors, including race and ethnicity, were not associated with SRS receipt. Before the 2014 "Choosing Wisely" guidelines, dual Medicare/Medicaid eligibility was associated with lower odds of SRS receipt (OR 0.74, 95% CI 0.57-0.96, p = 0.021). In the years after the guidelines, odds of SRS receipt was lower among rural patients (OR 0.79, 95% CI 0.62-1.00, p = 0.045) and those with ≥ 3 comorbidities (OR 0.76, 95% CI 0.61-0.94, p = 0.036).

CONCLUSIONS

Nationally, we observed differences in SRS receipt in Medicare beneficiaries with a greater number of comorbidities and those living in rural areas. This data suggests that there may be subpopulations in need of targeted interventions to improve equitable SRS receipt.