Impact of Social Determinants of Health on Melanoma Nodal Surveillance in a Multi-institutional Cohort

Kelsey B Montgomery; M Chandler McLeod; Danielle K DePalo; Michelle M Dugan; Jonathan S Zager; Kelly M Elleson; Michael S Sabel; Tina J Hieken; Lisa A Kottschade; David W Ollila; Veronica Pham; Dion Archer; Russell S Berman; Ann Y Lee; Jessica A Cintolo-Gonzalez; Hannah G McDonald; Sydney Winchester; Erin E Burke; Kristen E Rhodin; Georgia M Beasley; Kristy K Broman

doi:10.1245/s10434-024-16498-w

Impact of Social Determinants of Health on Melanoma Nodal Surveillance in a Multi-institutional Cohort

Ann Surg Oncol. 2024 Nov 22. doi: 10.1245/s10434-024-16498-w. Online ahead of print.

Authors

Kelsey B Montgomery¹, M Chandler McLeod², Danielle K DePalo³, Michelle M Dugan³, Jonathan S Zager³, Kelly M Elleson³, Michael S Sabel⁴, Tina J Hieken⁵, Lisa A Kottschade⁵, David W Ollila⁶, Veronica Pham⁶, Dion Archer⁶, Russell S Berman⁷, Ann Y Lee⁷, Jessica A Cintolo-Gonzalez⁸, Hannah G McDonald⁹, Sydney Winchester⁹, Erin E Burke^{9

10}, Kristen E Rhodin¹¹, Georgia M Beasley¹¹, Kristy K Broman^{2

12

13}

Affiliations

¹ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. kmontgomery@uabmc.edu.
² Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
⁴ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Surgery, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
⁷ Department of Surgery, NYU Langone Health, New York, NY, USA.
⁸ Department of Surgery, University of Vermont, Burlington, VT, USA.
⁹ Department of Surgery, University of Kentucky, Lexington, KY, USA.
¹⁰ Department of Surgery, Ohio State University, Columbus, OH, USA.
¹¹ Department of Surgery, Duke University Medical Center, Durham, NC, USA.
¹² Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
¹³ Department of Veterans Affairs, Birmingham VA Medical Center, Birmingham, AL, USA.

PMID: 39576454
DOI: 10.1245/s10434-024-16498-w

Abstract

Background: Nodal surveillance (NS) has overtaken completion lymphadenectomy as the preferred management for sentinel node-positive (SLN+) melanoma, but requires frequent exams and nodal ultrasound (US). Social determinants of health (SDoH) may affect US adherence in real-world populations, and evaluation of these potential impacts is needed.

Methods: Adults with SLN+ melanoma diagnosed from July 2017 to December 2019 who received NS at nine cancer centers were identified retrospectively. Exposures included insurance status, travel distance, and Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), a validated measure of area-level SDoH, indicated as 0 (low) to 1 (high) vulnerability. The primary outcome was US adherence (≥ 1 study per 6-month follow-up interval). The secondary outcomes were combined-modality adherence [US, computed tomography (CT), or positron emission tomography (PET)] and loss to follow-up (LTFU). Bivariate analyses and mixed-effects multivariable logistic regression were performed.

Results: Most of the 519 patients were male (57%), non-Hispanic white (94.4%), and insured privately (45.3%) or by Medicare (43.5%). The median travel distance was 63.3 miles (interquartile range [IQR], 31.2-111.0 miles), and the median SVI was 0.426 (IQR, 0.253-0.610). The surveillance adherence rates were 41.6% for US and 75.1% for combined modalities. No significant differences in US adherence were observed based on sociodemographic covariates in regression analysis. Medicaid (odds ratio [OR], 3.12; p = 0.02) and uninsured (OR 4.48; p = 0.01) patients had increased likelihood of LTFU.

Conclusions: Less than half of the patients in this multicenter cohort achieved US adherence, although the rates improved with combined modalities. Medicaid or non-insurance were social risk factors for LTFU. Optimizing surveillance practices for socially vulnerable groups will be crucial for the ongoing real-world implementation of NS.

Keywords: Melanoma; Nodal surveillance; Sentinel node positive; Social determinants of health.

Abstract

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