Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study

Abstract

Background: Asian American and Pacific Islander (AAPI) melanoma patients have higher mortality than non-Hispanic White (NHW) patients. Treatment delays may contribute, but whether AAPI patients have longer time from diagnosis to definitive surgery (TTDS) is unknown.

Objectives: Investigate TTDS differences between AAPI and NHW melanoma patients.

Methods: Retrospective review of AAPI and NHW melanoma patients in the National Cancer Database (NCD) (2004-2020). The association of race with TTDS was evaluated by multivariable logistic regression, controlling for sociodemographic characteristics.

Results: Of 354,943 AAPI and NHW melanoma patients identified, 1155 (0.33%) were AAPI. AAPI patients had longer TTDS for stage I, II, and III melanoma (P < .05 for all). Adjusting for sociodemographic factors, AAPI patients had 1.5 times the odds of a TTDS between 61 and 90 days and twice the odds of a TTDS >90 days. Racial differences in TTDS persisted in Medicare and private insurance types. Uninsured AAPI patients had the longest TTDS (mean, 53.26 days), while those with private insurance had the shortest TTDS (mean, 34.92 days; P < .001 for both).

Limitation: AAPI patients comprised 0.33% of the sample.

Conclusions: AAPI melanoma patients have increased odds of treatment delays. Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival.

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