Socioeconomic status tied to low use of adjuvant immunotherapy in stage III melanoma

Patients with stage III melanoma show inconsistent use of adjuvant immunotherapy despite its survival benefits, according to a study.

A team of investigators accessed the National Cancer Database to identify patients with nonmetastatic cutaneous melanoma who underwent surgical resection and sentinel lymph node biopsy (SLNB) with tumour involvement from 2015 to 2020.

The rates of adjuvant immunotherapy among patients were calculated based on patient, tumour, and facility variables, including insurance status, socioeconomic status, pathologic stage (IIIA–IIID), and treatment facility type and volume.

Use of adjuvant immunotherapy resulted in improved survival in patients with stage III melanoma, with a slight increase in 5-year overall survival in those with stage IIIA (87.9 percent vs 85.9 percent; p=0.044) and a higher increase in patients with stages IIIB–IIID disease (70.3 percent vs 59.6 percent; p<0.001).

However, older patients, those with low socioeconomic status (SES), and uninsured individuals were less likely to receive adjuvant immunotherapy.

Notably, low-volume and community cancer centres had higher rates of adjuvant immunotherapy overall for stage III patients, but the opposite was true for high-volume and academic centres, which had lower use of adjuvant immunotherapy for patients with stage IIIA versus stages IIIB–IIID disease.

“[T]here was a lower use of adjuvant immunotherapy in patients of lower SES and those treated at high-volume centres,” the investigators said. “Equity in access to novel standards of care represents an opportunity to improve outcomes for patients with melanoma.”