Identifying modifiable factors that reduce the burden of late stage melanoma in Hispanics

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Project Summary Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. In our recent analysis, while the risk of presenting with a late stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g. ability to access treatment) once they are diagnosed. A later stage of diagnosis among Hispanics could be due to a multitude of factors all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. The key question remaining to be answered is WHY Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test and implement effective interventions to improve earlier detection and reduce melanoma-related disparities for Hispanics. We will investigate modifiable factors related to diagnosis at later stage in Hispanics compared to NHW. Aim 1: Determine the roles of patient-perceived risk and knowledge of melanoma, perceived barriers to melanoma screening and diagnosis, patient access to screening and diagnosis, and cultural factors in determining the later stage at diagnosis of melanoma in Hispanic compared to NHW melanoma patients. Aim 2: Determine how, when and by whom melanomas are diagnosed (among Hispanics and NHW) and what factors are related to time delays in the diagnosis of melanoma. Aim 3: Develop, deliver and test a clinic-based health education telenovela intervention designed to achieve earlier diagnosis of melanoma among Hispanics. We will obtain data from multiple sources for this study in order to minimize the potential impact of selection, response and survival biases all of which would compromise the scientific rigor of our Approach. We will identify the key factors resulting in late diagnosis of melanoma among Hispanics to provide truly population- based data on HOW to develop targeted patient-and-systems level interventions to reduce the melanoma burden among Hispanics. We will then test targeted patient-and-physician level interventions carried out in low income primary care setting ensuring that we intervene at the earliest possible stage.