Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Shi-Yi Wang

Second Advisor

Szu-Chun Yang

Abstract

Background: With the rapidly evolving treatment options for patients with advance-staged Non-Small Cell Lung Cancer (NSCLC), the National Comprehensive Cancer Network (NCCN) offers systematic guidelines on treatment choices based on biomarker profiles and adjunctive information as the reference. This study aim to understand how patient’s biomarker profiles influence the receipt of Guideline-Concordant Treatments (GCTs) and exploring potential prognostic factors that exert such positive impacts on receiving these guideline-concordant therapies.Methods: This retrospective study focused on using the Flatiron Health NSCLC deidentified database, targeting at advanced NSCLC patients with 5 main confirmed actionable biomarker (ALK+, EGFR+, PD-L1 <1%, PD-L1 1%-49%, PD-L1 ≥50%). Patients with five main biomarkers were further described by whether they have undergone first lines of treatment (LOT) GCTs post-confirmation of biomarker status exclusively. Descriptive analysis was used to examine of the frequency distribution of GCTs across out cohort, while the multi-variate logistic regression model was used to identify potential prognostic factors influencing the receipt of NCCN GCTs. Results: 15,221 individuals were aligned with GCTs, underscoring a substantial compliance within the cohort with pre-treatment confirmed biomarker profiles. Descriptive analyses revealed a statistically significant correlation with receiving GCTs across gender, ECOG status, biomarker profiles, histology and smoking history. Strikingly, patients with PD-L1 expression and ECOG status of 2-4 had the highest rates of GCTs than other ECOG subgroups. By adjusting ORs, Asian and patients with PD-L1 expression were more predisposed to receive GCTs. Conclusion: By confirming the importance of biomarker profiles and ECOG status in the receipt of GCTs, results highlighted the necessity of addressing disparities in healthcare accessibility and treatment equity for patients from varied biological and social backgrounds, ensuring that advancements in precision medicine benefit all individuals equally.

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This is an Open Access Thesis.

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