INTRODUCTION
Melanoma is the fifth most common cancer in men and women in the United States (US), with an estimated 97,610 new cases in the year 2023.1 Although it accounts for only 1% of skin cancers, melanoma causes a majority of skin cancer deaths.2 When diagnosed at an early stage, surgical excision can be curative. Whereas the 5-year relative survival rate for localized disease is 99%, it drops to only 50% for distant metastatic disease.3,4 For patients with advanced stage melanoma, having access to immunotherapy significantly increases the odds of survival. For example, with the Food and Drug Administration (FDA) approval of ipilimumab (anti-CTLA-4 antibody) in 2011, patients with metastatic melanoma demonstrated significantly improved overall survival, with a median survival exceeding 60 months.4-6 Although immune checkpoint inhibitors (ICI) and targeted therapy have become the standard of care for metastatic melanoma, emerging evidence of disparities in access to immunotherapy for the treatment of melanoma has been documented (Table 1).
Health care disparities prevail across all aspects of cancer and cancer treatment, including melanoma. These disparities arise from social, economic, and environmental factors otherwise known as the social determinants of health (SDOH). Understanding, recognizing, and addressing SDOH is crucial. A study conducted by the Joint Center for Political and Economic Studies concluded that by eliminating health disparities among minoritized groups, direct medical expenditures would have been reduced by $229.4 billion for the years 2003-2006.7
Herein, we review the effects of various SDOH as they relate to melanoma, as well as their association with the utilization of immunotherapy for the treatment of melanoma in the US. The PubMed database was searched independently by 3 reviewers for studies published prior to May 2023. Only studies specifically evaluating disparities in access to immunotherapy for the treatment of melanoma were included. Search terms included health disparities, sociodemographic factors, racial health disparities, melanoma, immunotherapy, and ICIs. A total of 46 results were then manually filtered to exclude unrelated topics and non-English written studies. This approach led to a total of 10 relevant studies. With this narrative review, our goal is to provide insight into the disparities that occur to access these novel treatments for this devastating disease.
Health care disparities prevail across all aspects of cancer and cancer treatment, including melanoma. These disparities arise from social, economic, and environmental factors otherwise known as the social determinants of health (SDOH). Understanding, recognizing, and addressing SDOH is crucial. A study conducted by the Joint Center for Political and Economic Studies concluded that by eliminating health disparities among minoritized groups, direct medical expenditures would have been reduced by $229.4 billion for the years 2003-2006.7
Herein, we review the effects of various SDOH as they relate to melanoma, as well as their association with the utilization of immunotherapy for the treatment of melanoma in the US. The PubMed database was searched independently by 3 reviewers for studies published prior to May 2023. Only studies specifically evaluating disparities in access to immunotherapy for the treatment of melanoma were included. Search terms included health disparities, sociodemographic factors, racial health disparities, melanoma, immunotherapy, and ICIs. A total of 46 results were then manually filtered to exclude unrelated topics and non-English written studies. This approach led to a total of 10 relevant studies. With this narrative review, our goal is to provide insight into the disparities that occur to access these novel treatments for this devastating disease.
