Presentation (CTI)

OBJECTIVES: Precision oncology has improved survival in non-small cell lung cancer (NSCLC), but its sequential pathway—molecular testing, targeted therapy, immune checkpoint inhibitor (ICI) receipt, and survival—may accumulate socioeconomic inequities at each step. We mapped where socioeconomic status (SES) disparities arise and how they vary by health-system type.
METHODS: Following PRISMA-ScR, we searched PubMed and Web of Science (January 2015-May 2026) reporting an SES indicator and an NSCLC pathway outcome. Of 746 records, 541 remained after deduplication in Rayyan; screening yielded 28 studies. Each was charted by pathway stage, SES dimension (insurance, income, area deprivation, education), health-system type, and direction of effect, with ChatGPT supporting extraction; all extractions were reviewer-verified and synthesised in an evidence gap map.
RESULTS: Twenty-two of 28 studies were in the US multi-payer system, 5 in universal-coverage systems, 1 in China. Because studies often addressed multiple pathway stages or SES dimensions, categories were not mutually exclusive. Molecular testing had the most coded entries (n=29), then targeted therapy and ICI receipt (n=23 each), survival (n=21), and testing timeliness (n=13). Income and insurance were the most frequent SES dimensions, with fewer for area deprivation and education. Disadvantaged groups experienced worse outcomes in 21 of 28 studies, most consistently in testing and targeted therapy or ICI access. Universal coverage still showed socioeconomic gradients, including lower novel therapy use among deprived patients in England. Only two studies examined the full testing-to-treatment-to-survival pathway; none used formal mediation.
CONCLUSIONS: SES disparities in NSCLC precision oncology concentrate at molecular testing and novel therapy access and are not eliminated by universal coverage. The evidence is dominated by US, with limited coverage of Asian systems or the entire pathway. Diffusion of innovation alone does not ensure equity; pathway-level equity monitoring, from routine testing to treatment continuation, and linked real-world cohort studies in universal-coverage settings are needed to address them.