Racial and facility distance disparities in time to surgical treatment for sebaceous carcinoma

Summary: Abstract Body: This study investigates sociodemographic, tumor, and hospital factors associated with delays in time to definitive surgical treatment (TTDS) for sebaceous carcinoma, with the aim of identifying strategies to improve equity in care for this rare but aggressive skin cancer with increasing incidence. This retrospective study analyzed 2004–2021 National Cancer Database, where multivariable logistic regression evaluated characteristics impacting TTDS and multivariable linear regression estimated days contributed to delays. Among 4,496 SC patients identified in the NCDB, 242 (5.38%) were non-Hispanic Black (NHB). NHB patients experienced longer TTDS (10.6 days, P < 0.001) and time to radiation (59.2 days, P < 0.001) compared to non-Hispanic White (NHW) patients, despite living closer to hospitals (P < 0.001). NHB race was associated with higher odds of >90 days TTDS (aOR 1.58; P = 0.022). NHB race, Medicaid insurance, and treatment at academic facilities uniquely contributed 12.70 (p<0.001), 17.72 (p<0.01), and 5.51 (p=0.001) additional days of delay. Distance to the hospital of 40-59 miles and more than 60 miles were also independently associated with 8.97 (p=0.001) and 5.96 (p<0.01) additional days of delay. TTDS disparities for NHB and Medicaid-insured patients highlight inequities in SC care. Novel findings include incorporating facility type and distance when evaluating TTDS. Addressing these disparities through improved transportation programs, outreach to black communities, and increased coordination may enhance timely treatment and SC outcomes. Arya Patel¹, Omkar Pawar², Jeremy S. Bordeaux^{3, 4} 1. Case Western Reserve University, Cleveland, OH, United States. 2. Surgery, University Hospitals, Cleveland, OH, United States. 3. Dermatology, University Hospitals, Cleveland, OH, United States. 4. Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, United States. Clinical Research: Epidemiology and Observational Research