Social Vulnerability Among Individuals With Truncal-Extremity Melanomas Leads to Detriments in Care and Prognosis

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A recent retrospective cohort study found that social vulnerability among individuals with truncal-extremity melanomas (TEM) leads to detriments in care and prognosis.

Previous research on social determinants of truncal-extremity melanomas (TEM) has explored race, income, and environmental factors, yet gaps remain in assessing the interrelational contributions of these determinants, study authors wrote.

The analysis, spanning 1975 to 2017, examined 325,760 adult patients. The analysis utilized the Social Vulnerability Index (SVI), a tool encompassing 15 social determinant variables grouped into 4 themes: socioeconomic status, minority-language status, household composition, and housing-transportation. These SVI scores were matched to patient data from the National Cancer Institute-Surveillance, Epidemiology, and End Results Program (SEER) to account for patients' county of residence.

SEER program results encompassed patient variables, pathological characteristics, prognostic outcomes, and treatment modalities. This includes months survival, staging, and stage at patient presentation.

Total SVI scores ranged from 0.000 to 0.976, with 1.1% of patients receiving a score of 0.000 to 0.199 and 1.1% receiving a score of 0.800 to 0.999. This was followed by the second-highest rate of social vulnerability (0.600 to 0.799), experienced by 21% of patients; then a score of 0.200 to 0.399 experienced by 26% of patients; and a score of 0.400 to 0.599, the middle grouping of social vulnerability scoring, experienced by 51% of patients.

Increasing overall social vulnerability demonstrated significant decreases in the survival period for 7 out of 13 TEM histology types, with relative decreases as high as 44.0% for epithelioid cell. Socioeconomic status and minority-language status, housing-transportation, and household composition were identified as the highest contributors to these trends.

Odds of advanced presenting stage, decreased odds of indicated surgery receipt, and increased odds of indicated chemotherapy were observed in the analysis. Similarly to the above described trends of social vulnerability in relation to survival period of histology types, socioeconomic status and minority-language status, household composition, and housing-transportation were identified as contributing factors, with socioeconomic status leading to more increasing vulnerability.

Additionally, increasing SVI total vulnerability was also linked to significant odds of an advanced staging on preliminary diagnosis in several TEM subtypes. These odds were not applicable to melanomas or junctional nevi, but were applicable in diagnoses of acral lentiginous, amelanotic, nodular, superficial spreading, and spindle cell melanoma. Socioeconomic status, household composition, housing-transportation, and minority-language status were identified as contributors to these trends.

"As noted in our survival and treatment results, vulnerabilities with poor socioeconomic status (SES) showed the highest associations with worse outcomes and advanced presentation of disease compared to other social determinant themes," study authors wrote. "Our work adds to the growing body of evidence that suggests intersectionality, or the overlap of various social political and social identities which create unique suboptimal experiences for individuals and populations, is an important facet of inequities in melanoma outcomes. ...By using a theoretical and analytical framework centered upon intersectionality to understand cancer disparities, it may be possible to develop new solutions in a patient-centered and inclusive manner moving forward."

Reference

Goyal A, Fei-Zhang D, Pawlik T, et al. Associations of social vulnerability with truncal and extremity melanomas in the United States. J Surg Onc. 27 November 2023. https://doi.org/10.1002/jso.27532