Background
To identify socio-demographic factors affecting academic center access in Merkel cell carcinoma (MCC) patients. MCC is a leading cause of skin cancer death, disproportionately affecting males over 65. Treatment at academic cancer centers has been shown to improve survival in MCC, but there is limited literature on factors affecting accessibility. The National Cancer Database (NCDB) was analyzed to determine variables impacting treatment at academic versus non-academic facility types in MCC.
Methods
A retrospective cohort analysis using the NCDB from 2004 to 2021 included 21,866 patients with histologically confirmed MCC. Socio-demographic factors collected include sex, age, race, Hispanic status, population density, education level, income level, and distance to the treatment facility. Multivariate analysis of factors on academic center facility type was performed via binary logistic regression. Kaplan-Meier curves were used to estimate overall survival. A significance level of 0.05 was used.
Results
The majority of MCC patients were male (63.9%) and treated at a non-academic center (56.7%) with an average age of 74.4 (SD=10.8). Overall survival was significantly better at academic versus non-academic centers (97.1 months vs 80.1 months, P< 0.05). Those who were treated at a non-academic center were older (OR=1.004; CI, 1.001-1.007). Native Americans were 2.06 times as likely to be treated at a non-academic center relative to White patients (95% CI, 1.00-4.24). Patients with median household incomes in the top first or second quartile were 0.62 and 0.86 times as likely to receive treatment at a non-academic center compared to those in the bottom quartile (95% CI, 0.55-0.69 and CI, 0.77- 0.95, respectively). Those who were treated at an academic center lived in an urban area but traveled further for care (P< 0.05; 64.9 miles vs 20.7 miles, respectively).
Conclusions
Treatment at academic centers significantly improves survival in MCC patients. The results show that Native American, low-income, and older patients are undertreated at academic facilities, highlighting inequalities in access to care. Addressing these disparities is crucial for improving overall outcomes in MCC.
