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Manne S, Heckman CJ, Frederick S, Schaefer AA, Studts CR, Khavjou O, Honeycutt A, Berger A, Liu H. A Digital Intervention to Improve Skin Self-Examination Among Survivors of Melanoma: Protocol for a Type-1 Hybrid Effectiveness-Implementation Randomized Trial. JMIR Res Protoc 2024; 13:e52689. [PMID: 38345836 PMCID: PMC10897801 DOI: 10.2196/52689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Although melanoma survival rates have improved in recent years, survivors remain at risk of recurrence, second primary cancers, and keratinocyte carcinomas. The National Comprehensive Cancer Network recommends skin examinations by a physician every 3 to 12 months. Regular thorough skin self-examinations (SSEs) are recommended for survivors of melanoma to promote the detection of earlier-stage, thinner melanomas, which are associated with improved survival and lower treatment costs. Despite their importance, less than a quarter of survivors of melanoma engage in SSEs. OBJECTIVE Previously, our team developed and evaluated a web-based, fully automated intervention called mySmartSkin (MSS) that successfully improved SSE among survivors of melanoma. Enhancements were proposed to improve engagement with and outcomes of MSS. The purpose of this paper is to describe the rationale and methodology for a type-1 hybrid effectiveness-implementation randomized trial evaluating the enhanced MSS versus control and exploring implementation outcomes and contextual factors. METHODS This study will recruit from state cancer registries and social media 300 individuals diagnosed with cutaneous malignant melanoma between 3 months and 5 years after surgery who are currently cancer free. Participants will be randomly assigned to either enhanced MSS or a noninteractive educational web page. Surveys will be collected from both arms at baseline and at 3, 6, 12, and 18 months to assess measures of intervention engagement, barriers, self-efficacy, habit, and SSE. The primary outcome is thorough SSE. The secondary outcomes are the diagnosis of new or recurrent melanomas and sun protection practices. RESULTS Multilevel modeling will be used to examine whether there are significant differences in survivor outcomes between MSS and the noninteractive web page over time. Mixed methods will evaluate reach, adoption, implementation (including costs), and potential for maintenance of MSS, as well as contextual factors relevant to those outcomes and future scale-up. CONCLUSIONS This trial has the potential to improve outcomes in survivors of melanoma. If MSS is effective, the results could guide its implementation in oncology care and nonprofit organizations focused on skin cancers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/52689.
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Affiliation(s)
- Sharon Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Alexis A Schaefer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Christina R Studts
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Olga Khavjou
- RTI International, Research Triangle Park, NC, United States
| | | | - Adam Berger
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Hao Liu
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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Jasper S, Keim U, Leiter U, Amaral T, Flatz L, Forschner A. Die Prognose des Melanoms im Kopf-Hals-Bereich im Stadium II hängt vom histologischen Subtyp ab. J Dtsch Dermatol Ges 2023; 21:1137-1147. [PMID: 37845056 DOI: 10.1111/ddg.15164_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/28/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrund und ZieleDie Melanom‐Leitlinie basiert hauptsächlich auf dem AJCC‐Stadium. Hierbei wird nicht zwischen den histologischen Subtypen wie dem superfiziell spreitenden Melanom (SSM), dem Lentigo‐maligna‐Melanom (LMM) oder dem nodulären malignen Melanom (NM) unterschieden. Ziel der Studie war es zu untersuchen, ob sich Patienten mit LMM im klinischen Verlauf von Patienten mit SSM/NM unterscheiden. Dies ist aktuell besonders wichtig, da die adjuvante Anti‐PD‐1‐Therapie für Melanome im Stadium IIB und IIC zugelassen wurde.Patienten und MethodikDie Daten wurden aus dem Zentralregister „malignes Melanom“ entnommen. Es wurden nur Patienten mit LMM, SSM oder NM des Kopf‐Hals‐Bereichs und Primärdiagnose zwischen dem 01.01.2000 und dem 31.12.2019 eingeschlossen. Das progressionsfreie Überleben (PFÜ), das melanomspezifische Überleben (MSÜ) und das Metastasierungsmuster wurden für die Gruppe der LMM im Vergleich zur Gruppe der SSM/NM analysiert.ErgebnisseDie LMM‐Kohorte (n = 902) hatte ein signifikant besseres MSÜ als die SSM/NM‐Kohorte (n = 604). Beim PFÜ gab es keinen Unterschied. Das 5‐Jahres‐MSÜ der LMM‐Kohorte im Stadium II betrug 88,5 % (95 % KI 81,4–95,6), im Vergleich dazu das der SSM/NM‐Kohorte im Stadium II 79,7 % (95 % KI 72,8–86,6).SchlussfolgerungEs scheint nicht angebracht zu sein, eine adjuvante Therapie bei LMM‐Patienten im Stadium II im gleichen Umfang durchzuführen, wie bei Patienten mit SSM/NM.
