Adamson AS, et al. - An exploration was effectuated of the factors connected with delays between the diagnosis and surgery of melanoma in patients with Medicare, Medicaid, or private insurance. It was disclosed that delays in surgical treatment were common but were less prevalent in patients diagnosed or surgically treated by a dermatologist. A majority of the surgical delays were reported by the Medicaid patients. A better access to speciality care and cross-disciplinary coordination could assist in reducing the delays in melanoma surgery.

Methods

• The plot of this trial was a retrospective cohort study.
• It included patients who received a diagnosis of melanoma between 2004 and 2011 in North Carolina.
• Data was extracted from the North Carolina Cancer Registry linked to administrative claims from Medicare, Medicaid, and private insurance.
• Inclusion criteria comprised of incident patients with a diagnosis of melanoma stage 0 to III and with continuous insurance enrollment, from at least 1 month prior to the month of diagnosis to 12 months after diagnosis of melanoma.
• The main measure comprised of surgical delay, defined as definitive surgical excision occurring more than 6 weeks after melanoma diagnosis.
• Generalized linear models with log link, Poisson distributions, and robust standard errors computed the adjusted risk ratios (RRs) to model risk of delay in definitive surgery.

Results

• 7629 patients were recruited (4210 [55%] female; mean [SD] age, 64 [15] years), 48% (n = 3631) Medicare, 48% (n = 3667) privately insured, and 4% (n = 331) Medicaid patients.
• Privately insured patients exhibited least likelihood of experiencing a delay in definitive surgery, followed by Medicare and Medicaid patients (519 [14%], 609 [17%], and 79 [24%], respectively; P < .001).
• A substantial rise was noted in the risk of surgical delay with Medicaid compared with private insurance (RR, 1.36; 95% CI, 1.09-1.70), following demographic adjustment.
• The nonwhite patients (RR, 1.38; 95% CI, 1.02-1.87) demonstrated greater tendency of delays.
• Surgical delays appeared to be less likely if the physician performing the surgery (RR, 0.82; 95% CI, 0.72-0.93) or the diagnosing clinician (RR, 0.81; 95% CI, 0.71-0.93) was a dermatologist than with a nondermatologist.