Associations of Social and Demographic Factors on the Outcomes of Ocular Melanoma and Other Adult Ocular Neoplasms in the United States: A Systematic Review

TL;DR

This review shows that social and economic factors strongly affect diagnosis and survival rates for rare eye cancers in the U.S., with disadvantaged groups facing worse outcomes.

Contribution

The study systematically reviews how social determinants of health influence outcomes for rare adult ocular cancers in the U.S., highlighting disparities and potential interventions.

Findings

Lower socioeconomic status and public/no insurance are linked to later cancer stages and worse survival.

Racial and ethnic minorities face similar disadvantages in diagnosis and treatment outcomes.

Higher income and private insurance are associated with earlier diagnosis and better recovery chances.

Abstract

Social determinants of health (SDOH), including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context, shape gaps in health outcomes across many conditions. Ocular neoplasms are no exception. Cancers such as uveal melanoma, conjunctival squamous cell carcinoma, ocular lymphoma, and ocular Kaposi sarcoma may be especially vulnerable to social and demographic influences. We systematically reviewed documented associations between SDOH and these ocular cancers in the United States.

Following a pre‐registered protocol, we searched MEDLINE, Embase, and Web of Science (from January 2000 to November 2023) for primary studies of any design that evaluated one or more relationships between SDOH and outcomes related to the ocular cancers listed above. Outcomes included cancer incidence, stage at diagnosis, treatment patterns, survival, and mortality. We extracted study design, population, exposure, and outcome characteristics, classified each exposure‐outcome association by its direction (e.g., favorable, unfavorable, or null), and assessed the risk of bias using a modified Newcastle‐Ottawa Scale. Due to heterogeneity in exposure and outcome definitions, we narratively synthesized findings by SDOH domain.

We included 21 studies examining 167 unique associations. Social and community context, typically represented as race and ethnicity, was the most frequently studied domain, followed by economic stability (e.g., income) and healthcare access and quality (e.g., insurance type or travel distance). Across domains, lower socioeconomic status, public or no insurance, minority racial and ethnic identity, and care at academic centers generally are associated with later stage at diagnosis, higher odds of enucleation, or worse survival. Higher income, private insurance, and treatment at experienced facilities were often associated to earlier presentation and better outcomes.

SDOH have a measurable and often unfavorable relationship with the diagnosis, management, and prognosis of rare adult ocular cancers in the United States. Standardized SDOH exposures and measurements, prospective data collection, and adjustment for confounding are necessary to strengthen the evidence and guide multi‐domain interventions (e.g., expanded insurance, travel assistance to high‐volume centers, and community eye‐health initiatives) aimed at narrowing these gaps.

Not everyone with eye cancer in the United States receives the same quality of care. This review examined how social and economic factors affect survival and treatment outcomes for people with rare eye cancers (including uveal melanoma, ocular lymphoma, conjunctival squamous cell carcinoma, and ocular Kaposi sarcoma) by bringing together findings from 21 studies.

We found that patients with lower incomes, less education, or public or no health insurance were more likely to be diagnosed at a later stage, more likely to have their eye surgically removed, and less likely to survive. People from racial or ethnic minority groups faced similar disadvantages. In contrast, patients with higher incomes and private insurance tended to be diagnosed earlier and have better chances of recovery.

These findings make clear that where you start in life can shape where you end up in your cancer journey and that this is not inevitable. Improving access to health insurance, helping patients navigate their way to specialist care centers, and investing in community health education could all help close these gaps. People with eye cancer deserve the same chance of early diagnosis and effective treatment, regardless of their income, insurance status, or background.

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