Characteristics of patients with lung cancer at a large safety net health system: Implications for health equity.
Authors: Madeleine Hopson, Navid Sadeghi
Journal: Journal of Clinical Oncology (2025)

e13840 Background: Lung cancer remains the leading cause of cancer deaths in both men and women in the United States. Lack of access to health care and screening is associated with late-stage diagnosis and is common in racial and ethnic minorities. Safety net systems are designed to mitigate health inequities and reduce disparities. Understanding the patient population treated within these systems, which are often resource-limited, can help develop strategies to improve care delivery and outcomes. Here, we describe characteristics of lung cancer patients treated at a large safety net system. Methods: Parkland Health (PH) is the safety net system for Dallas County and is affiliated with the University of Texas Southwestern Simmons Comprehensive Cancer Center (NCI-CC). We reviewed the electronic medical records of all patients with a biopsy-proven diagnosis of lung cancer who presented to PH between 2017 to 2023. We collected information on patient demographics and clinical presentation. Statistical comparisons used Chi-square test for categorical data and Student’s t-test for continuous data with a significance level of 0.05. Comparisons were made to SEER and the National Cancer Database (NCDB). Results: A total of 1,071 patients were included in the analysis; 49% uninsured, 44% Medicare/Medicaid. The majority of patients belonged to racial/ethnic minorities (46% Black, 24% Hispanic). The median age at diagnosis was 62 +/- 10.6 years old. Most patients (56%) had stage 4 lung cancer at diagnosis. Patients &lt; 50 (10%) were more likely to have stage 4 lung cancer compared to those &gt; 50 (70% vs. 55%; p &lt; 0.01). Hispanics were more likely to present with stage 3 or 4 lung cancer compared to other race/ethnicities (78% vs 72%; p&lt;0.05). Only 18% of patients had stage 1 lung cancer. NSCLC constituted 89% of patients. Blacks and Hispanics were more likely than Whites to have adenocarcinoma (56% and 63% vs 44%, respectively; p &lt; 0.01) and less likely to have squamous cell (21% and 15% vs 24%, respectively; p &lt; 0.01) or small cell lung cancer (10% and 7% vs 18%, respectively; p &lt; 0.01). Compared to national data, our safety net patients were younger (median age 62 vs. 71), more likely to be &lt; 50 years old (10% vs. 3%), primarily Black or Hispanic (74% vs. 20%), more likely to have stage 4 lung cancer (56% vs 43%), less likely to have stage 1 lung cancer (18% vs. 30%), and more likely to be uninsured (49% vs. 2%); p &lt; 0.05 for all comparisons. Conclusions: The lung cancer patient population at our safety net system is significantly different from the national average. Notably, 10% of our patients were below the recommended USPSTF lung cancer screening age. Expansion of outreach lung cancer screening programs and simplifying access to indigent care programs are among strategies to promote health equity. Considering the high disease burden among safety net patients, a systematic effort to increase resources at safety net health systems is warranted.