Presentation (CTI)

OBJECTIVES: The objective of this study was to identify disparities in guideline-concordant treatment among older Medicare fee-for-service beneficiaries diagnosed with stage III or stage IV cutaneous melanoma.
METHODS: We conducted a retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We included adults older than 65 years, who had a new, first-time diagnosis for cutaneous melanoma from 2011-2015, and had no history of previous cancer diagnosis. Guideline-concordant treatment was defined as receipt of primary cancer treatment during the first six months after diagnosis, according to the published National Comprehensive Cancer Network (NCCN) guidelines. We identified the significant differences between those who received guideline-concordant treatment versus those who did not and conducted multivariable logistic regression to identify predictors of non-receipt of guideline-concordant treatment.
RESULTS: The study population consisted of 1,467 adults; 18.9% of them did not receive guideline-concordant treatment, while 81.1% received guideline-concordant treatment. In the adjusted model, the odds of not receiving guideline-concordant treatment increased when the following factors were present: stage IV tumor (adjusted odds ratio (AOR) 1.597, 95% confidence interval (CI) 1.077-2.369), patient age ≥85 (AOR 2.522, 95% CI 1.710-3.722), being non-white (AOR 2.647, 95% CI 1.309-5.352), not having a spouse/partner (AOR 1.536, 95% CI 1.143-2.065), living in the western region of the United States (AOR 2.001, 95% CI 1.296-3.091), having a Charlson comorbidity score of 0 (AOR 1.543, 95% CI 1.108-2.150), and having good performance status (AOR 1.401, 95% CI 1.007-1.949.)
CONCLUSIONS: Our findings suggest that older age, stage IV tumor, being married or partnered, non-white race, having no comorbidities and good performance status increased odds of not receiving guideline-concordant treatment for advanced cutaneous melanoma in Medicare fee-for-service beneficiaries. Earlier identification of cutaneous melanoma and having a social support system may increase receipt of guideline concordant treatment.