Racial differences in time to treatment for melanoma

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:83

Article

Tripathi, Raghav^1,2  Archibald, Laura K.³  Mazmudar, Rishabh S.^1,2  Conic, Rosalynn R. Z.⁴  Rothermel, Luke D.^1,5  Scott, Jeffrey F.^1,6  Bordeaux, Jeremy S.^1,2 

[1] Case Western Reserve Univ, Dept Dermatol, Sch Med, Cleveland, OH 44106 USA

[2] Univ Hosp Cleveland, Med Ctr, Dept Dermatol, Lakeside 3500,11100 Euclid Ave, Cleveland, OH 44106 USA

[3] Univ Minnesota, Dept Dermatol, Med Ctr, Minneapolis, MN 55455 USA

[4] Univ Maryland, Med Ctr, Dept Surg, Baltimore, MD 21201 USA

[5] Univ Hosp Cleveland, Dept Surg, Med Ctr, Div Surg Oncol, 2074 Abington Rd, Cleveland, OH 44106 USA

[6] Johns Hopkins Univ, Sch Med, Dept Dermatol, Baltimore, MD 21205 USA

关键词: black;    chemotherapy;    disparities;    immunotherapy;    insurance;    melanoma;    mortality;    National Cancer Database;    non-Hispanic white;    racial;    stage;    survival;    time to definitive surgery;    time to treatment;   

DOI  :  10.1016/j.jaad.2020.03.094

来源: Elsevier

【 摘 要 】

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 (2004-2015). 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.

【 授权许可】

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