May 15, 2020
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Black patients face longer delays in time to surgery for melanoma

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Black patients with earlier-stage melanoma were more likely than their non-Hispanic white counterparts to experience delayed time from diagnosis to definitive surgery, according to a study.

“Previous research with Dr. Jeremy Bordeaux’s research group has shown that black patients with melanoma have worse prognosis and that longer time from diagnosis to definitive surgical treatment is associated with worse survival,” Raghav Tripathi, MPH, of the departments of dermatology at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, told Healio. “Prior to this study, the specific relationship between race and time to treatment was unknown.”

The goal of Tripathi’s research group was to better characterize the factors associated with worse outcomes for black patients in order to reduce racial disparities in melanoma outcomes. “As such, the objective of this study was to investigate racial differences in time to treatment of melanoma,” he said.

A retrospective review of the National Cancer Database from 2004 through 2015 yielded data for 233,982 patients with melanoma. There were 1,221 black patients (0.52%) in the analysis.

Black patients with earlier-stage melanoma were more likely than their non-Hispanic white counterparts to experience delayed time from diagnosis to definitive surgery.

Compared with non-Hispanic white patients, time from diagnosis to definitive surgery in stage I to III melanoma was longer among black patients (P < .001). Similarly, time to immunotherapy was longer in black patients compared with non-Hispanic white patients (P = .01).

However, time from diagnosis to definitive surgery was not longer among black patients compared with non-Hispanic white patients for stage IV melanoma. Time to chemotherapy also was not longer in this subset.

In an analysis that controlled for sociodemographic characteristics, black patients carried more than a twofold risk for having a time from diagnosis to definitive surgery of 31 to 60 days (adjusted OR = 2.10; 95% CI, 1.74-2.34; P < .001), more than a threefold risk for a delay of 61 to 90 days (aOR = 3.15; 95% CI 2,.42-4.02; P < .001) and more than a fivefold risk for a delay longer than 90 days (aOR = 5.16; 95% CI, 3.84-6.80; P < .001).

Insurance type failed to mitigate racial differences in time from diagnosis to definitive surgery. Medicaid was associated with the longest such delay (mean 60.4 days; P < .001), while individuals with private insurance had the shortest time from diagnosis to definitive surgery (mean 44.6 days; P < .001).

“Even after controlling for sociodemographic factors, including insurance type, black patients with melanoma had significantly longer time from diagnosis to definitive surgery,” Tripathi said. “Additionally, we found that black patients also had increased time from diagnosis to definitive surgery despite living closer to hospitals, suggesting that physical distance from the hospital is not as much of a contributor to time from diagnosis to definitive surgery for melanoma as for other cancers.”

Ultimately, understanding the various components of underlying worse outcomes for black melanoma patients is critical in reducing disparities in melanoma outcomes, according to Tripathi. “Time from diagnosis to definitive surgery is an important contributor to survival in patients with melanoma, and targeted approaches should be taken to reduce racial disparities in time to melanoma treatment,” he said. – by Rob Volansky

 

Disclosure: Tripathi reports no relevant financial disclosures.