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Racial differences in time to treatment for melanoma - 19/08/20

Doi : 10.1016/j.jaad.2020.03.094 
Raghav Tripathi, MPH a, b, , Laura K. Archibald, MD c, Rishabh S. Mazmudar, BS a, b, Rosalynn R.Z. Conic, MD, PhD d, Luke D. Rothermel, MD, MPH a, e, Jeffrey F. Scott, MD a, f, Jeremy S. Bordeaux, MD, MPH a, b
a Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio 
b Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio 
c University of Minnesota Medical Center, Department of Dermatology, Minneapolis, Minnesota 
d Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland 
e Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio 
f Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 

Correspondence to: Raghav Tripathi, MPH, Department of Dermatology, University Hospitals Cleveland Medical Center, Lakeside 3500, 11100 Euclid Ave, Cleveland, OH 44106.Department of DermatologyUniversity Hospitals Cleveland Medical CenterLakeside 350011100 Euclid AveClevelandOH44106

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.

Le texte complet de cet article est disponible en PDF.

Key words : black, chemotherapy, disparities, immunotherapy, insurance, melanoma, mortality, National Cancer Database, non-Hispanic white, racial, stage, survival, time to definitive surgery, time to treatment

Abbreviations used : ALM, aOR, CI, NCDB, NHW, TTDS


Plan


 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Not applicable.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 3

P. 854-859 - septembre 2020 Retour au numéro
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