Lung cancer is the leading cause of death from cancer among persons of Native Hawaiian ancestry. Because a large number of Native Hawaiian patients with cancer are treated at this hospital, a single-institution review was conducted to compare recent non-small cell lung cancer (NSCLC) survival and treatment patterns in Native Hawaiian and non-Native Hawaiian patients. A total of 1,394 cases of NSCLC registered between January 1995 and December 2001 were reviewed; of those, 229 patients self-reported Native Hawaiian ancestry. Independent predictors of survival were determined by proportional hazards regression modeling. The median age at diagnosis for all cases of NSCLC, and for males and females separately, was significantly lower for Native Hawaiian vs. non-Native Hawaiian patients. Although there were no significant differences in the distribution of cancer stage, the median age at diagnosis at each stage was also significantly lower for Native Hawaiian vs. non-Native Hawaiian patients. A higher proportion of patients were women in the Native Hawaiian group. Differences in the time to receiving primary treatment, or the proportions receiving surgery, radiation therapy, or chemotherapy, for each stage of disease, were not significant. Controlling for age, gender, stage and Native Hawaiian ancestry was associated with an increased mortality risk. An observed higher mortality risk from NSCLC for Native Hawaiians was not associated with differences in treatment as appropriate for stage, nor with delays in treatment; this suggests other factors, including environmental or biological influences, as contributors to unfavorable lung cancer outcomes among Native Hawaiians.