Inequalities in access to immunotherapy in lung cancer: the influence of socioeconomic position and travel distance

A recent study published in Journal of Clinical Epidemiology shows that socioeconomic position (SEP) or status (SES) and distance from the hospital play a significant role in use of durvalumab, an immunotherapy for patients with stage III non-small cell lung cancer (NSCLC) who have completed chemoradiation and are still in relatively good health. Despite the fact that durvalumab is included in basic health insurance, patients with higher SEP are more likely to receive this treatment than those with lower SEP. In addition, it appears that the farther a patient lives from the hospital, the less likely he or she is to receive this therapy.

Key findings of the study

The researchers analyzed data from lung cancer patients in the Netherlands using IKNL's Netherlands Cancer Registry (NCR) and found the following trends:

• SEP influences durvalumab use: among patients who were eligible, patients with higher. SEP were 26% more likely to receive durvalumab than patients with lower SEP.
• These differences between SEP groups have been observed since 2017, when the medication became available in the Netherlands, and did not change over time.
• Distance to the hospital plays a role: for every additional 4 kilometers of travel distance to a treatment center, the likelihood of receiving treatment decreased by 7%.

These inequalities show that socioeconomic position and place of residence influence the use of advanced oncology treatments, even in a country with mandatory basic health insurance like the Netherlands.

Why does this matter for cancer care?

The findings of this study have important implications for physicians, policy makers, patient organizations and health care facilities. They underscore the need to ensure equal access to expensive cancer treatments, regardless of SEP or place of residence. They also emphasize the importance of person-centered care and collaborative decision-making. Afterall, differences in treatment are not necessarily undesirable and may indicate person-centered care. But then there must have been proper consideration of the patient's health status and personal factors, in shared decision-making. Unfortunately, the reasons for not starting durvalumab are not known and were therefore not included in this study.

“Being able to receive innovative treatments should not depend on income or travel distance,” said Dimitris Katsimpokis, sr. clinical data scientist at IKNL and lead author of the study. “These results call for actions to understand and then eliminate the systemic causes of health care inequities so that all patients receive the care they need.”

Next steps

• Healthcare professionals: focus even more on person-centered care.
• Patients: know that there is a choice in your treatment and discuss this with your healthcare provider.
• Policy changes: pay attention to accessibility for all patients when introducing new drugs and afterwards.
• Improved care logistics: hospitals and health insurers should work together to reduce travel barriers, for example by offering treatment closer to home or discussing travel reimbursement.
• Follow-up research: more data is needed to better understand how care use and referral patterns contribute to these disparities.
• The study highlights the urgency of addressing these disparities and ensuring fairer use of oncology care in the Netherlands.

More information

Read the the full study published in Journal of Clinical Epidemiology  
For any questions, please contact Dimitris Katsimpokis, sr. clinical data scientist at IKNL