Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

The incidence rate of melanoma is rising in Canada and other economically developed countries. There is a wide range of survival expectancies depending on the thickness at which the melanoma is diagnosed, with thick melanomas having 5-year survival rates of only 56% (compared to ~100% for thin lesions). Since melanoma thickness is highly related to survival, discovering factors related to an increased risk of a diagnosis of thick melanoma is critical to the development of public health strategies that target high-risk populations. Our previous research showed that living in certain healthcare regions in Ontario, being elderly, male, or living in more deprived neighbourhoods were all independently associated with a diagnosis of thick melanoma. However, further research is needed to determine the fundamental causes of advanced melanoma in universal health care settings. This will be the topic of our proposed research. One explanation is that differences in healthcare availability, utilization, and quality that result in diagnostic delay are leading to differences in tumour thickness, and thus melanoma survival. We plan to assess whether differences exist between advanced and non-advanced patients according to factors such as the diagnostic process and its length, patients' usual use of healthcare, patient characteristics and health status, and the melanoma-related resources in their community (e.g. dermatologist supply). This study will be conducted using electronic health data for the province of Ontario linked to our clinical population database containing detailed information on patient's melanoma characteristics. This work is important to Ontario and Canada as it will deliver knowledge on modifiable health system factors associated with a prolonged diagnostic interval, and provide benchmarks on optimal diagnostic intervals for melanoma, which are informed by real world data from Ontario, including information on the link between survival and diagnostic delay.