Racial differences in time to treatment for melanoma

Abstract

Background: Longer time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although black patients present with later-stage melanoma and have worse survival than non-Hispanic white patients, the association between race and TTDS is unknown.Objective: To investigate racial differences in time to melanoma treatment.Methods: Retrospective review of the National Cancer Database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Multivariable logistic regression was used to evaluate the association of race with TTDS, controlling for sociodemographic/ disease characteristics.Results: Of the 233,982 patients with melanoma identified, 1221 (0.52%) were black. Black patients had longer TTDS for stage I to III melanoma (P \.001) and time to immunotherapy (P = .01), but not for TTDS for stage IV melanoma or time to chemotherapy (P [.05 for both). When sociodemographic characteristics were controlled for, black patients had over twice the odds of having a TTDS between 41 and 60 days, over 3 times the odds of having a TTDS between 61 and 90 days, and over 5 times the odds of having a TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean, 60.4 days), and those with private insurance had the shortest TTDS (mean, 44.6 days; P \ .001 for both).Conclusions: Targeted approaches to improve TTDS for black patients are integral in reducing racial disparities in melanoma outcomes.

Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database

“…Reasons for this difference are unclear in the current analysis but could be partially attributed to the longer distance traveled for care by patients treated at academic facilities. Although the time to treatment has been implicated in worse survival outcomes for certain populations with melanoma, further investigation is needed to determine whether the difference seen in this analysis would impact melanoma‐specific survival long term 28 …”

Utilization of health information technology among skin cancer patients: A cross-sectional study of the National Health Interview Survey from 2011 to 2018

“…3 Although the exact mechanism of association remains unknown, several studies have implicated the role of TH-1 cell-mediated inflammation in the immunopathogenesis of psoriasis and autoimmune thyroid disease. 4 Several genes, including protein tyrosine phosphate nonreceptor alleles and a locus on 4q27, have also been found to be significantly associated with psoriatic and thyroid disease. 4 Patients aged $40 years may be particularly susceptible, as one case-control study found a higher prevalence of antiethyroid peroxidase antibody seropositivity in psoriasis patients with age of onset at diagnosis $40 years.…”

Association of surgical interval and survival among hospital and non-hospital based patients with melanoma in North Carolina

“…We had insufficient power to evaluate melanoma-specific survival due to the low number of observed events in our cohort; consequently, we were unable to assess whether there is an effect of surgical delay on mortality attributed to melanoma, a limitation of previous national studies [ 11 ]. Despite the inability to assess melanoma-specific survival, our findings add to the growing literature on variation in melanoma care which may adversely affect outcome [ 4 , 11 , 21 , 22 ]. As more early stage melanomas are diagnosed over time (a significant proportion outside of the hospital setting), understanding these patterns of care will be important for potentially designing interventions to reduce disparities in melanoma outcome.…”

“…A recent US national study of melanoma patients treated in a hospital setting showed factors associated with longer time to surgery include nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma [ 21 ]. In particular, black patients have been shown to have longer time to surgery for hospital-based melanoma [ 22 ]. Some of these delays may be explained by a higher proportion of acral lentiginous melanoma which may require coordination between unconnected specialties, worsening delays.…”