Differential melanoma outcomes in a regional VA center and a tertiary care center with shared physician staffing: A cohort study.

Abstract

Melanoma outcomes vary by subgroups. Identify institutional/systemic factors contributing to outcome differences. Retrospective cohort study of melanoma patients seen 1/1987-5/2023 at a VA center and nearby tertiary care center sharing providers. Outcomes include melanoma-specific survival (MSS) and mortality (MSM). Compared to the tertiary center (n=9,682, 5,564 males), VA patients (n=638, 612 males) were older and had a greater proportion of melanoma in situ (p<0.0001). When comparing VA males to males treated at the tertiary center, MSS was increased for localized melanoma (p=0.003), but decreased for regional (p=0.0002) and distant disease (p=0.02). When comparing VA males to VA-insured males at the tertiary center, MSS remained increased for localized disease (p<0.0001), but differences for regional or distant disease were no longer significant. Within the tertiary center, publicly insured patients had increased MSM compared to privately insured (Medicare, hazard ratio [95%CI] 1.46 [1.22,1.75]; Medicaid, 1.67 [1.28,2.18]; Military/VA 1.92 [1.15,3.20]). Smaller number of VA-insured patients. Differences in preventative screening and selective referrals may contribute to increased survival at the VA for early-stage melanoma. Insurance type within and between institutions is associated with differential mortality outcomes for advanced melanoma stages, indicating a need for additional care standardization.