Disparities in Surgical Oncologic Care
Jiali Cai, MS
Graduate Student
University of California - Irvine, California, United States
Jiali Cai, MS
Graduate Student
University of California - Irvine, California, United States
Lily L. Nguyen, MD
Resident Physician
University of California - Irvine
Tustin, California, United States
Lily L. Nguyen, MD
Resident Physician
University of California - Irvine
Tustin, California, United States
Yingjoy Li, BS
Medical Student
University of California - Irvine, United States
Tu Tran, BS
Graduate Student
University of California - Irvine, United States
Maki Yamamoto, MD
Physician
School of Medicine, University of California-Irvine, United States
Thuy B. Tran, MD
Physician, School of Medicine
University of California - Irvine, United States
Merkel Cell Carcinoma (MCC) is a rare form of skin cancer that progresses rapidly. Rural populations are known to have lower life expectancy and face numerous challenges with access to cancer care. The objective of this study is to address the impact of rurality and pathological factors that contribute to the health disparities in MCC in the United States.
Methods:
Patients with Merkel Cell Carcinoma were identified using the National Cancer Database. Surgical patients with MCC aged ≥18 were included and stratified based on their geographic settings: metropolitan area (MA) and rural area (RA). Descriptive statistics were used to evaluate demographic, clinical, pathologic, and treatment characteristics. Kaplan-Meier method was used to estimate overall survival (OS).. Multivariate Cox proportional hazard regressions were performed to identify predictors of OS.
Results:
A total of 23,733 MCC patients were identified, of which 20,191 patients underwent surgical resection. Of the 20,191 patients who underwent surgery, 85% were MA and 15% were RA patients. MA patients travelled shorter distance to the hospital for treatment to the hospital (23.4mi vs. 56.1mi, P< 0.001) had higher income greater than $74,000 (48% vs. 6.2%, P< 0.001), more likely to be treated at academic facilities (44% vs. 36%, P< 0.001), and higher private insurance rates (22.4% vs. 16.3%; P< 0.001). The median survival time was higher in MA patients than that in RA patients (median 68.0 mos, 95% CI: 65.4-70.6 vs. 56.3 mos, 95% CI: 51.3-61.2, p=0.015). On multivariate analysis, RA was a strong predictor of worse OS (HR=1.074, 95% CI: 1.000-1.153, p=0.049). Higher clinical staging (p< 0.001), higher in Charlson-Deyo comorbidity score (1: p< 0.001) and receipt of chemotherapy (HR=1.332, p< 0.001) were also independent predictors of poor survival.
Conclusions:
Rural and small-town patients with surgically treated Merkel Cell Carcinoma had worse survival outcomes compared to metropolitan patients. Further investigation is needed to understand how socioeconomic deprivation and geographic isolation leads to worse outcomes in rural patients with Merkel Cell Carcinoma.