The COVID-19 Pandemic and Delays in Melanoma Treatment: A National Cancer Database Study

Abstract

Introduction

Timely treatment for patients with melanoma is critical. This study evaluated associations between the COVID-19 pandemic and time to treatment for patients with melanoma and delineated factors associated with delayed treatment.

Methods

Using the National Cancer Database, patients with cutaneous melanoma were categorized using year of diagnosis: COVID era (2020) versus pre-COVID era (2018-2019). Multivariable logistic regression was used to estimate the odds of delayed time to surgery (DTS) and/or chemoimmunotherapy (DTC), defined as >30 d.

Results

Among 72,590 patients with melanoma, 71.2% were diagnosed in the pre-COVID era (25,210 in 2018; 26,471 in 2019) compared to 28.8% diagnosed in the 2020 COVID era. Of the COVID era patients, 40.4% received COVID-19 testing, with 5.7% having a positive result. COVID era patients were diagnosed at a later stage (3 and 4), 7.4% versus 6.6%. While overall DTS decreased for COVID era patients, a higher proportion of patients tested for COVID experienced longer DTS. In multivariable logistic analysis, male sex, Black race, Hispanic ethnicity, uninsured or underinsured status, less education, stage > 1, and treatment locations in the Northeast, West, and South were associated with DTS. COVID era diagnosis was not associated with DTC; however, uninsured or underinsured status and treatment in the South were associated with DTC.

Conclusions

The pandemic was not associated with overall delays in treatment for melanoma; however, vulnerable populations and certain geographic areas experienced disproportionate differences in treatment timing. The potential long-term associations between delayed treatment and outcomes warrant further investigation, especially for marginalized populations.