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Affiliation(s)
- Sophie Jasper
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Ulrike Keim
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Ulrike Leiter
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Teresa Amaral
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Lukas Flatz
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Andrea Forschner
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
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Jasper S, Keim U, Leiter U, Amaral T, Flatz L, Forschner A. Prognosis in stage II melanoma of the head and neck depends on the histological subtype. J Dtsch Dermatol Ges 2023; 21:1137-1146. [PMID: 37485634 DOI: 10.1111/ddg.15164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/28/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The melanoma guideline is mainly based on the AJCC stage. There is no difference according to histological subtypes such as superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM) or nodular malignant melanoma (NM). We aimed to evaluate whether patients with LMM have a different clinical course from patients with SSM/NM. This is particularly important as adjuvant anti-PD-1 therapy is approved for stage IIB and IIC melanoma. PATIENTS AND METHODS Data were extracted from the Central Registry of Malignant Melanoma. Only patients with LMM, SSM, and NM of the head and neck with primary diagnosis between 01/01/2000 and 12/31/2019 were included. Progression-free survival (PFS), melanoma-specific survival (MSS), and pattern of metastases were analyzed for the LMM group compared to SSM/NM. RESULTS The LMM cohort (n = 902) had significantly better MSS than the SSM/NM cohort (n = 604). There was no difference in PFS. The 5-year MSS of the stage II LMM cohort was 88.5% (95% CI 81.4-95.6) compared to 79.7% (95% CI 72.8-86.6) in the stage II SSM/NM cohort. CONCLUSION It does not appear appropriate to use adjuvant therapy in stage II LMM patients to the same extent as in patients with SSM/NM.
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Affiliation(s)
- Sophie Jasper
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Keim
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
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O'Sullivan DE, Boyne DJ, Gogna P, Brenner DR, Cheung WY. Understanding Real-World Treatment Patterns and Clinical Outcomes among Metastatic Melanoma Patients in Alberta, Canada. Curr Oncol 2023; 30:4166-4176. [PMID: 37185430 PMCID: PMC10136717 DOI: 10.3390/curroncol30040317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Immunotherapy and targeted therapies have been shown to considerably improve long-term survival outcomes in metastatic melanoma patients. Real-world evidence on the uptake of novel therapies and outcomes for this patient population in Canada are limited. We conducted a population-based retrospective cohort study of all metastatic melanoma patients diagnosed in Alberta, Canada (2015-2018) using electronic medical records and administrative data. Information on BRAF testing for patients diagnosed in 2017 or 2018 was obtained through chart abstraction. In total, 434 metastatic melanoma patients were included, of which 110 (25.3%) were de novo metastatic cases. The median age at diagnosis was 66 years (IQR: 57-76) and 70.0% were men. BRAF testing was completed for the majority of patients (88.7%). Among all patients, 60.4%, 19.1%, and 6.0% initiated first-line, second-line, and third-line systemic therapy. The most common therapies were anti-PD-1 and targeted therapies. The two-year survival probability from first-line therapy, second-line therapy, and third-line therapy was 0.50 (95% CI: 0.44-0.57), 0.26 (95% CI: 0.17-0.40), and 0.14 (95% CI: 0.40-0.46), respectively. In the first-line setting, survival was highest for patients that received ipilimumab or ipilimumab plus nivolumab, while targeted therapy had the highest survival in the second-line setting. This study indicates that novel therapies improve survival in the real world but a considerable proportion of patients do not receive treatment with systemic therapy.
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Affiliation(s)
- Dylan E O'Sullivan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB T2S 3C3, Canada
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Devon J Boyne
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
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Mathew T, Ianno DJ, Sidhu SK. Stage
IA
melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care. Australas J Dermatol 2023; 64:e135-e144. [PMID: 37002712 DOI: 10.1111/ajd.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/06/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The literature highlights the role of Australian general practitioners (GP) in the management of skin cancers. With melanoma incidences on the rise, there have been discussions into whether lower-risk stage IA patients could safely be followed up by their GPs for annual surveillance full skin examinations (FSE). This study explores the level of confidence of South Australian (SA) GPs in undertaking FSEs including factors that could support discussions around shared care between GPs and dermatology units for lower-risk patients. METHODS An online survey was designed and distributed to SA GPs via email, newsletters and social media between 5 December 2021 and 30 January 2022. Descriptive statistics were used to describe survey responses. Pearson's Chi-squared analysis was used to investigate associations between key variables of interest and explanatory variables. Logistic regression analysis was used to model odds ratios for associations between the dependent variable and independent variables. RESULTS A total of 135 responses were obtained. Forty-four per cent of GPs were comfortable undertaking annual FSEs, 41% were uncomfortable and 15% were unsure. Scope of work, >20 years experience and additional training had statistically significant relationships (p < 0.05). Dermoscopy and detecting melanoma recurrences were reported to be skills with lower levels of confidence. With regards to shared care, 77% indicated that they would feel supported undertaking FSEs if rapid access referral pathways were allocated for patients who developed suspicious lesions. Preferred upskilling modalities included, face-to-face sessions in a dermatology unit (39%), dermatologist run webinars (25%) and certificate courses (20%). CONCLUSIONS At present, there is a subset of SA GPs who are comfortable undertaking FSEs and therefore could be engaged in shared care with specialists. Further considerations have to be made in the areas of upskilling and supporting the workforce to enhance engagement in shared care.
