Background: Timely treatment for melanoma may affect survival, and characterizing predictors of treatment delay may inform intervention strategies.
Objective: To determine patient-, provider-, and facility-level characteristics associated with a delay to treatment in melanoma.
Methods: The National Cancer Database was used to examine factors associated with an increased interval between diagnosis and definitive surgical treatment among 205,665 patients with Stage I, II, or III cutaneous melanoma between 2004 and 2015 using multivariable Cox proportional hazards modeling.
Results: The data demonstrated that the direction of the association between age at diagnosis and timing of surgery differed depending on insurance status. Among 115,461 privately insured patients, delay in surgical treatment was associated with older age (HR 0.85 in 70+ years, p <0.0001; HR 0.97 in 50-70 years, p <0.0001). By contrast, in 90,204 patients without private insurance, the association with age was weaker and in the opposite direction (HR 1.09 in 70+ years, p <0.0001; HR 1.09 in 50-70 years, p <0.0001). After adjustment for important patient and disease characteristics, other factors significantly associated with a longer time from diagnosis to surgery included non-white race, higher comorbidity burden, thicker tumor, higher disease stage, and head or neck melanoma location.
Conclusion: Melanoma patients experience disparities in timely receipt of surgery. Identifying groups at risk of delay reveals who would benefit most from patient navigation or care-coordination programs. Public health intervention is warranted to address specific roadblocks contributing to surgical delay to improve care for all patients with melanoma.
Citation Format: Marissa L.H. Baranowski, Howa Yeung, Suephy C. Chen, Theresa W. Gillespie, Michael Goodman. Factors associated with longer time to surgical treatment in melanoma [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B084.