Melanoma treatment delays increased in Asian American, Pacific Islander patients
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Key takeaways:
- Asian American and Pacific Islander patients have a longer time to melanoma treatment compared with white patients.
- Decreasing disparities in melanoma treatment should be explored.
Asian American and Pacific Islander patients are more likely to experience melanoma treatment delays compared with white patients, and these delays are associated with higher mortality rates, according to a study.
“Asian American and Pacific Islander (AAPI) patients with melanoma have a longer time from diagnosis to definitive surgery (TTDS) than non-Hispanic White (NHW) patients and would thus benefit from interventions to reduce delays,” Lauren Fane, BSE, a medical student at Case Western University School of Medicine and the study’s lead author, told Healio. “A longer TTDS is associated with decreased survival.”
Fane and colleagues conducted a retrospective review of AAPI and non-Hispanic white patients diagnosed with cutaneous melanoma between 2004 and 2020 using the National Cancer Database.
Using multivariable logistic regression, the association of race and TTDS was evaluated.
More than 350,000 patients were included in the analysis, of which 0.33% were identified as AAPI. For stage I, II and III melanomas, a longer TTDS was found in AAPI patients compared with white patients (44 days vs. 37 days; P < .001).
AAPI patients, however, did have a shorter mean TTDS than Black patients (44 vs. 48 days; P = .003). The researchers also found the same mean TTDS in AAPI patients and Hispanic patients (44 vs. 46 days).
AAPI patients had more than 1.5 times the odds of a TTDS between 61 and 90 days compared with white patients when sociodemographic factors were included in the analysis, as well as twice the odds of a TTDS of more than 90 days.
“When stratifying by insurance and melanoma stage, racial differences persisted for private and Medicare insurance, as well as melanoma stages I, II and III,” Fane told Healio. “Interestingly, there were no racial differences between AAPI and NHW patients with no insurance or Medicaid. The same pattern between TTDS and insurance type was found in the study comparing Black and NHW patients.”
TTDS for stage IV melanoma, as well as time to chemotherapy, immunotherapy or radiotherapy, had no racial differences between AAPI and white patients.
“There is less known about AAPI disparities due to lack of research, which may have precluded them from access to social services. This study identifies a racial difference in receipt of health care. By highlighting this disparity of AAPI patients, we aim to promote inclusion of the AAPI group in future racial disparities studies,” Fane said.
“Potential avenues to expedite treatment include establishing focus groups with community leaders to better understand the AAPI experience with melanoma and educating patients on the impact of timely treatment,” Fane said.