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Effects of treatment methods on cutaneous melanoma related mortality and all-cause mortality in Texas: TCR-Medicare 2007–2017 database

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Abstract

Purpose

The incidence of cutaneous melanoma is rising, and Melanoma related deaths are highest among people aged 65–74. Herein, we aim to understand the impact of novel and established melanoma treatment methods on CM related mortality and all-cause mortality. We further compared these effects among Hispanic and non-Hispanic Whites (NHW).

Methods

The data was extracted from the Texas Cancer Registry from 2007 to 2017. A Cox Proportional Hazard regression analysis was performed to assess treatment effect on melanoma mortality and all-cause mortality, with race-ethnicity as an effect modifier.

Results

A higher percentage of Hispanic patients presented with CM-related mortality (22.11%) compared to NHW patients (14.39%). In both the Hispanic and NHW, post-diagnosis radiation (HR = 1.610, 95% CI 0.984–2.634, HR = 2.348, 95% CI 2.082–2.648, respectively), post-diagnosis chemotherapy (HR = 1.899, 95% CI 1.085–3.322, HR = 2.035, 95% CI 1.664–2.489, respectively), and post-diagnosis immunotherapy (HR = 2.100, 95% CI 1.338–3.296, HR = 2.402, 95% CI 2.100–2.748) are each associated with an increased risk in CM-related mortality. Similar results were seen with post-diagnosis radiation (Hispanic HR = 1.640, 95% CI 1.121–2.400, NHW HR = 1.800, 95% CI 1.644–1.971), post-diagnostic chemotherapy (Hispanic HR = 1.457, 95% CI 0.898–2.364, NHW HR = 1.592, 95% CI 1.356–1.869), and post-diagnosis immunotherapy (Hispanic HR = 2.140, 95% CI 1.494–3.065, NHW HR = 2.190, 95% CI 1.969–2.435) with respect to all-cause mortality. Post-diagnosis surgery (HR = 0.581, 95% CI 0.395–0.856, HR = 0.622, 95% CI 0.571–0.678) had the opposite effect in CM-related mortality for Hispanics and NHWs respectively.

Conclusion

Our results propose differences in all-cause and CM-only related mortality with separate treatment modalities, particularly with chemotherapy, radiation therapy and immunotherapy. In addition, this retrospective cohort study showed that health disparities exist in the Hispanic Medicare population of Texas with CM.

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Abbreviations

(US):

United States

(FDA):

US Food and drug administration

(PCP):

Primary care physician

(SEER):

Surveillance, epidemiology, and end results

(ALS):

Amyotrophic lateral sclerosis

(TCR):

Texas cancer registry

(CI):

Confidence interval

(MEK):

Mitogen-activated protein kinase

(TLR7/8):

Toll-like receptor 7 and 8

(TNF):

Tumor necrosis factor

(DMAC):

Data management and analysis core

(CM):

Cutaneous melanoma

(NHW):

Non-Hispanic White

(HMO):

Health maintenance organization

(cci):

Charlson’s comorbidity index

(PH):

Cox proportional hazard

(E&M):

Evaluation and management

(HR):

Hazard ratio

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Acknowledgements

Texas cancer data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756 (www.dshs.texas.gov/tcr). Data from the Texas Cancer Registry is supported by the following: Cooperative Agreement #1NU58DP007140 from the Centers for Disease control and Prevention, Contract #75N91021D00011 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, and the Cancer Prevention and Research Institute of Texas.

Funding

Jessica Chacon and David S. Lopez were supported by Cancer Prevention and Research Institute of Texas (CPRIT), Grant #: RP210130. Cancer Prevention and Research Institute of Texas, RP210130

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Author notes

  1. David S. Lopez and Jessica Chacon have contributed equally as Senior Authors.

Authors and Affiliations

  1. Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA

    Fabiola Ramirez, Hannah Riva, Michelle Samaniego, Lorena Fernandez, Sara Mansour & Jessica Chacon

  2. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA

    Biai Digbeu & David S. Lopez

  3. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Rebecca Vasquez

  4. Department of Epidemiology, Medical Branch, The University of Texas, 301 University Blvd., Galveston, TX, 77555, USA

    David S. Lopez

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  1. Fabiola Ramirez
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Contributions

FR: Investigation, Project administration, Writing—Original draft preparation HR: Writing—Review and editing BD: Writing—Review and editing, Investigation MS: Writing – Review and editing LF: Writing—Review and editing SM: Writing—Review and editing RV: Writing—Review and editing DSL: Conceptualization, Supervision, Writing—Review and editing JC: Conceptualization, Supervision, Writing—Review and editing.

Corresponding authors

Correspondence to David S. Lopez or Jessica Chacon.

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The authors declare no funding, employment, financial or non-financial interests to disclose.

Ethical approval

The secondary data analysis was approved by Institutional review Board at the Texas Tech University Health Sciences Center El Paso, El Paso, TX, IRB#00009946.

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Appendices

Appendix

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Table 4 Treatment HCPCS/CPT and NDC codes
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Ramirez, F., Riva, H., Digbeu, B. et al. Effects of treatment methods on cutaneous melanoma related mortality and all-cause mortality in Texas: TCR-Medicare 2007–2017 database. Cancer Causes Control 35, 265–275 (2024). https://doi.org/10.1007/s10552-023-01780-1

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