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Affiliation(s)
- Thomas Mathew
- Royal Adelaide Hospital, SA Health Adelaide South Australia Australia
- Royal Australian College of General Practitioners North Adelaide South Australia Australia
| | - Damian J. Ianno
- The Royal Melbourne Hospital, Melbourne Health Parkville Victoria Australia
| | - Shireen K. Sidhu
- Royal Adelaide Hospital, SA Health Adelaide South Australia Australia
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Evaluating the effect of detection modalities in the Danish clinical follow-up program of cutaneous melanoma—a retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Allan JL, Johnston DW, Johnston M, Murchie P. Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma: a 12-month longitudinal study. BMJ Open 2022; 12:e056755. [PMID: 36041758 PMCID: PMC9438032 DOI: 10.1136/bmjopen-2021-056755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/10/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline. DESIGN A longitudinal observational study nested within the intervention arm of the ASICA (Achieving Self-Directed Integrated Cancer Aftercare) randomised controlled trial. SETTING Follow-up secondary care in Aberdeen and Cambridge UK. PARTICIPANTS n=104 adults (48 men/56 women; mean age 58.83 years, SD 13.47, range 28-85 years; mean Scottish Index of Multiple Deprivation score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial. INTERVENTIONS All participants were using the ASICA intervention-a tablet-based intervention designed to support monthly TSSE. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app. RESULTS Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent. CONCLUSIONS Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03328247).
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Affiliation(s)
- Julia L Allan
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Derek W Johnston
- Aberdeen Health Psychology Group, School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Centre for Academic Primary Care, Insitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Follow-up Schedule for Patients with Sentinel Node Negative Cutaneous Melanoma: an International Phase III Randomised Clinical Trial. Ann Surg 2022; 276:e208-e216. [PMID: 35866644 DOI: 10.1097/sla.0000000000005621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES DESIGN The MELFO (MELanoma FOllow-up) study is an international phase III RCT comparing an experimental low-intensity schedule against current national guidelines. BACKGROUND Evidence-based guidelines for the follow-up of sentinel node negative melanoma patients are lacking. METHODS Overall, 388 adult patients diagnosed with sentinel node negative primary melanoma patients were randomized in cancer centers in the Netherlands and UK between 2006 and 2016. The conventional schedule group (control: n=196) was reviewed as per current national guidelines. The experimental schedule group (n=192) was reviewed in a reduced-frequency schedule. QoL was the primary outcome measurement. Detection rates and survival outcomes were recorded. Patient satisfaction rates and compliance with allocated schedules were compared. RESULTS At five years, both arms expressed high satisfaction with their regimens (>97%). This study found no significant group effect on any PROMs scores between the follow-up protocols. In total, 75/388 (19.4%) patients recurred, with no difference in incidence found between the two arms (HR=0.87 (0.54-1.39), P=0.57). Self-examination was the method of detection for 25 experimental patients and 32 control patients (75.8% vs. 76.2%; P=0.41). This study found no difference in any survival outcomes between the two study arms (disease-free survival: HR=1.00 (0.49-2.07), P=0.99). CONCLUSIONS A reduced intensity, AJCC stage-adjusted follow-up schedule for sentinel node negative melanoma patients is a safe strategy and patient self-examination is effective for recurrence detection with no evidence of diagnostic delay. Patients' acceptance is very high.
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Manne S, Heckman CJ, Kashy D, Ritterband L, Thorndike F, Lozada C, Coups EJ. Moderators of the Effects of mySmartSkin, a Web-Based Intervention to Promote Skin Self-examination and Sun Protection Among Individuals Diagnosed With Melanoma. Ann Behav Med 2022; 56:804-815. [PMID: 35028656 PMCID: PMC9345181 DOI: 10.1093/abm/kaab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Identifying the characteristics of persons who benefit more from behavioral interventions can help health care providers decide which individuals should be offered particular interventions because this is the subgroup of persons who are more likely to derive greater benefit from the intervention and refine the underlying constructs of the model guiding the intervention. PURPOSE This study evaluated possible demographic, medical, knowledge and attitudinal, and psychosocial variables that may moderate the impact of an online intervention, called mySmartSkin (MSS), on engagement in skin self-examination (SSE) and sun protection behaviors among melanoma survivors. METHODS Participants completed a baseline survey and were then randomized to the MSS condition or usual care. Follow-up surveys were completed by participants at 8-, 24-, and 48-week postrandomization. RESULTS A greater impact of MSS on SSE was illustrated among participants with more phenotypic skin cancer risk factors and participants reporting lower baseline self-efficacy in conducting SSE. A more favorable response of MSS on sun protection behaviors was shown when initial knowledge about abnormal lesions and sun protection barriers were high. Greater use of MSS and more favorable evaluations of it were also associated with higher intervention response. CONCLUSIONS Future studies seeking to improve SSE and sun protection among melanoma survivors might benefit from focusing on survivors who report more skin cancer risk factors, lower self-efficacy in conducting SSE, less knowledge about what abnormal skin lesions look like, more perceived barriers to sun protection behaviors, and less worry about recurrence and cancer-related distress.
