The Role of Social Determinants of Health in the Receipt of Systemic Treatment for Metastatic Melanoma.

Abstract

Simple summary: The development of contemporary immune and targeted therapies for patients with metastatic extended survival compared to the previous standard of care treatments. Therefore, equitable access to these therapies for all patients with advanced melanoma is of high importance. We aimed to understand the association between SES with treatment receipt and prognosis. Furthermore, we aimed to identify detailed reasons why patients with stage IV melanoma do not undergo systemic treatment. Our findings would help us understand what interventions are most helpful to improve the care of patients with advanced melanoma within our regional hospital system.

Objectives: The Area Deprivation Index (ADI) has not been used to study the effects of socioeconomic status (SES) in the receipt of treatment in melanoma. We set out to understand the effect of SES on the receipt of systemic treatment upon diagnosis of stage IV melanoma patients within our health system.

Methods: We queried patients with stage IV melanoma at our institution between 2010 and 2021. We defined SES based on ADI (highest quartile considered "low SES"). Multivariable regression analysis was performed to identify predictors of systemic therapy receipt. Additionally, we reviewed granular reasons for not receiving systemic treatment.

Results: One hundred seventy-nine patients were included, of whom 119 (66.5%) received any type of systemic treatment. Patients were less likely to receive systemic therapy if they had worse performance status, low SES, or were diagnosed between 2010 and 2017. The majority of barriers to receiving systemic therapy included poor baseline medical condition and advanced disease with recommendation for hospice care (39 patients, 65%). Potentially modifiable reasons included refusal by the patient (5 patients, 8.3%), which did not differ between high and low SES patients, and occurred in only 1 patient ≥2018.

Conclusions: Low SES predicted lower systemic treatment receipt for stage IV melanoma at our institution; however, most limitations to treatment came from nonmodifiable barriers to care at the time of diagnosis. These findings provide valuable insight into equity-focused programming at our institution and others.