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 (2004-2015). 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.

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