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Affiliation(s)
| | - Carolyn J Heckman
- Department of Medicine, Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Deborah Kashy
- Michigan State University, Department of Psychology, East Lansing, MI, USA
| | - Lee Ritterband
- School of Medicine, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolina Lozada
- Department of Medicine, Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Newcomer K, Robbins KJ, Perone J, Hinojosa FL, Chen D, Jones S, Kaufman CK, Weiser R, Fields RC, Tyler DS. Malignant melanoma: evolving practice management in an era of increasingly effective systemic therapies. Curr Probl Surg 2022; 59:101030. [PMID: 35033317 PMCID: PMC9798450 DOI: 10.1016/j.cpsurg.2021.101030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Ken Newcomer
- Department of Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, MO
| | | | - Jennifer Perone
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - David Chen
- e. Department of Medicine, Washington University, St. Louis, MO
| | - Susan Jones
- f. Department of Pediatrics, Washington University, St. Louis, MO
| | | | - Roi Weiser
- University of Texas Medical Branch, Galveston, TX
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX.
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Manne SL, Heckman CJ, Kashy DA, Ritterband LM, Thorndike FP, Lozada C, Coups EJ. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection among individuals diagnosed with melanoma. Transl Behav Med 2021; 11:1461-1472. [PMID: 33904921 DOI: 10.1093/tbm/ibaa103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adherence to regular, thorough skin self-examination (SSE) and consistent sun protection behaviors among melanoma survivors is relatively low. This study reports on the impact of an online intervention, called mySmartSkin (MSS), on engagement in SSE and sun protection behaviors among melanoma survivors, as well as the mediators of the intervention effects. The intervention was compared with usual care (UC), and primary outcomes were assessed at 24 and 48 weeks. Short-term outcomes were also evaluated at 8 weeks postbaseline. Results demonstrate a significant effect on SSE and sun protection. At all three follow-up assessments, the proportion of participants reporting conducting a thorough SSE in the time since the previous assessment was significantly greater in MSS than in UC. In addition, both multivariate and univariate analyses indicated that engagement in sun protection behaviors was significantly higher in MSS than UC at 24 weeks, but the effect on sun protection at 48 weeks was significant only in multivariate analyses. Beneficial effects of MSS were significantly mediated by knowledge about melanoma and characteristics of suspicious lesions, as well as self-efficacy. Participant engagement in MSS was satisfactory, with approximately two-thirds of participants completing at least two of the three core components. Content was rated as highly trusted, easy to understand, easy to navigate, and helpful. In conclusion, MSS illustrated significant and durable effects on SSE and mixed results on sun protection. Future studies should consider ways to further enhance treatment effects and engagement in MSS.
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Affiliation(s)
- Sharon L Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Deborah A Kashy
- Michigan State University, Department of Psychology, East Lansing, MI, USA
| | - Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Center for Behavioral Health & Technology, Charlottesville, VA, USA
| | - Frances P Thorndike
- Department of Psychiatry and Neurobehavioral Sciences, Pear Therapeutics, Boston, MA, USA
| | - Carolina Lozada
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Naeser Y, Helgadottir H, Brandberg Y, Hansson J, Bagge RO, Elander NO, Ingvar C, Isaksson K, Flygare P, Nilsson C, Jakobsson F, Del Val Munoz O, Valachis A, Jansson M, Sparring C, Ohlsson L, Dyrke U, Papantoniou D, Sundin A, Ullenhag GJ. TRIM study protocol - a prospective randomized multicenter Trial to assess the Role of Imaging during follow-up after radical surgery of stage IIB-C and III cutaneous malignant Melanoma. BMC Cancer 2020; 20:1197. [PMID: 33287744 PMCID: PMC7720485 DOI: 10.1186/s12885-020-07632-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. In Sweden, over 4600 cases were diagnosed in 2018. The prognosis after radical surgery varies considerably with tumor stage. In recent years, new treatment options have become available for metastatic CMM. Early onset of treatment seems to improve outcome, which suggests that early detection of recurrent disease should be beneficial. Consequently, in several countries imaging is a part of the routine follow-up program after surgery of high risk CMM. However, imaging has drawbacks, including resources required (costs, personnel, equipment) and the radiation exposure. Furthermore, many patients experience anxiety in waiting for the imaging results and investigations of irrelevant findings is another factor that also could cause worry and lead to decreased quality of life. Hence, the impact of imaging in this setting is important to address and no randomized study has previously been conducted. The Swedish national guidelines stipulate follow-up for 3 years by clinical examinations only. METHODS The TRIM study is a prospective randomized multicenter trial evaluating the potential benefit of imaging and blood tests during follow-up after radical surgery for high-risk CMM, compared to clinical examinations only. Primary endpoint is overall survival (OS) at 5 years. Secondary endpoints are survival from diagnosis of relapse and health-related quality of life (HRQoL). Eligible for inclusion are patients radically operated for CMM stage IIB-C or III with sufficient renal function for iv contrast-enhanced CT and who are expected to be fit for treatment in case of recurrence. The planned number of patients is > 1300. Patients are randomized to clinical examinations for 3 years +/- whole-body imaging with CT or FDG-PET/CT and laboratory tests including S100B protein and LDH. This academic study is supported by the Swedish Melanoma Study Group. DISCUSSION This is the first randomized prospective trial on the potential benefit of imaging as a part of the follow-up scheme after radical surgery for high-risk CMM. RESULTS The first patient was recruited in June 2017 and as of April 2020, almost 500 patients had been included at 19 centers in Sweden. TRIAL REGISTRATION ClinicalTrials.gov , NCT03116412 . Registered 17 April 2017, https://clinicaltrials.gov/ct2/show/study/NCT03116412.
