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Interventions needed to improve surgery access in melanoma
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To improve the rate of melanoma survival, targeted health care interventions are needed for certain patients who experience the most delays in surgical care, according to researchers.
“Equalizing the surgical interval for nonwhite patients could be a step in improving melanoma care for all patients, regardless of skin color,” Howa Yeung, MD, assistant professor from the department of dermatology at Emory University School of Medicine, and colleagues wrote.
The interval between diagnosis and receipt of treatment is a key determinant of melanoma survival, according to the National Cancer Database (NCDB).
The researchers identified longer surgery wait times in patients with melanoma who are not white, live in a city suburb, have attained less education, and/or present with two or more comorbidities.
The researchers identified 213,146 patients with stage I, II or III cutaneous melanoma from the NCDB who received surgical therapy. They also analyzed the factors associated with the interval between diagnosis and surgery.
The median interval between diagnosis and surgery was 29 days in patients younger than 50 years, 30 days in those aged 50 to 70 years and 33 days in patients older than 70 years, according to the study.
Of 119,541 patients who had private insurance, the average wait time was longer for those aged 50 to 70 years (HR = 0.96; 95% CI, 0.95-0.97).
The researchers reported that, of 93,605 patients who were insured but not through a private company, older patients had a shorter surgical wait time.
Patients with head or neck melanoma and those at a higher stage experienced longer wait times. Racial differences and lower educational attainment had more of an effect on surgical wait time than insurance status.
Among patients with Medicaid, the new patient acceptance rate is lower, and the mean appointment wait time is 13 days longer among dermatology practices, according to the researchers.
“Despite comprising a small proportion of melanoma diagnoses, nonwhite patients have poorer survival outcomes and present with more advanced disease, often attributed to low suspicion for melanoma in nonwhite patients and health care providers,” the researchers wrote. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Noelani González, MD
We know that African American patients are typically diagnosed at later, more advanced stages of melanoma. African Americans are four times more likely to present with advanced stage IV melanoma and 1.5 times more likely to die of melanoma than Caucasians. The findings in this study show a positive effect and a decrease in time to diagnosis for these patients, which could potentially aid in decreasing the disparity among prognosis for these patients. However, we should continue to seek ways to improve access to health care and education in regard to health care among minorities to improve equity in health care.
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