In a comprehensive national database study investigating how social determinants of health may relate to ocular oncology, factors including lower income, Medicare insurance status, and rural residency were found to be associated with more severe ocular tumor presentations and a higher likelihood of 30-day readmission. While additional studies are needed, these findings suggest possible socioeconomic barriers to care for certain patients with ocular malignancies.
Study Design
Using ocular oncology data included in the US National Cancer Database, this multicenter, retrospective cohort study analyzed 3968 cases of uveal melanoma, 352 cases of conjunctival melanoma, and 480 cases of retinoblastoma diagnosed between January 2006 and December 2017 to assess the possible relationships between social determinants of health and ocular cancer. Primary factors evaluated included age, sex, race, insurance status, income, population density, care facility, and comorbidities as related to tumor characteristics, treatment course, and overall survival.
Outcomes
A decreased likelihood of having an advanced tumor classification at presentation was seen in females, patients in the top 3 income quartiles (particularly the highest quartile, relative to the lowest), and patients with private insurance (vs Medicaid or no insurance). Readmission within 30 days after initial treatment was more likely among patients living in rural areas than among those living in metropolitan or urban areas. Older age, chemotherapy, history of malignancy, and advanced classification at presentation were associated with lower overall survival.
Limitations
Given that most patients included in this study were diagnosed with uveal melanoma, the study’s 5-year follow-up duration may not have been long enough to detect a significant association with overall survival. The high proportion of uveal melanoma cases also means findings may not be generalizable across different types of ocular cancers.
Clinical Significance
Enhanced screening efforts for ocular malignancies, particularly among patients with certain barriers to care (e.g., lack of insurance or living in a rural area), may improve treatment outcomes. Additional public health initiatives focused on these barriers could help to provide more equitable patient care in ocular oncology.
Financial Disclosures: Dr. Michael Heiferman discloses no financial relationships.