Socioeconomic and demographic factors associated with use of sentinel node biopsy and adjuvant biologic response modifiers in melanoma

Abstract

6027 Background: Cancer management may be influenced by factors other than disease characteristics. Little is known about the association of demographic and socioeconomic factors with melanoma care. Methods: The National Cancer Data Base, a hospital-based registry, was queried on reported use of adjuvant biologic response modifiers (BRM) for patients with resected regional metastases and the use of sentinel node biopsy (SNBx) for patients with clinical stage I and II melanoma in patients ages 1–69 between 1994 and 2003. Independent variables were age, sex, race, severity of disease, income, insurance type, U. S. Census region and type of treating facility. Analysis was performed by forward stepwise logistic regression. Results: Between 1994 and 2003, 37.8% of 10,790 patients with resected node-positive melanoma received BRM. Between 1998 and 2002, 61,251 patients with clinical stage I and II melanoma had a SNBx in 13.2%, 46.2%, 55.9%, and 41.7% of those with T1, T2, T3, and T4 tumors, respectively. In multivariate analysis, geographic variance in use of BRM and SNBx was striking ( Table ). Insurance type (commercial vs. others) and facility type (teaching/research vs. others) were also significantly associated with these modalities. Use of BRM was also associated with age, number of positive nodes and earlier treatment year, but not with sex, income or race. Use of SNBx was also associated with T stage, later treatment year, age and income, but not with sex or race. Conclusions: BRM and SNBx use varied significantly with geographic region, insurance type, and type of treating facility; this may have implications for provider education and public policy. [Table: see text] No significant financial relationships to disclose.