Disparities of Immunotherapy Utilization in Patients with Stage III Cutaneous Melanoma: A National Perspective

Al‐Qurayshi, Zaid; Crowther, Jason E.; Hamner, John B.; DuCoin, Christopher; Killackey, Mary; Kandil, Emad

doi:10.21873/anticanres.12536

Cited by 14 publications

(22 citation statements)

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“…Ultimately, 44 studies met our inclusion criteria and were included in this systematic review ( Supplemental Figure S1 ). 2 , 4 , 6 , 10 , 14 - 53…”

Section: Resultsmentioning

confidence: 99%

“…As multiple studies drew patient data from the same database, we pooled effect estimates from a representative study from each database with the longest timeframe from which patient data were drawn (HR 1.38, 95% CI, 1.10-1.73) ( Figure 1 ). 2 , 6 , 28 , 52 We also performed sensitivity analyses removing any studies using patient data from the Surveillance, Epidemiology, and End Results (SEER) program database (HR 1.29, 95% CI, 1.07-1.56), 6 , 28 , 51 , 52 and removing any studies with patient data from any national cancer database (HR 1.62, 95% CI, 1.20-2.19). 6 , 52 Overall, results of our meta-analyses suggest that black melanoma patients are significantly more likely to experience death from any cause compared to non-Hispanic white patients.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-three studies reported 62505 Hispanic patients, 4 , 6 , 10 , 15 , 19 - 22 , 24 , 25 , 27 , 30 , 31 , 36 - 38 , 43 - 45 , 50 - 53 with 10 studies reporting melanoma-specific survival, 4 , 15 , 19 , 20 , 30 , 31 , 36 , 45 , 50 , 53 where all but 2 studies 50 , 53 reported lower survival for Hispanic patients compared to non-Hispanic white patients.…”

Section: Resultsmentioning

confidence: 99%

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Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis

Lam

Zhu

et al. 2021

J Cutan Med Surg

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Background Factors influencing the difference in the diagnosis and treatment of melanoma in racial minority groups are well-described in the literature and include atypical presentations and socioeconomic factors that impede access to care. Objective To characterize the differences in melanoma survival outcomes between non-Hispanic white patients and ethnic minority patients in North America. Methods We conducted searches of Embase via Ovid and MEDLINE via Ovid of studies published from 1989 to August 5, 2020. We included observational studies in North America which reported crude or effect estimate data on patient survival with cutaneous melanoma stratified by race. Results Forty-four studies met our inclusion criteria and were included in this systematic review. Pooled analysis revealed that black patients were at a significantly increased risk for overall mortality (HR 1.42, 95% CI, 1.25-1.60), as well as for melanoma-specific mortality (HR 1.27, 95% CI, 1.03-1.56). Pooled analyses using a representative study for each database yielded similar trends. Other ethnic minorities were also more likely report lower melanoma-specific survival compared to non-Hispanic white patients. Conclusion Our results support findings that melanoma patients of ethnic minorities, particularly black patients, experience worse health outcomes with regards to mortality. Overall survival and melanoma-specific survival are significantly decreased in black patients compared to non-Hispanic white patients. With the advent of more effective, contemporary treatments such as immunotherapy, our review identifies a gap in the literature investigating present-day or prospective data on melanoma outcomes, in order to characterize how current racial differences compare to findings from previous decades.

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“…Ultimately, 44 studies met our inclusion criteria and were included in this systematic review ( Supplemental Figure S1 ). 2 , 4 , 6 , 10 , 14 - 53…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis

Lam

Zhu

et al. 2021

J Cutan Med Surg

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“…Previous studies 29 , 30 , 31 , 32 , 33 have analyzed the NCDB cohort before our analysis of the 2016 participant user file. These analyses evaluated the disparity in use of immunotherapy for all stages of melanoma in diagnosis years before 2013, 29 before 2014, 30 , 31 and in 2015 32 and for stage III disease.…”

Section: Discussionmentioning

confidence: 99%

“…These analyses evaluated the disparity in use of immunotherapy for all stages of melanoma in diagnosis years before 2013, 29 before 2014, 30 , 31 and in 2015 32 and for stage III disease. 33 These prior studies 29 , 30 , 31 , 32 , 33 indicated the presence of comorbidities, older age, government or no insurance, lower educational and income levels, and treatment at a community practice as factors associated with decreased receipt of immunotherapy. Our study further supports that many of these prior demographic factors may be associated with receipt of immunotherapy with the addition of cases diagnosed in 2015 and 2016.…”

Section: Discussionmentioning

confidence: 99%

Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US

et al. 2020

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Key Points Question Are sociodemographic factors associated with likelihood of receiving immunotherapy for patients diagnosed with metastatic melanoma in the US? Findings In this cohort study of 9512 metastatic melanoma cases diagnosed between 2013 and 2016 in the National Cancer Database, factors associated with receiving immunotherapy included diagnosis in Medicaid expansion states, residence in areas with high rates of high school graduation, and treatment at academic cancer centers or integrated cancer networks. Meaning This study found that patients with metastatic melanoma diagnosed in Medicaid expansion states, treated at academic or integrated cancer centers, and living in high graduation–rate areas were more likely to receive immunotherapy.

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Factors influencing receipt and time to treatment of immunotherapy relative to chemotherapy in stage III and stage IV melanoma

Dhaliwal,

Shahin,

Lim

et al. 2024

Cancer Medicine

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BackgroundImmunotherapies have changed the landscape of late‐stage melanoma; however, data evaluating timely access to immunotherapy are lacking.MethodsA retrospective cohort study utilizing the National Cancer Database was conducted. Stage III and IV melanoma cases diagnosed between 2011 and 2018 that received systemic treatment with either immunotherapy or chemotherapy were included. Chemotherapy included BRAF/MEK inhibitors. Multivariable logistic regression models were utilized to evaluate factors associated with the likelihood of receiving immunotherapy as primary systemic treatment relative to chemotherapy; additionally, Cox proportional hazards models were utilized to incorporate time from diagnosis to primary systemic therapy into the analysis.ResultsThe study population was comprised of 14,446 cases. The cohort included 12,053 (83.4%) immunotherapy and 2393 (16.6%) chemotherapy cases. In multivariable logistic regression analysis, factors significantly associated with immunotherapy receipt included population density, circle distance, year of diagnosis, Breslow thickness, and cancer stage. Immunotherapy timing was evaluated using multivariable Cox regression analysis. Minorities were less likely to receive timely immunotherapy than non‐Hispanic Whites (HR 0.83, CI 0.74–0.93, p = 0.001). Patients at circle distances of 10–49 miles (HR 0.94, CI 0.89–0.99, p = 0.02) and ≥50 miles (HR 0.83, CI 0.77–0.90, p < 0.001) were less likely to receive timely immunotherapy.ConclusionPatients traveling ≥10 miles and minorities have a decreased likelihood of receiving timely immunotherapy administration for primary systemic treatment. Future research is needed to identify what barriers and approaches can be leveraged to address these inequities.

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Disparities of Immunotherapy Utilization in Patients with Stage III Cutaneous Melanoma: A National Perspective

Abstract: Compared to other demographic factors, insurance status was associated with the greatest disparities in immunotherapy utilization and mortality for patients who underwent surgery for advanced melanoma.

Cited by 14 publications

References 0 publications

Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis

Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis

Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US

Factors influencing receipt and time to treatment of immunotherapy relative to chemotherapy in stage III and stage IV melanoma

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