DELAYS in treatment for melanoma are associated with higher mortality rates, according to a study explaining that Asian American and Pacific Islander patients are more likely to experience delays than non-Hispanic White patients.
Lauren Fane, Case Western University School of Medicine, Cleveland, Ohio, USA, and colleagues conducted a retrospective review of patients diagnosed with cutaneous melanoma between 2004–2020. They used the National Cancer Database, and analysed more than 350,000 patients, including Asian American and Pacific Islander patients and White patients. The researchers used multivariable logistic regression to evaluate the association of race and time from diagnosis to definitive surgery.
A total of 0.33% of patients were identified as Asian American and Pacific Islander, and they had a longer time from diagnosis to definitive surgery compared with White patients (44 versus 37 days, respectively; p>0.001). Meanwhile, Asian American and Pacific Islander patients had a similar mean time from diagnosis to surgery as Hispanic patients (44 versus 46 days, respectively). However, Black patients had a longer mean time from diagnosis to definitive surgery than Asian American patients (48 versus 44 days, respectively; p<0.003).
When sociodemographic factors were included in the analysis, Asian American and Pacific Islander patients had >1.5 times the odds of a time from diagnosis to definitive surgery between 61–90 days compared with White patients. Furthermore, Asian American and Pacific Islander patients had twice the odds of having a time from diagnosis to definitive surgery of >90 days.
However, there were no racial differences between Asian American and Pacific Islander, and White patients regarding time to chemotherapy, immunotherapy, or radiotherapy, for Stage IV melanoma.
Fane notes that Asian American and Pacific Islander patients would benefit from interventions to decrease delays, highlighting that “a longer time from diagnosis to definitive surgery is associated with decreased survival.”
They also stated that there were racial differences around insurance and melanoma stage. Fane said: “When stratifying by insurance and melanoma stage, racial differences persisted for private and Medicare insurance, as well as melanoma Stages I, II, and III. Interestingly, there were no racial differences between Asian American and Pacific Islander and non-Hispanic White patients with no insurance or Medicaid. The same pattern between time from diagnosis to definitive surgery and insurance type was found in the study comparing Black and non-Hispanic and White patients.
