Presentation (CTI)

OBJECTIVES: We examined the association between guideline-concordant treatment on healthcare resource utilization and clinical outcomes, among older Medicare fee-for-service beneficiaries diagnosed with advanced stage cutaneous melanoma.
METHODS: A retrospective observational 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, with no previous cancer history. Guideline-concordant treatment was defined as the receipt of primary cancer treatment during the first six months after diagnosis. We examined clinical outcomes by assessing all-cause mortality and melanoma-specific mortality. We assessed healthcare utilization including emergency department visit, inpatient hospitalizations, outpatient visits, and office-based physician visits, and any hospice use. Generalized linear regressions and Cox proportional hazards model were conducted to examine the association between guideline-concordant treatment and healthcare utilization and mortality, respectively. A log offset was applied to each model to account for different measurement periods for each patient.
RESULTS: Out of 1,467 adults included, 81.1% received guideline-concordant treatment. Patients who did not receive guideline concordant treatment had higher hazards of all-cause mortality (adjusted hazard ratio (AHR)1.747, 95% confidence interval (CI) 1.457-2.094, p<.0001) and melanoma-specific mortality (AHR 1.644, 95% CI 1.329-2.033, p<.0001) compared to those who received guideline-concordant treatment. Rates of inpatient hospitalizations were 70% higher for those who did not receive guideline concordant treatment (adjusted incident rate ratio (AIRR) 1.7866, 95% CI 1.3062-2.4437, p 0.0003), but 32% lower for outpatient visits (AIRR 0.6869, 95% CI 0.6008-0.7853, p <.0001), and 17% lower for physician office visits (AIRR 0.8355, 95% CI 0.8399-0.9449, p 0.0042) compared to those who received guideline-concordant treatment.
CONCLUSIONS: Our findings suggest that not receiving guideline-concordant treatment for advanced cutaneous melanoma is significantly associated with increased mortality rates. Patients receiving guideline concordant treatment utilized office-based physicians and outpatient visits more but were less likely to be hospitalized.