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Impact of Socioeconomic Disparities and Facility Type on Overall Survival in Stage I vs Stage IV Amelanotic Melanoma: An Analysis of the National Cancer Database
PURPOSE
This study addresses a gap in knowledge regarding socioeconomic factors, facility type, and overall survival in stage I vs stage IV Amelanotic Melanoma.
BACKGROUND
Amelanotic Melanoma (AM) is a rare form of melanoma that lacks pigment and accounts for approximately 5% of melanomas. Light skin color and increasing age are important risk factors. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. A study investigating the impact of facility type on overall survival between stage I vs stage IV AM has yet to be done.
METHODS
This is a retrospective study of patients diagnosed with Amelanotic Melanoma (ICD-8730) between 2004 and 2020 in the National Cancer Database (NCDB) to compare demographic features and overall survival (n = 2147). Exclusion criteria included missing data.
DATA ANALYSIS
Descriptive statistics for all AM patients were collected. Median household income and facility type were compared between patients diagnosed with stage I and stage IV AM using Pearson Chi- Square test. Breslow thickness and overall survival between stage I and stage IV were evaluated using independent t-test and Kaplan-Meier test, respectively. All variables were evaluated for a significance of P < .05.
RESULTS
Most cases analyzed were White (98.1%), male (58.6%), and had Medicare as the primary payor at diagnosis (51.1%). Of 2147 cases, 497 were stage I (23.1%) and 164 were stage IV AM (7.6%) with a mean age at diagnosis of 66.05 and 63.72 years, respectively. There was a significant difference in overall survival between stage I (mean = 118.7 months) and stage 4 (mean = 42.4 months, P < 0.001). The average Breslow thickness was 1.17mm in stage I and 2.59mm in stage IV (P<0.05). More patients diagnosed at stage I used academic facilities than those diagnosed at stage IV (43.9% vs 33.8%, P<0.05). Most patients diagnosed at stage I were high income compared to patients diagnosed at stage IV (55% vs 43.2%, P<0.05).
CONCLUSIONS
With the overall survival of stage IV AM being significantly worse, we hope this study can provide a starting point in the study and prevention of disparities in the early diagnosis of AM.
PURPOSE
This study addresses a gap in knowledge regarding socioeconomic factors, facility type, and overall survival in stage I vs stage IV Amelanotic Melanoma.
BACKGROUND
Amelanotic Melanoma (AM) is a rare form of melanoma that lacks pigment and accounts for approximately 5% of melanomas. Light skin color and increasing age are important risk factors. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. A study investigating the impact of facility type on overall survival between stage I vs stage IV AM has yet to be done.
METHODS
This is a retrospective study of patients diagnosed with Amelanotic Melanoma (ICD-8730) between 2004 and 2020 in the National Cancer Database (NCDB) to compare demographic features and overall survival (n = 2147). Exclusion criteria included missing data.
DATA ANALYSIS
Descriptive statistics for all AM patients were collected. Median household income and facility type were compared between patients diagnosed with stage I and stage IV AM using Pearson Chi- Square test. Breslow thickness and overall survival between stage I and stage IV were evaluated using independent t-test and Kaplan-Meier test, respectively. All variables were evaluated for a significance of P < .05.
RESULTS
Most cases analyzed were White (98.1%), male (58.6%), and had Medicare as the primary payor at diagnosis (51.1%). Of 2147 cases, 497 were stage I (23.1%) and 164 were stage IV AM (7.6%) with a mean age at diagnosis of 66.05 and 63.72 years, respectively. There was a significant difference in overall survival between stage I (mean = 118.7 months) and stage 4 (mean = 42.4 months, P < 0.001). The average Breslow thickness was 1.17mm in stage I and 2.59mm in stage IV (P<0.05). More patients diagnosed at stage I used academic facilities than those diagnosed at stage IV (43.9% vs 33.8%, P<0.05). Most patients diagnosed at stage I were high income compared to patients diagnosed at stage IV (55% vs 43.2%, P<0.05).
CONCLUSIONS
With the overall survival of stage IV AM being significantly worse, we hope this study can provide a starting point in the study and prevention of disparities in the early diagnosis of AM.
PURPOSE
This study addresses a gap in knowledge regarding socioeconomic factors, facility type, and overall survival in stage I vs stage IV Amelanotic Melanoma.
BACKGROUND
Amelanotic Melanoma (AM) is a rare form of melanoma that lacks pigment and accounts for approximately 5% of melanomas. Light skin color and increasing age are important risk factors. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. A study investigating the impact of facility type on overall survival between stage I vs stage IV AM has yet to be done.
