Original Study Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer Apar Kishor Ganti, 1 Fred R. Hirsch, 2 Murry W. Wynes, 3 Arliene Ravelo, 4 Suresh S. Ramalingam, 5 Raluca Ionescu-Ittu, 6 Irina Pivneva, 6 Hossein Borghaei 7 Abstract MarketScan and Surveillance, Epidemiology, and End ResultseMedicare databases were analyzed separately to evaluate the access to cancer specialists and treatment of patients with advanced stage lung cancer. Between 4% and 12% of the patients were never seen by a cancer specialist, and between 6% and 10% did not receive cancer-directed therapy. Patients seen by a cancer specialist were more likely to receive cancer- directed therapy. Background: Access to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer. Materials and Methods: Two study samples were extracted from 2 claims databases and analyzed independently: patients aged  18 years with de novo diagnosis of metastatic lung cancer in the MarketScan database between 2008 and 2014 (commercially insured adult patients; n ¼ 22,268); and patients aged  65 years in the Surveillance, Epidemiology, and End ResultseMedicare database with a diagnosis of advanced nonesmall-cell lung cancer be- tween 2007 and 2011 (Medicare-insured elderly patients; n ¼ 9651). The study period spanned from 6 weeks before the first lung biopsy tied to the initial lung cancer diagnosis until the end of continuous health insurance enrollment, or data availability, or death. Results: Among the commercially insured adults (MarketScan), most patients were seen by a cancer specialist within a month of first lung biopsy (80%), 12% were never seen by a cancer specialist, and 6% did not receive cancer-directed therapy. Among the Medicare-insured elderly patients (SEEReMedicare), the proportions were 79%, 4%, and 10%, respectively. Patients seen by a cancer specialist were more likely to receive cancer- directed therapy (95% vs. 92%, P < .001 and 92% vs. 38%, P < .001, respectively). Conclusion: Between 4% and 12% of patients with advanced stage lung cancer do not have appropriate access to cancer specialist, which appears to negatively affect access to optimal and timely treatment. Clinical Lung Cancer, Vol. -, No. -, 1-11 Published by Elsevier Inc. Keywords: Access to care, Cancer-directed therapy, Metastatic lung cancer, Nonesmall-cell lung cancer, Referral Introduction Lung cancer is the most common cancer and the leading cause of cancer deaths worldwide. 1 Approximately 75% of patients present with advanced disease in stages III and IV at the time of diag- nosis, 2,3 and approximately 85% have nonesmall-cell lung cancer (NSCLC). 4 The prognosis of advanced stage lung cancer is poor, with only about 4% of patients with stage IV NSCLC surviving 5 years after diagnosis. 5 Because of the aggressive and progressive nature of the disease, the management of advanced stage lung cancer typically involves different options, including targeted therapy, chemotherapy, and radiotherapy. 6 As such, treatment decisions are often complex, and access to cancer specialists is particularly important to ensure that patients receive appropriate care. Indeed, specialist care has been associated with improved survival and greater use of anticancer treatments among lung cancer patients. 7-9 Several studies have reported gaps in specialist care for patients with advanced NSCLC in the United States: Goulart et al 8 found that 16% of patients diagnosed between 2000 and 2005 were not 1 Veteran’s Affairs NebraskaeWestern Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE 2 Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO 3 International Association for the Study of Lung Cancer (IASLC), Aurora, CO 4 Genentech Inc, South San Francisco, CA 5 Medical Oncology, Emory University Winship Cancer Institute, Atlanta, GA 6 Analysis Group Inc, Montreal, Quebec, Canada 7 Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA Submitted: Feb 6, 2017; Accepted: Apr 18, 2017 Address for correspondence: Apar Kishor Ganti, MD, MS, FACP, Division of Oncology-Hematology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680 Fax: (402) 559-6520; e-mail contact: aganti@unmc.edu 1525-7304/$ - see frontmatter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.cllc.2017.04.010 Clinical Lung Cancer Month 2017 - 1