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Affiliation(s)
- Ylva Naeser
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Johan Hansson
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nils O Elander
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Christian Ingvar
- Department of Surgery, Clinical Sciences, Lund University, BMC F12, 22184, Lund, Sweden
| | - Karolin Isaksson
- Department of Surgery, Central Hospital Kristianstad, 29133, Kristianstad, Sweden
- Department of Clinical Sciences, Surgery, Lund University, BMC F12, 22184, Lund, Sweden
| | - Petra Flygare
- Department of Oncology, Sundsvall County Hospital, Lasarettsgatan 21, 856 43, Sundsvall, Sweden
| | - Cecilia Nilsson
- Department of Oncology, Hospital of Västmanland Västerås, 72189, Västerås, Sweden
| | - Frida Jakobsson
- Department of Oncology, Örebro University Hospital, 70185, Örebro, Sweden
| | | | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Malin Jansson
- Department of Surgical and perioperative sciences, Umeå University and Umeå University Hospital, 90185, Umeå, Sweden
| | - Charlotte Sparring
- Department of Dermatology, Skaraborg County Hospital, 54185, Skövde, Sweden
| | - Lars Ohlsson
- Department of Surgery, Karlstad County Hospital, Rosenborgsgatan 9, 65230, Karlstad, Sweden
| | - Ulf Dyrke
- Department of Surgery, Falun County Hospital, 79182, Falun, Sweden
| | | | - Anders Sundin
- Department of Surgical Sciences Radiology & Molecular Imaging, Uppsala University, 75185, Uppsala, Sweden
| | - Gustav J Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden.
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden.
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13
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Bhurosy T, Heckman CJ, Riley M. Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review. Transl Behav Med 2020; 10:1120-1133. [PMID: 33044529 DOI: 10.1093/tbm/ibaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).
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Affiliation(s)
- Trishnee Bhurosy
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mary Riley
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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14
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Moncrieff MD, Underwood B, Garioch JJ, Heaton M, Patel N, Bastiaannet E, Hoekstra-Weebers JEHM, Hoekstra HJ. The MelFo Study UK: Effects of a Reduced-Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma 1B to 2C Patients After 3-Years. Ann Surg Oncol 2020; 27:4109-4119. [PMID: 32623608 PMCID: PMC7497689 DOI: 10.1245/s10434-020-08758-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Background Evidence-based guidelines for follow-up treatment of American Joint Committee on Cancer (AJCC) stages 1B to 2C melanoma patients are lacking. The MELanoma FOllow-up study is an international phase 3 randomized trial, and the 3-year interim data were recently reported from the Netherlands. The study was undertaken concurrently with a British cohort for comparison and validation of the Dutch study. Methods The study enrolled and stratified 207 patients by AJCC stage. The conventional schedule group (CSG; n = 103) cohort was reviewed as per UK guidelines. The experimental schedule group (ESG; n = 104) cohort was reviewed in a reduced-frequency nurse-led, consultant-supervised clinic. Quality of life (QoL) was measured at baseline (T1), a 1 year (T2), and at 3 years (T3) using the State-Trait Anxiety Inventory, the Cancer Worry Scale, the Impact-of-Event Scale, and the Mental and Physical Component scales (PCS/MCS) of the RAND-36. Results Of the 207 QoL questionnaires, 170 (82.1%) were completed at T3. Both cohorts expressed high satisfaction (> 93%) with their regimens. At T3, no significant group effect was found on any patient-reported outcome measures scores, indicating no QoL difference between the follow-up protocols. Recurrence had developed in 33 patients Conventional follow-up (CFU), 16 [15.5%]; Experimental follow-up (EFU), 17 [16.3%]. Self-examination was the method of detection for 12 ESG patients (70.6%) and 11 CSG patients (68.8%). The melanoma-specific survival was identical. Conclusion The UK 3-year data were consistent with the previous Dutch report. The reduced follow-up strategy was shown to be safe, with significant resource usage benefits for national cancer services. Patient anxiety levels were not increased by a less-intensive follow-up regimen, and acceptance was high. The study data indicate that patient self-examination is very effective for recurrence detection.
