Disparities in the occurrence of late effects following treatment among adolescent and young adult melanoma survivors

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Cancer Epidemiol Biomarkers Prev. 2020 Aug 20:cebp.0427.2020. doi: 10.1158/1055-9965.EPI-20-0427. Online ahead of print.


BACKGROUND: Melanoma is the third most common cancer in the adolescent and young adult (AYA) population, however no studies have addressed the occurrence of adverse health conditions following melanoma treatment in these survivors.

METHODS: Patients age 15-39 diagnosed with cutaneous melanoma from 1996-2012 and surviving ≥2 years were obtained from the California Cancer Registry and linked to statewide hospitalization data. The influence of age at diagnosis, sex, race/ethnicity, neighborhood socioeconomic status (SES), health insurance, and surgery on the development of adverse health conditions was evaluated using Cox proportional hazards regression models.

RESULTS: Of 8,259 patients, 35.3% were male, 83.3% non-Hispanic white, 82.4% had private health insurance, and 60.5% were considered high SES. In Cox regression models, males had an increased risk of developing adverse health conditions across all systems, including cardiac [Hazard Ratio (HR):1.73, 95% Confidence Interval (CI) 1.47-2.03], lymphedema (HR:1.56, CI 1.37-1.77), hematologic disorders (HR:1.17, 95%CI 1.03-1.33), major infection/sepsis (HR:1.59, CI 1.39-1.82), and second cancers (HR:1.51, CI 1.31-1.74). Patients with public/no insurance (vs. private) had a greater risk of developing all studied adverse health conditions, including subsequent cancers (HR:2.34, CI 1.94-2.82). AYA patients residing in low SES neighborhoods had similar increased risk of developing adverse health conditions.

CONCLUSIONS: Of AYA melanoma survivors, males, those with public/no health insurance, and those living in low SES neighborhoods had a greater likelihood of developing of adverse health conditions.

IMPACT: Strategies to improve surveillance and secondary prevention of these adverse health conditions is needed among AYA melanoma survivors, specifically the at-risk populations identified.

PMID:32856613 | DOI:10.1158/1055-9965.EPI-20-0427