Melanoma Treatment Delays Due to Insurance Status, Other Factors

10/11/17

A recent study found that multiple factors including insurance status, ethnicity, and individual providing the diagnosis are associated with delays in treatment for patients with melanoma, published in JAMA Dermatology (online October 4, 2017; doi:10.1001/jamadermatol.2017.3338).

Prior studies have shown that patients who are insured through Medicare and Medicaid are significantly more likely to experience melanoma treatment delays – a period of at least 6 weeks from initial diagnosis to surgery. However, further research is needed to better understand the impact of insurance type—as well as the impact of other baseline factors—on delays of surgery for patients with melanoma.

Adewole S Adamson, MD, MPP, department of dermatology, University of North Carolina at Chapel Hill, and colleagues conducted a retrospective analysis of 7629 patients who received a diagnosis of melanoma between 2004 and 2011 from the North Carolina cancer registry to evaluate factors associated with delayed surgery. Inclusion criteria included diagnosis of stage 0 to stage III disease, as well as proof of continuous insurance enrollment from at least 1 month prior to diagnosis to 12 months after diagnosis.

Researchers noted that most patients were insured privately (48%, n = 3667) or through Medicare (48%, n = 3631), with the remaining patients covered by Medicaid (4%, n = 331).

Results of the analysis showed that 24% of patients (n = 79) covered by Medicaid experienced delays in surgery, compared with only 17% (n = 609) and 14% (n = 519) of patients insured by Medicare and privately, respectively.

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After adjusting for demographic risk factors, researchers found that the risk of surgical delay was significantly increased in patients with Medicaid compared with private insurance (risk ratio [RR], 1.36; 95% CI, 1.09-1.70). Other factors that contributed to increased surgical delay rates included non-Caucasian ethnicity (RR, 0.83) or if the physician performing the surgery (RR, 0.82) or the diagnosing clinician (RR, 0.81) was a dermatologist.

Researchers concluded that a reduction in melanoma surgical delays could be achieved through improved access to specialty care and cross-disciplinary coordination. “Either the suggested 6-week period between biopsy and excision is a flawed measure of quality, or the health care system is systematically failing to deliver high-quality care to a substantial proportion of patients with melanoma in general,” they wrote.—Zachary Bessette