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Affiliation(s)
- Marc D Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK. .,University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
| | - Beverly Underwood
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jennifer J Garioch
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Martin Heaton
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Nakul Patel
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Josette E H M Hoekstra-Weebers
- University Medical Center Groningen, Wenckebach Institute, University of Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Manne SL, Heckman CJ, Kashy D, Lozada C, Gallo J, Ritterband L, Coups EJ. Prevalence and correlates of skin self-examination practices among cutaneous malignant melanoma survivors. Prev Med Rep 2020; 19:101110. [PMID: 32461880 PMCID: PMC7240727 DOI: 10.1016/j.pmedr.2020.101110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/06/2020] [Accepted: 04/26/2020] [Indexed: 11/05/2022] Open
Abstract
Melanoma patients are at elevated risk for recurrence of the primary cancer as well as second primary melanomas. Regular skin self-examination (SSE) is recommended as part of follow-up surveillance. In this study, we examined SSE performance and comprehensiveness as well as knowledge and attitudinal correlates of SSE performance and comprehensiveness. Four hundred forty-one melanoma survivors completed measures of SSE performance as well as knowledge and attitudes about SSE and melanoma. Approximately two-thirds of the sample reported having conducted an SSE in the past two months; the average number of body parts examined was 10.64 (out of 15 maximum). Only 7.5% of the sample checked all 15 body parts. Greater worry about recurrence, fewer barriers to SSE, more planning for when to conduct SSE, and more confidence in the ability to conduct SSE and recognize a suspicious growth were associated with both SSE performance and greater SSE comprehensiveness. Physician influence was positively associated with SSE performance. Survivor education efforts may benefit from reminding survivors to check hard-to-see and sensitive areas, develop a plan for how to ask for assistance in conducting exams, as well as use mirrors to see hard-to-reach areas. Addressing perceived SSE barriers, fostering SSE planning, and improving SSE self-efficacy may be important foci for intervention efforts to enhance SSE performance and comprehensiveness.
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Affiliation(s)
| | | | | | | | - Joseph Gallo
- Rutgers Cancer Institute of New Jersey, United States
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16
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Stellato D, Gerbasi ME, Ndife B, Ghate SR, Moynahan A, Mishra D, Gunda P, Koruth R, Delea TE. Budget Impact of Dabrafenib and Trametinib in Combination as Adjuvant Treatment of BRAF V600E/K Mutation-Positive Melanoma from a U.S. Commercial Payer Perspective. J Manag Care Spec Pharm 2019; 25:1227-1237. [PMID: 31663466 PMCID: PMC10398148 DOI: 10.18553/jmcp.2019.25.11.1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Before the approval of dabrafenib and trametinib in combination, there were no approved therapies in the adjuvant setting that target the RAS/RAF/MEK/ERK pathway. OBJECTIVE To evaluate the budget impact of dabrafenib and trametinib in combination for adjuvant treatment of patients with BRAF V600 mutation-positive resected Stage IIIA, IIIB, or IIIC melanoma from a U.S. commercial payer perspective using data from the COMBI-AD trial, as well as other sources. METHODS The budget impact of dabrafenib and trametinib in combination for patients with BRAF V600E/K mutation-positive, resected Stage IIIA, IIIB, or IIIC melanoma was evaluated from the perspective of a hypothetical population of 1 million members with demographic characteristics consistent with those of a commercially insured U.S. insurance plan (i.e., adults aged less than 65 years) using an economic model developed in Microsoft Excel. The model compared melanoma-related health care costs over a 3-year projection period under 2 scenarios: (1) a reference scenario in which dabrafenib and trametinib are assumed to be unavailable for adjuvant therapy and (2) a new scenario in which the combination is assumed to be available. Treatments potentially displaced by dabrafenib and trametinib were assumed to include observation, high-dose interferon alpha-2b, ipilimumab, and nivolumab. Costs considered in the model include those of adjuvant therapies and treatment of locoregional and distant recurrences. The numbers of patients eligible for treatment with dabrafenib and trametinib were based on data from cancer registries, published sources, and assumptions. Treatment mixes under the reference and new scenarios were based on market research data, clinical expert opinion, and assumptions. Probabilities of recurrence and death were based on data from the COMBI-AD trial and an indirect treatment comparison. Medication costs were based on wholesale acquisition cost prices. Costs of distant recurrence were from a health insurance claims study. RESULTS In a hypothetical population of 1 million commercially insured members, 48 patients were estimated to become eligible for treatment with dabrafenib and trametinib in combination over the 3-year projection period; in the new scenario, 10 patients were projected to receive such treatment. Cumulative costs of melanoma-related care were estimated to be $6.3 million in the reference scenario and $6.9 million in the new scenario. The budget impact of dabrafenib and trametinib in combination was an increase of $549 thousand overall and 1.5 cents per member per month. CONCLUSIONS For a hypothetical U.S. commercial health plan of 1 million members, the budget impact of dabrafenib and trametinib in combination as adjuvant treatment for melanoma is likely to be relatively modest and within the range of published estimates for oncology therapies. These results may assist payers in making coverage decisions regarding the use of adjuvant dabrafenib and trametinib in melanoma. DISCLOSURES Funding for this research was provided to Policy Analysis Inc. (PAI) by Novartis Pharmaceuticals. Stellato, Moynahan, and Delea are employed by PAI. Ndife, Koruth, Mishra, and Gunda are employed by Novartis. Ghate was employed by Novartis at the time of this study and is shareholder in Novartis, Provectus Biopharmaceuticals, and Mannkind Corporation. Gerbasi was employed by PAI at the time of this study and is currently an employee, and stockholder, of Sage Therapeutics. Delea reports grant funding from Merck and research funding from Amgen, Novartis, Sanofi, Seattle Genetics, Takeda, Jazz, EMD Serono, and 21st Century Oncology, unrelated to this work.
