Socioeconomic Factors in Uveal Melanoma Treatment and Survival in Veterans

Uveal melanoma (UM) is a rare but serious eye cancer. It has a high chance of metastatic spread, especially in advanced stages, which significantly worsens survival. In recent years, eye-sparing treatments, such as targeted radiation therapy, have become more common than enucleation (complete removal of the eye). However, these treatments are not always available to low-income patients or those who live in rural areas, where ophthalmologists or ocular melanoma experts may be limited.

Veterans can receive medically necessary care through the Veterans Affairs (VA) system, which offers free services for service-connected disabilities and reduced costs for non-service-connected care, based on priority groups determined from factors like military history, disability, and income. Veterans disproportionately live in rural areas, where disparities in cutaneous melanoma (CM) outcomes are more pronounced in civilians. However, this urban-rural disparity with CM has not been observed with veterans, suggesting that the VA’s care model may mitigate the impact of rurality and other socioeconomic factors on UM treatment and survival outcomes.

This study will use VA data to examine whether social vulnerability (measured by the Social Vulnerability Index, SVI) or area deprivation (measured by the Area Deprivation Index, ADI) significantly affect treatment patterns and survival outcomes in veterans with UM. These analyses will identify the relative contributions of socioeconomic vulnerabilities faced by the patient versus the area they live in to treatment selection and UM outcomes. Such knowledge can help guide targeted interventions to address treatment and survival disparities. If no significant differences in outcomes are found among veterans, it could suggest that the VA’s centralized care model reduces the effects of socioeconomic challenges on healthcare. These results could inform how similar approaches might be used to improve UM care in civilian healthcare systems.