Treatment Contraindications Based on Comorbidity Status in Patients With Melanoma in the United States

Melanoma incidence has increased in the United States over the past few decades, and disparities in patient treatment have been described. Although most patients with melanoma are good candidates for curative treatment, some are considered poor candidates for treatment because of comorbid conditions. We examined whether patient demographics influence treatment contraindication in melanoma.

The National Cancer Database (NCDB) was used to identify patients with melanoma from 2004 through 2015. Multivariate logistic regression was used to determine independent associations, adjusted for confounders. We excluded patients who did not receive treatment for reasons and patients with unknown treatment status.

A total of 499,092 patients met the inclusion criteria. Of these, 525 (0.1%) had Treatment contraindicated because of comorbid conditions (TCBC) and 498,567 (99.9%) received treatment. Multivariate logistic regression showed higher odds of TCBC in patients with government insurance (OR=1.34, 95%CI=03-1.73; p=0.03) and patients without insurance (OR=2.75, 95%CI=1.76-4.29; p<0.001) than patients with private insurance.

Demographic disparities affects treatment decision in oncological patients. Our study demonstrated a significantly higher likelihood of "nontreatment because of comorbid conditions" among melanoma patients with government insurance or without insurance. Greater efforts are needed to address inequalities in melanoma treatment in the United States.