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Affiliation(s)
| | | | - Briana Ndife
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | | | - Dinesh Mishra
- Novartis Pharmaceuticals, Hyderabad, Telangana, India
| | - Praveen Gunda
- Novartis Pharmaceuticals, Hyderabad, Telangana, India
| | - Roy Koruth
- Novartis Pharmaceuticals, East Hanover, New Jersey
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17
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Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB-IIC Patients-Results After 3 Years. Ann Surg Oncol 2019; 27:1407-1417. [PMID: 31535302 PMCID: PMC7138761 DOI: 10.1245/s10434-019-07825-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/18/2022]
Abstract
Background This study compares well-being, recurrences, and deaths of early-stage cutaneous melanoma patients in follow-up, as recommended in the Dutch guideline, with that of patients in a stage-adjusted reduced follow-up schedule, 3 years after diagnosis, as well as costs. Methods Overall, 180 eligible pathological American Joint Committee on Cancer (AJCC) stage IB–IIC, sentinel node staged, melanoma patients (response rate = 87%, 48% male, median age 57 years), randomized into a conventional (CSG, n = 93) or experimental (ESG, n = 87) follow-up schedule group, completed patient-reported outcome measures (PROMs) at diagnosis (T1): State-Trait Anxiety Inventory–State version (STAI-S), Cancer Worry Scale (CWS), Impact of Event Scale (IES), and RAND-36 (Mental and Physical Component scales [PCS/MCS]). Three years later (T3), 110 patients (CSG, n = 56; ESG, n = 54) completed PROMs, while 42 declined (23%). Results Repeated measures analyses of variance (ANOVAs) showed a significant group effect on the IES (p = 0.001) in favor of the ESG, and on the RAND-36 PCS (p = 0.02) favoring the CSG. Mean IES and CWS scores decreased significantly over time, while those on the RAND-36 MCS and PCS increased. Effect sizes were small. Twenty-five patients developed a recurrence or second primary melanoma, of whom 13 patients died within 3 years. Cox proportional hazards models showed no differences between groups in recurrence-free survival (hazard ratio [HR] 0.71 [0.32–1.58]; p = 0.400) and disease-free survival (HR 1.24 [0.42–3.71]; p = 0.690). Costs per patient after 3 years (computed for 77.3% of patients) were 39% lower in the ESG. Conclusion These results seemingly support the notion that a stage-adjusted reduced follow-up schedule forms an appropriate, safe, and cost-effective alternative for pathological AJCC stage IB–IIC melanoma patients to the follow-up regimen as advised in the current melanoma guideline.
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Affiliation(s)
- Eric A Deckers
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Samantha Damude
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sylvia Ter Meulen
- Skin-Melanoma Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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18
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Coups EJ, Manne SL, Ohman Strickland P, Hilgart M, Goydos JS, Heckman CJ, Chamorro P, Rao BK, Davis M, Smith FO, Thorndike FP, Ritterband LM. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection behaviors among individuals diagnosed with melanoma: study design and baseline characteristics. Contemp Clin Trials 2019; 83:117-127. [PMID: 31255801 PMCID: PMC6690854 DOI: 10.1016/j.cct.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948.
