Socioeconomic and demographic factors on academic center accessibility in sebaceous adenocarcinoma: An NCDB analysis.

Abstract

e21501 Background: Sebaceous adenocarcinoma (SA) is a rare, aggressive adnexal tumor shown to have both local and distant metastatic potential. The 5-year overall survival rate for this cancer is 78% for localized/regional disease and 50% for metastatic disease. Improved survival in other skin malignancies, such as melanoma, has been previously linked to treatment at academic cancer centers. The National Cancer Database (NCDB) was analyzed to determine variables impacting treatment at academic versus non-academic facility types in SA. Methods: A retrospective cohort analysis using the NCDB from 2004 to 2019 included patients diagnosed with histologically confirmed SA (N = 3,378). Socio-demographic factors (sex, age, race, Hispanic status, insurance type, urban/rural designation, facility location, education, income, distance from facility, and Charlson-Deyo score) were analyzed using Pearson Chi-squared tests and multivariate analysis of factors on academic center accessibility (facility type) was performed via binary logistic regression. A significance level of 0.05 was used. Results: The number of cases diagnosed with SA has steadily increased from 2004 to 2019 (152 and 287, respectively, R2 = 0.894). Most patients were male (59.1%), White (89.8%), not Hispanic (89.6%), insured (95.7%), and lived in an urban area (98.4%). There was a statistically significant difference between sex, race, insurance type, urban/rural designation, facility location, education, income, and distance from residence to the facility on academic facility type. Male patients were 1.3 times more likely to access academic centers compared to female patients (p < 0.001, CI = [0.681 - 0.911]). Patients with median household incomes in the top quartile were also 2.2 times more likely than those in the bottom quartile to receive treatment at an academic center (p < 0.001, CI = [1.676 - 2.992]). Conclusions: There has been an upward trend in the diagnosis of SA since 2004 with a predilection for White males. Female patients and patients with a lower income are less likely to receive treatment at an academic center. Given the rarity of the disease, this study serves as a valuable tool for understanding the factors associated with facility-type access. Future studies aim to determine the effect of academic center type on overall survival. Additional research is needed to understand the difference in treatment at academic versus non-academic facilities.