METHODS
This is a retrospective study of patients diagnosed with Amelanotic Melanoma (ICD-8730) between 2004 and 2020 in the National Cancer Database (NCDB) to compare demographic features and overall survival (n = 2147). Exclusion criteria included missing data.
DATA ANALYSIS
Descriptive statistics for all AM patients were collected. Median household income and facility type were compared between patients diagnosed with stage I and stage IV AM using Pearson Chi- Square test. Breslow thickness and overall survival between stage I and stage IV were evaluated using independent t-test and Kaplan-Meier test, respectively. All variables were evaluated for a significance of P < .05.
RESULTS
Most cases analyzed were White (98.1%), male (58.6%), and had Medicare as the primary payor at diagnosis (51.1%). Of 2147 cases, 497 were stage I (23.1%) and 164 were stage IV AM (7.6%) with a mean age at diagnosis of 66.05 and 63.72 years, respectively. There was a significant difference in overall survival between stage I (mean = 118.7 months) and stage 4 (mean = 42.4 months, P < 0.001). The average Breslow thickness was 1.17mm in stage I and 2.59mm in stage IV (P<0.05). More patients diagnosed at stage I used academic facilities than those diagnosed at stage IV (43.9% vs 33.8%, P<0.05). Most patients diagnosed at stage I were high income compared to patients diagnosed at stage IV (55% vs 43.2%, P<0.05).
CONCLUSIONS
With the overall survival of stage IV AM being significantly worse, we hope this study can provide a starting point in the study and prevention of disparities in the early diagnosis of AM.
Mucinous Adenocarcinoma of the Rectum: Clinical Outcomes and Characteristics of 14,044 Patients From the National Cancer Database
PURPOSE
Study clinical characteristics of Rectal Mucinous Adenocarcinoma (RMA).
BACKGROUND
RMA is a rare histological subtype with an impaired response to chemoradiotherapy and an overall poor prognosis. High-grade tumors are associated with older age. Previous studies have shown conflicting results on prognosis.
METHODS
Retrospective analysis of National Cancer Database was conducted from 2004-2020 for subjects with histology code 8480 in primary sites C19 and C20 (rectosigmoid-junction and rectum, n = 14,044), using multivariate analysis with Cox regression.
RESULTS
Median age of diagnosis was 65 years with 69.5% were in the 45-75 years age range. 59.2% were male while 40.8% were female. 84.7% were White, 9.7% were Black, 0.4% were American Indian and 3.4% were Asian. 6.9% were Hispanic. 33.9% were in the upper-income quartile. 40.6% were seen at community cancer programs while 33% went to academic programs. 36.5% had stage III RMA. Out of the 14,044 patients with RMA, 10,546 received surgery, 5,179 received chemotherapy, 233 received immunotherapy and 55 received hormone therapy. Patients >75 years had significantly lower overall survival (OS) compared to those <45 years (HR 0.67). Female patients had significantly higher OS than male (HR - 0.07). Black patients had significantly lower OS than White (HR 0.08). Hispanic patients had significantly higher OS than non- Hispanic (HR - 0.14). Patients with private and government insurance had significantly higher OS than noninsured patients (HR - 0.35 and - 0.26 respectively). Patients with median higher-income quartiles had significantly higher OS than lower quartiles (HR - 0.13). Academic facilities had significantly higher OS than community programs (HR - 0.13). Patients who received surgery had significantly higher OS than those that did not (HR - 0.67); median survival for patients who received surgery was 71 months vs 28 months for non-surgical candidates.
CONCLUSIONS
Surgery is the most important treatment modality in RMA. Uninsured, older Black male patients from lower-income quartiles had significantly lower OS. Access to academic centers also contributed to differences in OS outcomes which throws light on healthcare disparities.
IMPLICATIONS
Additional studies need to be conducted for viable solutions to assist with social determinants of healthcare in RMA.
PURPOSE
Study clinical characteristics of Rectal Mucinous Adenocarcinoma (RMA).
BACKGROUND
RMA is a rare histological subtype with an impaired response to chemoradiotherapy and an overall poor prognosis. High-grade tumors are associated with older age. Previous studies have shown conflicting results on prognosis.
METHODS
Retrospective analysis of National Cancer Database was conducted from 2004-2020 for subjects with histology code 8480 in primary sites C19 and C20 (rectosigmoid-junction and rectum, n = 14,044), using multivariate analysis with Cox regression.
