Demographic, socioeconomic, and geographic predictors of treatment utilization and survival in Merkel cell carcinoma: an analysis of the national cancer database

Abstract Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with a mortality rate exceeding that of melanoma. While previous studies have examined frequencies, the influence of demographic factors on treatment likelihood and survival is limited. The National Cancer Database was used to identify patients diagnosed with MCC ( n = 20,078) between 2004 and 2021. Multivariable binomial logistic regression estimated predictors of surgery, radiation, and chemotherapy. Stage-adjusted Cox models evaluated overall survival (OS). Hispanic patients had lower odds of surgery (OR 0.731) and radiation (OR 0.824). Women were less likely to receive radiation (OR 0.907). Chemotherapy use declined with age (65–79: OR 0.568; ≥80: OR 0.220). Patients from higher-income areas were less likely to receive chemotherapy. Traveling > 50 miles increased odds of surgery (OR 1.247) but reduced odds of chemotherapy (OR 0.524) and radiation (OR 0.737). Female sex predicted lower mortality (HR 0.716). Private insurance (HR 0.565) and Medicare (HR 0.730) were protective compared to uninsured patients, while Medicaid was not. Higher income improved survival (≥$63,000: HR 0.876). Patients in smaller metropolitan or small urban areas had worse OS (HR 1.119 and 1.163, respectively). Traveling > 50 miles predicted improved OS (HR 0.786). In this nationwide stage-adjusted analysis of MCC, survival outcomes were influenced by age, sex, insurance, income, geography, and receipt of therapy, with notable treatment disparities among Hispanic patients. Targeted efforts to improve access to definitive and adjuvant therapy may help reduce survival inequities in this rare but aggressive skin cancer.