Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database

• Type of Material: Article
• Authors: Marissa L.H. Baranowski, Emory University; Howa Yeung, Emory University; Suephy Chen, Emory University; Theresa Gillespie, Emory University; Michael Goodman, Emory University
• Language: English
• Date: 2019-10-01
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by the American Academy of Dermatology, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaad.2019.05.079
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
• Volume: 81
• Issue: 4
• Start Page: 908
• End Page: 916
• Grant/Funding Information: Supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and National Institutes of Health/National Cancer Institute under award number P30CA138292 and in part by the National Institutes of Health/National Center for Advancing Translational Sciences under award numbers UL1TR002378 and KL2TR002381 (to Dr Yeung).
• Keywords: UNITED-STATES; SURVIVAL; patient disparities; Science & Technology; MEDICARE; EPIDEMIOLOGY; epidemiology; surgical interval; Dermatology; ACCESS; MALIGNANT-MELANOMA; melanoma; OUTCOMES; Life Sciences & Biomedicine; BIOPSY; INSURANCE; DISPARITIES; National Cancer Data Base

Abstract

Background: Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. Objective: To determine characteristics associated with the interval between diagnosis and surgery in melanoma. Methods: The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. Results: Among privately insured patients, time to surgery was longer for patients aged 50 to 70 years (hazard ratio [HR], 0.96) and older than 70 years (HR, 0.83) compared with those younger than 50 years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70 years, 1.07; HR for age >70 years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. Limitations: Use of zip code–level data for income and education level. Conclusion: Patients with melanoma experience disparities in timely receipt of surgery.