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September 5, 2025Journal of Clinical Oncology1 citations

Racial and Ethnic Disparities Along the Treatment Cascade Among Medicare Fee-for-Service Beneficiaries With Metastatic Breast, Colorectal, Lung, and Prostate Cancers

JLJohn K. LinThe University of Texas MD Anderson Cancer Center JNJiangong NiuThe University of Texas MD Anderson Cancer Center SGSharon H. GiordanoNorthwestern University

Key Points

Significant disparities exist in treatment receipt among Medicare beneficiaries with metastatic cancers.
Among patients with newly diagnosed breast cancer, only 59% of Black patients received systemic therapy compared to 68% of White patients (P = .021).
Multivariable logistic regression and Cox regressions were utilized to evaluate treatment disparities and survival outcomes.
Policy interventions must address disparities in first-line systemic therapy to improve overall survival in this population.

Abstract

This study evaluated racial and ethnic disparities along the treatment cascade for Medicare fee-for-service patients with metastatic breast, colorectal, lung, and prostate cancers and disparities in overall survival by treatment receipt and quantified factors contributing to these disparities. Medicare fee-for-service beneficiaries with newly diagnosed metastatic hormone receptor-positive/human epidermal growth factor receptor 2-negative breast, colorectal, non-small cell lung, and prostate cancers from the SEER-Medicare-linked database (2016-2020) were studied. We used multivariable logistic regression to evaluate disparities along the treatment cascade, multivariable Cox regressions to evaluate disparities in overall survival by treatment receipt, and Oaxaca-Blinder decomposition to quantify the contribution of factors related to disparities. Of 18,652 White, 1,898 Black, and 1,465 Hispanic beneficiaries, within 2 months of diagnosis, 78% of patients were alive and 87% saw a medical oncologist-without consistent disparities. There were disparities in receiving any systemic therapy: breast (59% of Black patients received systemic therapy, 60% Hispanic, 68% White, P = .021), colorectal (23% Black, 31% Hispanic, 34% White, P < .001), lung (26% Black, 37% Hispanic, 39% White, P < .001), and prostate (56% Black, 76% Hispanic, 77% White, P < .001) cancers. For every cancer, <35% of patients received guideline-directed systemic therapy. After restricting to patients who received any systemic therapy within 2 months of diagnosis, overall survival disparities were no longer significant. Across all malignancies, low-income subsidy status-of which 87.6% was dual-eligible-contributed most to explaining disparities in treatment (20%-45% of the disparity). Care delivery and policy interventions intended to narrow racial and ethnic overall survival disparities in Medicare patients with metastatic cancer should target disparities in not receiving first-line systemic therapy and address the unique needs of beneficiaries with low-income subsidy status or dual eligibility.

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