Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Melanoma Surgery Delays Linked with Insurance Type

JAMA Dermatol; ePub 2017 Oct 4; Adamson, et al

Surgical treatment delays were common but were less prevalent in patients diagnosed or surgically treated by a dermatologist, according to a recent study, with Medicaid patients experiencing the most surgical delays. Researchers evaluated a retrospective cohort study of patients (n=7,629) who received a diagnosis of melanoma between 2004 and 2011 using data from the North Carolina Cancer Registry linked to administrative claims from Medicare, Medicaid, and private insurance. Inclusion criteria were 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. They found:

  • Privately insured patients were least likely to experience a delay in definitive surgery, followed by Medicare and Medicaid patients (519 [14%], 609 [17%], and 79 [24%], respectively).
  • After demographic adjustment, the risk of surgical delay was significantly increased in patients with Medicaid compared with private insurance.
  • Delays were more likely in non-white patients.
  • Surgical delays were less likely if the physician performing the surgery or the diagnosing clinician was a dermatologist as compared with a non-dermatologist.

Citation:

Adamson AS, Zhou L, Baggett CD, Thomas NE, Meyer A-M. Association of delays in surgery for melanoma with insurance type. [Published online ahead of print October 4, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.3338.