Persistent poverty impacts survival and national comprehensive cancer network guideline-concordant care for patients with melanoma

Background Sentinel lymph node biopsy (SLNB) should be routinely performed in patients with high-risk stage IB (T2a) or stage II melanoma and adjuvant systemic therapy is recommended for patients with stage III disease. Persistent poverty (PP) census tracts are areas where at least 20% of residents were poor as measured by multiple censuses and the American Community Survey 5-year average. This study sought to describe the association between PP and adherence to NCCN guidelines and disease-specific survival (DSS) in patients with cutaneous melanoma. Methods Patients diagnosed with cutaneous melanoma from 2012-2018 were identified in Survival, Epidemiology, and End Results Program registries. Demographics and tumor characteristics associated with receipt of adequate LN staging were analyzed amongst clinical stage IB (T2a) and II cases and were analyzed separately amongst stage III cases. DSS was examined using Kaplan-Meier curves and accelerated failure time models. Results Of 74,933 patients, 3.3% (n=2,447) lived in census tracts with PP. In adjusted analyses, PP was associated with later stage at diagnosis (OR 1.31 [95% CI 1.18-1.46] p<0.001). PP was also associated with lower likelihood of receiving adequate LN staging (OR 0.60 [0.51-0.72] p<0.01) and with worse DSS (HR 1.25 [1.02-1.72], p=0.0376). Conclusions Patients from PP areas had a later stage at diagnosis, worse DSS, and were less likely to receive adequate LN staging. Ensuring adequate LN staging may help address disparities in melanoma patients' treatment and survival. Synopsis Melanoma patients from persistent poverty areas between 2012-2018 had a later stage at diagnosis, worse DSS, and were less likely to receive adequate LN staging. These results suggest that ensuring adequate LN staging may help address disparities in melanoma patients' treatment and survival.