Association of surgical interval and survival among hospital and non-hospital based patients with melanoma in North Caro
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ORIGINAL PAPER
Association of surgical interval and survival among hospital and non‑hospital based patients with melanoma in North Carolina Adewole S. Adamson1,2,3 · Bradford E. Jackson4 · Christopher D. Baggett4,5 · Nancy E. Thomas3,4 · Michael P. Pignone1,2 Received: 1 July 2020 / Revised: 30 August 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Surgical excision is important for melanoma treatment. Delays in surgical excision after diagnosis of melanoma have been linked to decreased survival in hospital-based cohorts. This study was aimed at quantifying the association between the timeliness of surgical excision and overall survival in patients diagnosed with melanoma in hospital- and non-hospitalbased settings, using a retrospective cohort study of patients with stage 0–III melanoma and using data linked between the North Carolina Central Cancer Registry to Medicare, Medicaid, and private health insurance plan claims across the state. We identified 6,496 patients diagnosed between 2004 and 2012 with follow-up through 2017. We categorized the time from diagnostic biopsy to surgical excision as 90 days after melanoma diagnosis. Multivariable Cox regression was used to estimate differences in survival probabilities. Five-year overall survival was lower for those with time to surgery over 90 days (78.6%) compared with those with less than 6 weeks (86%). This difference appeared greater for patients with Stage 1 melanoma. This study was retrospective, included one state, and could not assess melanoma specific mortality. Surgical timeliness may have an effect on overall survival in patients with melanoma. Timely surgery should be encouraged. Keywords Melanoma · Surgery · Delays · Quality of care · Insurance · Medicare · Medicaid · Private insurance · Disparities Abbreviations CIPHR Cancer information and population health resource NCCCR North Carolina Central Cancer Registry
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00403-020-02146-2) contains supplementary material, which is available to authorized users. * Adewole S. Adamson [email protected] 1
Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas At Austin, 1601 Trinity St., Stop Z0900, Austin, TX 78712, USA
2
LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX, USA
3
Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
4
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
5
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
AJCC American joint committee on cancer NCI National cancer institute
Introduction Nearly 100,000 people were diagnosed with melanoma in 2019. Based on Surveillance, Epidemiology, and End Results (SEER) data, the incidence of invasive melanoma increased more than threefold over
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