Abstract
Purpose :
To investigate patient-level disparities in uveal melanoma (UM), the most common primary intraocular tumor in adults.
Methods :
We analyzed 14,674 UM cases from 2004-2016 National Cancer Database records. Enucleation, brachytherapy, and proton beam utilization were analyzed over time. We performed logistic regression analyses to assess odds of worse stage at diagnosis, use of brachytherapy or proton beam versus enucleation, and use of proton beam versus other radiation. Patient-level variables included diagnosis year, tumor stage and location, age, sex, comorbidities, insurance, income, metropolitan residence, distance to hospital, hospital type and location (by census division), and treatment at multiple hospitals.
Results :
Brachytherapy and proton beam use increased from 2004-2016, while enucleations declined. Patients who were nonwhite (OR=1.2, p<0.01), uninsured (OR=1.7, p<0.01), and who were treated at academic centers had higher odds of presenting with worse-stage disease. By contrast, those in the highest income quartile had lower odds of worse stage at presentation (OR=0.9, p<0.05). Patients with public (OR=0.7, p<0.01) or no insurance (OR=0.4, p<0.01), or who were treated at community cancer programs (annual caseload<500, OR=0.2, p<0.01) were less likely to receive radiation over enucleation, while those with higher incomes, metropolitan residence, treatment at academic centers, or treatment at facilities on the East and West coasts were significantly more likely to be treated via radiation. Metropolitan and high-income patients, and those treated at academic centers or facilities in the Pacific region were significantly more likely to receive proton beam over other types of radiation, while those treated at hospitals in the Middle Atlantic were less likely to receive proton beam (OR=0.2, p<0.05). Enucleation was predominant in Central US regions, brachytherapy in the Middle Atlantic, and proton beam in the Pacific (Figure 1).
Conclusions :
Although utilization of enucleations for UM has decreased over time and utilization of brachytherapy and proton beam has increased, substantial treatment differences persist based on factors such as patient income, insurance status, and—especially—geography, with radiation therapies most common in Coastal regions. Further work is needed to evaluate treatment availability and ensure equitable access to UM care.
This is a 2021 ARVO Annual Meeting abstract.