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      Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US

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      , MD 1 , , , DO 2 , , DrPh 3 , , MD 1
      JAMA Network Open
      American Medical Association

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          Key Points

          Question

          Are sociodemographic factors associated with likelihood of receiving immunotherapy for patients diagnosed with metastatic melanoma in the US?

          Findings

          In this cohort study of 9512 metastatic melanoma cases diagnosed between 2013 and 2016 in the National Cancer Database, factors associated with receiving immunotherapy included diagnosis in Medicaid expansion states, residence in areas with high rates of high school graduation, and treatment at academic cancer centers or integrated cancer networks.

          Meaning

          This study found that patients with metastatic melanoma diagnosed in Medicaid expansion states, treated at academic or integrated cancer centers, and living in high graduation–rate areas were more likely to receive immunotherapy.

          Abstract

          Importance

          Strides to improve survival in metastatic melanoma have been made with the use of immunotherapeutic agents in the form of immune checkpoint inhibitors.

          Objective

          To examine the factors associated with immunotherapy receipt in patients with metastatic melanoma in the era of immune checkpoint inhibitors and the Patient Protection and Affordable Care Act.

          Design, Setting, and Participants

          This cohort study used data on 9882 patients with metastatic melanoma diagnosed from January 1, 2013, to December 31, 2016, from the National Cancer Database. Patients who did not have documentation regarding immunotherapy receipt were excluded. Data analysis was performed from July 1, 2019, to December 15, 2019.

          Exposure

          Receipt of immunotherapy.

          Main Outcomes and Measures

          The primary outcome was the association of receipt of immunotherapy as first-line therapy with sociodemographic factors. The secondary outcome was overall survival by receipt of immunotherapy.

          Results

          A total of 9512 patients (mean [SD] age, 65.1 [14.4] years; 6481 [68.1%] male; 9217 [96.9%] White) met the criteria for treatment analysis. A total of 3428 (36.0%) received immunotherapy, and 6084 (64.0%) did not. Increasing age (odds ratio [OR], 0.98; 95% CI, 0.97-0.98; P < .001) and increasing Charlson-Deyo comorbidity index (OR, 0.86; 95% CI, 0.80-0.92; P < .001) were associated with lower odds of receiving immunotherapy on regression analysis. Diagnosis in Medicaid expansion states (OR, 1.16; 95% CI, 1.05-1.27; P = .003), treatment at an academic or integrated cancer network program (OR, 1.59; 95% CI, 1.45-1.75; P < .001), and residence within the highest quartile of high school graduation rate zip code area (OR, 1.31; 95% CI, 1.09-1.56; P = .003) were associated with an increased likelihood of receiving immunotherapy. Median overall survival was 10.1 months (95% CI, 9.6-10.6 months) among all patients. Patients who received first-line immunotherapy had a median overall survival of 18.4 months (95% CI, 16.6-20.1 months) compared with 7.5 months (95% CI, 7.0-7.9 months) ( P < .001) among patients who did not.

          Conclusions and Relevance

          In this cohort study, patients who received immunotherapy for metastatic melanoma had improved overall survival. Residence in Medicaid expansion states, younger age, low comorbidity index, care at academic medical centers or integrated network cancer programs, and residence in zip codes within the highest quartile of high school graduation were associated with an increased likelihood of receiving immunotherapy. Recognizing sociodemographic associations with treatment receipt is important to identify potential barriers to treatment.

          Abstract

          This cohort study examines the sociodemographic factors associated with immunotherapy receipt in patients with metastatic melanoma in the era of immune checkpoint inhibitors and the Patient Protection and Affordable Care Act in the US.

          Related collections

          Most cited references27

          • Record: found
          • Abstract: found
          • Article: not found

          Final version of 2009 AJCC melanoma staging and classification.

          To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database. The melanoma staging recommendations were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria. Findings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm(2)), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level. Using an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Treatment of metastatic melanoma: an overview.

            The 10-year survival rate for patients with metastatic melanoma is less than 10%. Although surgery and radiation therapy have a role in the treatment of metastatic disease, systemic therapy is the mainstay of treatment for most patients. Single-agent chemotherapy is well tolerated but is associated with response rates of only 5% to 20%. Combination chemotherapy and biochemotherapy may improve objective response rates but do not extend survival and are associated with greater toxicity. Immunotherapeutic approaches such as high-dose interleukin-2 are associated with durable responses in a small percentage of patients. In this article, we review the treatments for metastatic melanoma including promising investigational approaches.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Survival Outcomes in Patients With Previously Untreated BRAF Wild-Type Advanced Melanoma Treated With Nivolumab Therapy

              This analysis provides long-term follow-up in patients with BRAF wild-type advanced melanoma receiving first-line therapy based on anti-programmed cell death 1 receptor inhibitors.
                Bookmark

                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                2 September 2020
                September 2020
                2 September 2020
                : 3
                : 9
                : e2015656
                Affiliations
                [1 ]Division of Hematology and Oncology, Department of Internal Medicine, Loma Linda University, Loma Linda, California
                [2 ]Department of Internal Medicine, Loma Linda University, Loma Linda, California
                [3 ]School of Public Heath, Loma Linda University, Loma Linda, California
                Author notes
                Article Information
                Accepted for Publication: June 20, 2020.
                Published: September 2, 2020. doi:10.1001/jamanetworkopen.2020.15656
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Moyers JT et al. JAMA Network Open.
                Corresponding Author: Justin T. Moyers, MD, Division of Medical Oncology and Hematology, Department of Internal Medicine, Loma Linda University, 11175 Campus St, Room CSP 11015, Loma Linda, CA 92354 ( justintmoyers@ 123456gmail.com ).
                Author Contributions: Drs Moyers and Shih had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Moyers, Nagaraj.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Moyers, Patel, Nagaraj.
                Critical revision of the manuscript for important intellectual content: Moyers, Shih, Nagaraj.
                Statistical analysis: Moyers, Shih.
                Supervision: Nagaraj.
                Conflict of Interest Disclosures: Dr Moyers reported receiving travel reimbursement from Astellas Pharmaceuticals outside the submitted work. No other disclosures were reported.
                Funding/Support: Loma Linda Graduate Medical Education provided funding for statistical analysis.
                Role of the Funder/Sponsor: Loma Linda Graduate Medical Education had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Disclaimer: The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods used or the conclusions drawn from these data.
                Article
                zoi200582
                10.1001/jamanetworkopen.2020.15656
                7489862
                32876684
                a6fcd9a9-1c1a-4568-bb3f-553a08ef12b6
                Copyright 2020 Moyers JT et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 31 March 2020
                : 20 June 2020
                Categories
                Research
                Original Investigation
                Online Only
                Health Policy

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