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Racial & Ethnic Disparities in Treatment Refusal for Head & Neck Cutaneous Malignancies
Introduction: Despite comprising the minority of patients diagnosed with skin cancers, racial and ethnic minority groups experience worse prognoses and are at increased risk for adverse outcomes compared to non-Hispanic, White patients. We aim to quantify disparities in treatment-associated outcomes across race and ethnicity for patients with cutaneous malignancies of the head and neck. Methods: We analyzed patients diagnosed with melanoma and nonmelanoma skin cancers between 2010 to 2021 using data from the National Cancer Database (NCDB). The primary outcome variable, treatment refusal, was examined via logistic regression. Secondary variables included days from diagnosis to treatment, tumor depth, and mortality. These were analyzed using multi-way ANOVA and binary logistic regression. Results: Of 151,733 patients analyzed, most were non-Hispanic White (99%) and male (71%). Black patients had the greatest odds of treatment refusal (4.166, 95% CI: 2.054-8.452, p<0.001) across all cutaneous malignancies of the head and neck. Black and Hispanic patients also had increased times from diagnosis to treatment (p<0.001). Black patients had a higher odd of 90-day mortality compared to non-Hispanic White patients (p<0.001). This coincided with greater tumor depth in Black and Hispanic patients compared to non-Hispanic White patients (p<0.001). Conclusions: Black patients are more likely to refuse treatment for cutaneous head and neck malignancies overall and both Black and Hispanic patients experience more treatment delays. These findings may relate to the increased 90-day mortality among Black patients and increased tumor depth for both Black and Hispanic patients. Further investigation into quality of life and functional impairment are warranted alongside culturally sensitive interventions to reduce these disparities.