Melanoma surgery delays are common for Medicare patients

One in five Medicare patients with melanoma experience delays in getting surgery, a Yale study found.

The research was published April 8 in JAMA Dermatology.

Melanoma, a type of skin cancer, is a leading cause of new cancer diagnoses in the United States. A delay between diagnosis and surgery to remove melanomas may cause patients psychological harm and affect health-care quality. Using the national Surveillance, Epidemiology, and End Result-Medicare database, the Yale team conducted the first population-based analysis of delay of surgery among Medicare patients with melanoma. 

The researchers reviewed data on more than 32,000 Medicare patients diagnosed with melanoma. They found that 22% of patients waited longer than 1.5 months for melanoma surgery, and 8% were delayed more than 3 months. Although no gold standard exists, a timeframe of less than six weeks between diagnosis and surgery has been recommended.

“Delay for melanoma surgery in this population is more common than we expected,” said Jason Lott, M.D., who was first author of the study as postdoctoral fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at Yale School of Medicine.

Delays were most common for patients who were treated by providers who were not dermatologists — such as primary care physicians or general surgeons. That particular finding may point to opportunities to increase coordination of care between providers who diagnose and treat melanoma patients, said the researchers.

The study revealed significant variation in the timing of melanoma surgery for Medicare patients after diagnosis. “We are working to identify reasons for delay in the time it takes for patients to get surgery,” said Lott. “That information will help ensure that we are delivering more prompt and patient-centered surgical care.”

Other Yale authors include Dr. Deepak Narayan, Pamela R. Soulos, Dr. Jenerius Aminawung, and Dr. Cary P. Gross.

The study was supported in part by the Robert Wood Johnson Foundation and developmental funding from the P30 Cancer Center Support Grant at Yale Cancer Center.

Citation: JAMA Dermatology

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