Disparities in the Receipt of Systemic Treatment in Metastatic Melanoma

Abstract

Introduction: In 2011, immunotherapy and targeted therapy revolutionized melanoma treatment. However, inequities in their use may limit the benefits seen by certain patients. Methods: We performed a retrospective review of patients in the National Cancer Database for patients with stage IV melanoma from 2 time periods: 2004–2010 and 2016–2020, distinguishing between those who received systemic therapy and those who did not. We investigated the rates and factors associated with treatment omission. We employed Kaplan-Meier analysis to explore the impact of treatment on overall survival. Results: A total of 19,961 patients met the inclusion criteria: 7621 patients were diagnosed in 2004–2010 and 12,340 patients in 2016–2020, of whom 54.9% and 28.3% did not receive systemic treatment, respectively. The rate of “no treatment” has decreased to a plateau of ∼25% in 2020. Median overall survival was improved with treatment in both time periods (2004–2010: 8.8 vs. 5.6 mo [P<0.05]; and 2016–2020: 25.9 vs. 4.3 mo [P<0.05]). Nonmedical factors associated with the omission of treatment in both periods included low socioeconomic status, Medicaid or no health insurance, and treatment at low-volume centers. In the period from 2016 to 2020, patients treated at nonacademic programs were also less likely to receive treatment. Conclusions: Systemic therapies significantly improve survival for patients with metastatic melanoma, but significant disparities exist with their receipt. Local efforts are needed to ensure all patients benefit from these revolutionary treatments.