Disparities in the Receipt of Immunotherapy for Patients With Head and Neck Mucosal Melanoma

To evaluate the relationship between socioeconomic status (SES) and the use of immunotherapy (IT) in patients with head and neck mucosal melanoma (HNMM); and to assess trends in 3-year overall survival (OS) associated with IT.

This retrospective study used National Cancer Database (NCDB) data from 2004 to 2021. SES was assessed using a composite measure incorporating race, ethnicity, insurance status, and rural residence. Trends in IT use and OS were evaluated using Joinpoint analysis. Multivariable logistic regression and Cox proportional hazards models assessed associations between SES, IT receipt, and OS. Sensitivity analyses were performed by SES components and time period.

Among 3163 patients, 22.7% received IT. Use of IT increased over time (2013-2021 AAPC: 21.9%, 95% CI: 19.6-26.9) without significant differences between SES groups. SES was not associated with IT receipt (aOR: 1.15; 95% CI: 0.84-1.55) or OS (aHR: 0.94; 95% CI: 0.78-1.13). IT was not associated with improved OS (aHR: 1.05; 95% CI: 0.87-1.26).

Despite increasing IT use, no disparities in access or survival by SES were observed. While survival improved modestly over time, IT was not independently associated with this trend. These findings highlight equitable IT use in HNMM and underscore the need for future prospective studies to clarify its survival impact.