RESULTS
Median age of diagnosis was 65 years with 69.5% were in the 45-75 years age range. 59.2% were male while 40.8% were female. 84.7% were White, 9.7% were Black, 0.4% were American Indian and 3.4% were Asian. 6.9% were Hispanic. 33.9% were in the upper-income quartile. 40.6% were seen at community cancer programs while 33% went to academic programs. 36.5% had stage III RMA. Out of the 14,044 patients with RMA, 10,546 received surgery, 5,179 received chemotherapy, 233 received immunotherapy and 55 received hormone therapy. Patients >75 years had significantly lower overall survival (OS) compared to those <45 years (HR 0.67). Female patients had significantly higher OS than male (HR - 0.07). Black patients had significantly lower OS than White (HR 0.08). Hispanic patients had significantly higher OS than non- Hispanic (HR - 0.14). Patients with private and government insurance had significantly higher OS than noninsured patients (HR - 0.35 and - 0.26 respectively). Patients with median higher-income quartiles had significantly higher OS than lower quartiles (HR - 0.13). Academic facilities had significantly higher OS than community programs (HR - 0.13). Patients who received surgery had significantly higher OS than those that did not (HR - 0.67); median survival for patients who received surgery was 71 months vs 28 months for non-surgical candidates.
CONCLUSIONS
Surgery is the most important treatment modality in RMA. Uninsured, older Black male patients from lower-income quartiles had significantly lower OS. Access to academic centers also contributed to differences in OS outcomes which throws light on healthcare disparities.
IMPLICATIONS
Additional studies need to be conducted for viable solutions to assist with social determinants of healthcare in RMA.
PURPOSE
Study clinical characteristics of Rectal Mucinous Adenocarcinoma (RMA).
BACKGROUND
RMA is a rare histological subtype with an impaired response to chemoradiotherapy and an overall poor prognosis. High-grade tumors are associated with older age. Previous studies have shown conflicting results on prognosis.
METHODS
Retrospective analysis of National Cancer Database was conducted from 2004-2020 for subjects with histology code 8480 in primary sites C19 and C20 (rectosigmoid-junction and rectum, n = 14,044), using multivariate analysis with Cox regression.
RESULTS
Median age of diagnosis was 65 years with 69.5% were in the 45-75 years age range. 59.2% were male while 40.8% were female. 84.7% were White, 9.7% were Black, 0.4% were American Indian and 3.4% were Asian. 6.9% were Hispanic. 33.9% were in the upper-income quartile. 40.6% were seen at community cancer programs while 33% went to academic programs. 36.5% had stage III RMA. Out of the 14,044 patients with RMA, 10,546 received surgery, 5,179 received chemotherapy, 233 received immunotherapy and 55 received hormone therapy. Patients >75 years had significantly lower overall survival (OS) compared to those <45 years (HR 0.67). Female patients had significantly higher OS than male (HR - 0.07). Black patients had significantly lower OS than White (HR 0.08). Hispanic patients had significantly higher OS than non- Hispanic (HR - 0.14). Patients with private and government insurance had significantly higher OS than noninsured patients (HR - 0.35 and - 0.26 respectively). Patients with median higher-income quartiles had significantly higher OS than lower quartiles (HR - 0.13). Academic facilities had significantly higher OS than community programs (HR - 0.13). Patients who received surgery had significantly higher OS than those that did not (HR - 0.67); median survival for patients who received surgery was 71 months vs 28 months for non-surgical candidates.
CONCLUSIONS
Surgery is the most important treatment modality in RMA. Uninsured, older Black male patients from lower-income quartiles had significantly lower OS. Access to academic centers also contributed to differences in OS outcomes which throws light on healthcare disparities.
IMPLICATIONS
Additional studies need to be conducted for viable solutions to assist with social determinants of healthcare in RMA.
Palliative Care Disparities in Small Cell Carcinoma of the Prostate: An Analysis of the National Cancer Database
Purpose
This study addresses a gap in knowledge regarding palliative care utilization patterns in smallcell carcinoma of the prostate.
Background
Prostate cancer is the most common cancer affecting males. One of the most aggressive malignancies of the prostate is small cell carcinoma (SCC) of the prostate. Almost 70% of patients diagnosed with SCC present with the disseminated disease with a low 5-year survival rate of less than 2%. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course. Despite evidence favoring palliative care for prostate cancer in several patient populations, it remains under-utilized. Palliative care utilization patterns in SCC of the prostate have not yet been studied.
Methods
This is a retrospective study of patients diagnosed with all subtypes of AJCC staged metastatic SCC of the prostate between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 615). Exclusion criteria included missing data.
