Introduction <p>The impact of socioeconomic factors on cancer outcomes is well documented; however, their role in access to and receipt of care within universal health systems for advanced lung cancer is less established. We investigated inequalities in specialized cancer consultation and treatment for stage IV non-small cell lung cancer (NSCLC).</p> Methods <p>We used a population-based cohort with administrative health data to study people aged 18+ diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario. We measured consultations with medical oncologists, radiation oncologists, and thoracic surgeons as well as systemic therapy, radiation, surgery, and palliative care in the year following diagnosis, comparing consultation and treatment rates across quintiles of census measures of community material resources. Multivariable cause-specific Cox proportional hazards regression, accounting for death, was used.</p> Results <p>We included 32,902 stage IV NSCLC patients. People living in the least materially resourced neighborhoods were less likely to have a cancer-directed consultation with a medical oncologist, radiation oncologist, or thoracic surgeon (hazard ratio [HR] = 0.91; 95% confidence interval [CI] 0.87–0.94) and less likely to receive any cancer-directed treatment (HR = 0.90; 95% CI 0.86–0.94) compared to those with the most material resources. We did not detect a difference in the rate of palliative care (HR = 1.04; 95% CI 1.00–1.08). Results were consistent in urban but not rural populations.</p> Conclusions <p>We identified inequities in access to cancer-directed consultation and treatment among adults with stage IV NSCLC by material resources, limited to urban and suburban populations. Future research should explore root causes and identify interventions to address these inequities.</p>