Melanoma disparities in urban vs rural communities in the era of immunotherapy: An NCDB analysis.

Abstract

9578 Background: Several barriers to care exist for melanoma patients including distance to specialty care, transportation, and cost. Additionally, differences in rural and urban melanoma incidence have not been fully investigated. Using a large nationwide database, we aim to investigate the relationship between urban and rural locations in stage of melanoma presentation and access to adjuvant systemic treatment. Methods: The National Cancer Database (NCDB) was queried for all adult patients (≥ 18 years old) with diagnosis of cutaneous melanoma from 1/1/2011 – 12/31/2020. For receipt of adjuvant immunotherapy, diagnosis from only 1/1/2017 - 12/31/2020 was analyzed. Demographic, socioeconomic, tumor-related, and treatment-related factors were analyzed using SPSS Statistics, with Chi-square analysis performed for categorical variables and ANOVA performed for continuous. Results: Between 2011 and 2020, 558,445 patient cases were identified and included in the analyses. The average age was 63.7 years, and patients predominantly identified as White (97.6%) and non-Hispanic (96.2%). Patients in urban areas were more likely to present with melanoma of the extremities (40.8% vs 36.2%, p < 0.001), while patients in rural areas presented with head and neck melanoma (26.2% vs 31.0%, p < 0.001). Additionally, patients in urban areas were more likely to have an early-stage melanoma (0, 1, or 2) melanoma (51.4% vs 48.5%, p < 0.001). Patients in rural areas traveled an average of 68 miles for care, in contrast to urban patients who traveled an average of 20 miles (p < 0.001). There was no significant difference when comparing receipt of immunotherapy for stage 3 or stage 4 patients. Conclusions: In rural areas, patients with melanoma tended to present with a higher portion of head and neck melanoma and of later stage. Rural patients also had to travel farther for care. However, these differences did not result in fewer patients in rural areas receiving immunotherapy for appropriate treatment. Further studies are needed to evaluate how these presentation differences influence care outcomes.