Data Analysis
Variables were evaluated for significance (P < .05) in relation to the receipt of palliative care using Pearson Chi-Square, ANOVA, and Kaplan- Meier tests. Multivariate analysis was performed via binary logistics regression.
Results
Among the 961 patients diagnosed with SCC of the prostate, 64% had metastatic disease (n = 615). The metastatic cohort was more likely to receive palliative care than those that did not have distant metastasis (24.2% vs 5.7%, P < .001). Palliative care use has grown between 2004 (n = 6) and 2017 (n = 20). Patients that were uninsured were more likely than insured patients to receive palliative care (50% vs 23.5%, P = .003; 95% CI, 0.051- 0.546). Non-Hispanic patients were also more likely than Hispanic patients to receive palliative care (P = .033; 95% CI, 1.154-28.140). New England locations had the highest utilization of palliative care (43.%, P = .009). Factors that impacted palliative care use included facility region, insurance status, and Hispanic status. As palliative care continues to be utilized more frequently, we hope that this study can provide a starting point in studying and preventing palliative treatment disparities.
Purpose
This study addresses a gap in knowledge regarding palliative care utilization patterns in smallcell carcinoma of the prostate.
Background
Prostate cancer is the most common cancer affecting males. One of the most aggressive malignancies of the prostate is small cell carcinoma (SCC) of the prostate. Almost 70% of patients diagnosed with SCC present with the disseminated disease with a low 5-year survival rate of less than 2%. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course. Despite evidence favoring palliative care for prostate cancer in several patient populations, it remains under-utilized. Palliative care utilization patterns in SCC of the prostate have not yet been studied.
Methods
This is a retrospective study of patients diagnosed with all subtypes of AJCC staged metastatic SCC of the prostate between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 615). Exclusion criteria included missing data.
Data Analysis
Variables were evaluated for significance (P < .05) in relation to the receipt of palliative care using Pearson Chi-Square, ANOVA, and Kaplan- Meier tests. Multivariate analysis was performed via binary logistics regression.
Results
Among the 961 patients diagnosed with SCC of the prostate, 64% had metastatic disease (n = 615). The metastatic cohort was more likely to receive palliative care than those that did not have distant metastasis (24.2% vs 5.7%, P < .001). Palliative care use has grown between 2004 (n = 6) and 2017 (n = 20). Patients that were uninsured were more likely than insured patients to receive palliative care (50% vs 23.5%, P = .003; 95% CI, 0.051- 0.546). Non-Hispanic patients were also more likely than Hispanic patients to receive palliative care (P = .033; 95% CI, 1.154-28.140). New England locations had the highest utilization of palliative care (43.%, P = .009). Factors that impacted palliative care use included facility region, insurance status, and Hispanic status. As palliative care continues to be utilized more frequently, we hope that this study can provide a starting point in studying and preventing palliative treatment disparities.
Purpose
This study addresses a gap in knowledge regarding palliative care utilization patterns in smallcell carcinoma of the prostate.
Background
Prostate cancer is the most common cancer affecting males. One of the most aggressive malignancies of the prostate is small cell carcinoma (SCC) of the prostate. Almost 70% of patients diagnosed with SCC present with the disseminated disease with a low 5-year survival rate of less than 2%. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course. Despite evidence favoring palliative care for prostate cancer in several patient populations, it remains under-utilized. Palliative care utilization patterns in SCC of the prostate have not yet been studied.
Methods
This is a retrospective study of patients diagnosed with all subtypes of AJCC staged metastatic SCC of the prostate between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 615). Exclusion criteria included missing data.
Data Analysis
Variables were evaluated for significance (P < .05) in relation to the receipt of palliative care using Pearson Chi-Square, ANOVA, and Kaplan- Meier tests. Multivariate analysis was performed via binary logistics regression.
Results
Among the 961 patients diagnosed with SCC of the prostate, 64% had metastatic disease (n = 615). The metastatic cohort was more likely to receive palliative care than those that did not have distant metastasis (24.2% vs 5.7%, P < .001). Palliative care use has grown between 2004 (n = 6) and 2017 (n = 20). Patients that were uninsured were more likely than insured patients to receive palliative care (50% vs 23.5%, P = .003; 95% CI, 0.051- 0.546). Non-Hispanic patients were also more likely than Hispanic patients to receive palliative care (P = .033; 95% CI, 1.154-28.140). New England locations had the highest utilization of palliative care (43.%, P = .009). Factors that impacted palliative care use included facility region, insurance status, and Hispanic status. As palliative care continues to be utilized more frequently, we hope that this study can provide a starting point in studying and preventing palliative treatment disparities.