Do Racial/Ethnic Disparities in Rates of Enucleation for Uveal Melanoma Indicate Poor Quality of Care or Financial Obstacles?
Bertil Damato, MD, PhDRead More
To the Editor Rajeshuni et al1 examined the association of race/ethnicity and socioeconomic status with uveal melanoma treatment by performing a retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registries in the US. They reported that treatment consisted of primary enucleation in 27% of non-White individuals compared with 20% of non-Hispanic White individuals and in 27% of individuals in a lower socioeconomic group compared with 14% of those in a higher socioeconomic group. They concluded, “Given the consequences of enucleation, including postoperative vision loss, decreased quality of life, decreased functionality, and increased perceived stigma, efforts should be made to appropriately reduce differences in enucleation rates across populations.”1
Talhah Zubair, MD; Nitya Rajeshuni, MD, MS; Prithvi Mruthyunjaya, MD, MHS
In Reply We appreciate Damato’s interest in our work.1 We concur that there are a multitude of factors that impact treatment decisions in cancer care from all sides, including the patient, the medical team, and the structure of the health care system.2 It is our opinion that enucleation in uveal melanoma may, in many cases, be the most appropriate treatment for a particular tumor and may not represent a last-resort treatment even during a pandemic.3 The underlying premise behind our work is that there are no guidelines indicating that patients of different racial/ethnic or socioeconomic status (SES) groups should have their uveal melanoma managed differently. Yet on examination we found racial/ethnic and SES differences in enucleation rates. These incongruencies call for further investigation and may point to health care system–wide issues, such as access to care, health care costs, and treatment burden for different populations, as noted by our work and others.1,4 We marveled at the facilities provided by the British National Health System to afford transportation and accommodation for patients with eye cancer—a service generally not available to patients in the US. We would be interested to learn whether any of the treatment decisions could be attributed to race/ethnicity or SES in that population.