A MAJOR new analysis of more than 18,000 adults with early-onset non-small cell lung cancer (NSCLC) has revealed that survival outcomes vary sharply depending on both clinical and socioeconomic factors. The findings, drawn from a large USA cohort, emphasise how income, treatment delays, and place of residence can significantly influence chances of survival, even among younger patients.
The study, published in 2025, analysed data from the Surveillance, Epidemiology, and End Results (SEER) database, focusing on individuals aged 18 to 50 diagnosed with NSCLC between 2010 and 2021. Researchers identified 18,595 patients, more than half (53.4%) of whom presented with Stage IV disease at diagnosis, signalling that most cancers were detected only after they had spread.
Late Diagnosis and Income Strongly Linked to Survival in NSCLC
Researchers found that stage at diagnosis was the single most powerful determinant of survival. Patients with Stage IV NSCLC had a 17-fold higher risk of death compared to those diagnosed at earlier stages. Liver metastases and squamous cell carcinoma histology were also associated with poorer outcomes.
Socioeconomic factors played a key role. Individuals with low household income faced a 45% higher risk of death, while those living in rural areas saw a 65% increased risk compared with urban counterparts. Among patients diagnosed with stage I disease, lower income nearly doubled the risk of mortality. Delays between diagnosis and treatment further reduced survival odds, highlighting the need for faster clinical intervention.
Advanced modelling techniques, including random survival forest and machine learning models, confirmed that stage, income, residence, and time to treatment were among the strongest predictors of overall survival. The models demonstrated strong performance and reinforced the interplay between modifiable and non-modifiable risk factors.
Targeted Strategies Needed for Early NSCLC Detection and Equity
Researchers concluded that most adults with early-onset NSCLC are diagnosed at advanced stages, but survival can be improved by addressing modifiable determinants such as timely access to treatment and socioeconomic inequities.
The study calls for enhanced early detection, particularly for younger adults who may not meet current screening criteria, and policy measures to reduce disparities in access to high-quality cancer care. Increasing awareness of lung cancer symptoms among under-50s and ensuring equitable healthcare delivery could substantially improve long-term survival outcomes.
Reference
Kar İ et al. Survival Determinants and Sociodemographic Disparities in Early-Onset Non–Small Cell Lung Cancer. JAMA Netw Open. 2025;8(10):e2537307.
