Asian American and Pacific Islander Patients Face Increased Odds of Melanoma Treatment Delay

A 2020 study published in the Journal of the American Academy of Dermatology¹ found that while Asian American and Pacific Islander (AAPI) patients have a significantly lower risk of melanoma than White patients, they face poorer outcomes and an overall lowered risk of survival.

In 2023, researchers Fane et al authors a study titled, "Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study." The study, published in the Journal of the European Academy of Dermatology and Venereology, found that AAPI patients also face increased odds of treatment delay when it comes to melanoma.²

This AAPI Heritage Month, Dermatology Times is reviewing the study, its findings, and researchers' recommendations for improving outcomes in this patient population.

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Background and Methods

While treatment delays have been suggested as a potential contributing factor to these disparities, little research has specifically examined whether AAPI patients experience longer time from diagnosis to definitive surgery (TTDS) compared to non-Hispanic White (NHW) patients.

To address this gap, the team of researchers conducted a retrospective review of AAPI and NHW melanoma patients using data from the National Cancer Database (NCD) spanning the years 2004 to 2020.

The primary objective of the study was to investigate any differences in TTDS between AAPI and NHW melanoma patients. The association between race and TTDS was assessed through multivariable logistic regression analysis, controlling for various sociodemographic characteristics.

Findings

The study identified a total of 354,943 patients with melanoma, among whom 1155 (0.33%) were of AAPI descent. Across all stages of melanoma (stages I, II, and III), AAPI patients consistently experienced longer TTDS compared to NHW patients, with statistical significance observed (P < .05 for all stages).

Upon adjusting for sociodemographic factors, they found that AAPI patients had 1.5 times the odds of experiencing a TTDS between 61 and 90 days compared to NHW patients. Furthermore, AAPI patients were found to have twice the odds of enduring a TTDS exceeding 90 days. This suggests a substantial disparity in treatment timelines between the 2 patient groups.

The racial disparities in TTDS persisted across different types of insurance coverage. Additionally, uninsured AAPI patients exhibited the longest TTDS, with an average duration of 53.26 days, whereas those with private insurance experienced the shortest TTDS, with an average duration of 34.92 days. These differences were statistically significant (P < .001 for both uninsured and privately insured patients).

Conclusions

The study highlights the increased odds of treatment delays among AAPI melanoma patients compared to their NHW counterparts.

One limitation of the study, as noted by researchers, was the relatively small proportion of AAPI patients within the sample (0.33%). While the findings provide insights into TTDS differences between AAPI and NHW melanoma patients, the limited representation of AAPI individuals within the dataset underscores the need for further research with larger sample sizes to confirm and expand upon these findings.

These disparities in TTDS were evident across various stages of melanoma and persisted across different types of insurance coverage.

"Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival," according to study authors Fane et al. Moving forward, targeted interventions aimed at reducing barriers to timely diagnosis and treatment access for AAPI populations are warranted to promote equitable health care delivery and enhance melanoma outcomes.

References

1. Zheng YJ, Ho C, Lazar A, Ortiz-Urda S. Poor melanoma outcomes and survival in Asian American and Pacific Islander patients. J Amer Acad Dermatol. August 25, 2020. https://doi.org/10.1016/j.jaad.2020.08.086
2. Fane LS, Wei AH, Tripathi R, Bordeaux JS. Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study. J Am Acad Dermatol. 2023;89(3):529-536. doi:10.1016/j.jaad.2023.05.028