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Affiliation(s)
- Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Michelle Hilgart
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Paola Chamorro
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Moira Davis
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | - Franz O Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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19
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Leeneman B, Franken MG, Coupé VM, Hendriks MP, Kruit W, Plaisier PW, van Ruth S, Verstijnen JA, Wouters MW, Blommestein HM, Uyl – de Groot CA. Stage-specific disease recurrence and survival in localized and regionally advanced cutaneous melanoma. Eur J Surg Oncol 2019; 45:825-831. [DOI: 10.1016/j.ejso.2019.01.225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/20/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022] Open
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20
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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21
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Verver D, van Klaveren D, Franke V, van Akkooi ACJ, Rutkowski P, Keilholz U, Eggermont AMM, Nijsten T, Grünhagen DJ, Verhoef C. Development and validation of a nomogram to predict recurrence and melanoma-specific mortality in patients with negative sentinel lymph nodes. Br J Surg 2018; 106:217-225. [PMID: 30307046 PMCID: PMC6585628 DOI: 10.1002/bjs.10995] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/04/2018] [Accepted: 08/08/2018] [Indexed: 12/21/2022]
Abstract
Background Patients with melanoma and negative sentinel nodes (SNs) have varying outcomes, dependent on several prognostic factors. Considering all these factors in a prediction model might aid in identifying patients who could benefit from a personalized treatment strategy. The objective was to construct and validate a nomogram for recurrence and melanoma‐specific mortality (MSM) in patients with melanoma and negative SNs. Methods A total of 3220 patients with negative SNs were identified from a cohort of 4124 patients from four EORTC Melanoma Group centres who underwent sentinel lymph node biopsy. Prognostic factors for recurrence and MSM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c‐index) and calibration in cross‐validation across the four centres. A nomogram was developed for graphical presentation. Results There were 3180 eligible patients. The final prediction model for recurrence and the calibrated model for MSM included three independent prognostic factors: ulceration, anatomical location and Breslow thickness. The c‐index was 0·74 for recurrence and 0·76 for the calibrated MSM model. Cross‐validation across the four centres showed reasonable model performance. A nomogram was developed based on these models. One‐third of the patients had a 5‐year recurrence probability of 8·2 per cent or less, and one‐third had a recurrence probability of 23·0 per cent or more. Conclusion A nomogram for predicting recurrence and MSM in patients with melanoma and negative SNs was constructed and validated. It could provide personalized estimates useful for tailoring surveillance strategies (reduce or increase intensity), and selection of patients for adjuvant therapy or clinical trials. Could personalize care
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Affiliation(s)
- D Verver
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - D van Klaveren
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - V Franke
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute Cancer Centre, Warsaw, Poland
| | - U Keilholz
- Charité Comprehensive Cancer Centre, University of Medicine Berlin, Berlin, Germany
| | - A M M Eggermont
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - T Nijsten
- Department of Dermatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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22
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Lim WY, Turner RM, Morton RL, Jenkins MC, Irwig L, Webster AC, Dieng M, Saw RPM, Guitera P, Low D, Low C, Bell KJL. Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma. BMC Health Serv Res 2018; 18:477. [PMID: 29925350 PMCID: PMC6011416 DOI: 10.1186/s12913-018-3291-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. METHODS We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. RESULTS Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%). CONCLUSIONS The majority of people treated for a first primary localised melanoma at a specialist centre, without recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine diagnostic imaging as part of their melanoma surveillance.
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak Malaysia
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Robin M. Turner
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Marisa C. Jenkins
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Angela C. Webster
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW Australia
- Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Dermatology, The University of Sydney, Sydney, NSW Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, NSW Australia
| | | | - Katy J. L. Bell
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- Centre for Evidence Based Practice, Bond University, Gold Coast, QLD Australia
- The University of Sydney, Rm 333 Edward Ford Building (A27), Sydney, NSW 2006 Australia
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23
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Kukar M, Gabriel E, May R, Cho E, Lichtenthal M, Groman A, Skitzki J, Francescutti V, Kane JM. Conditional Survival-Based “Abbreviated” Routine Cancer Surveillance for Pathologic Stage IB Melanoma. Am Surg 2017. [DOI: 10.1177/000313481708301128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A negative sentinel lymph node biopsy (SLNB) for stage IB (T1b/T2a N0) melanoma would predict an excellent long-term prognosis. Combined with the concept of conditional survival, an “abbreviated” cancer surveillance strategy was implemented to reduce the number of visits and total length of follow-up. Retrospective review of all pathologic stage IB melanoma patients (negative SLNB) at a single institution between 2006 and 2008 after implementation of an “abbreviated” cancer surveillance; clinic visits every six months for five years followed by one annual visit (total follow-up six years). Patient demographics, tumor characteristics, and information regarding recurrences were obtained. Recurrence-free, disease-specific, and overall survival were calculated. Eighty-seven patients underwent the “abbreviated” cancer surveillance. Median age was 55.4 years and 50.6 per cent were male. Median Breslow thickness was 1.1 mm (range 0.5–2.0 mm) and 1.1 per cent were ulcerated. Primary tumor site was 49 per cent extremities, 39 per cent trunk, and 12 per cent head/ neck. Median follow-up was 68.6 months. Five-year recurrence-free, disease-specific, and overall survivals were 89, 95, and 88 per cent, respectively. During surveillance, 10 patients had concerning symptoms or physical findings prompting subsequent workup, all of which were negative for recurrence/metastases. There were only three true melanoma recurrences; all were distant metastases and presented symptomatically between scheduled follow-up visits. In light of the excellent prognosis for pathologic (SLNB negative) stage IB melanoma, an “abbreviated” cancer surveillance schedule based on conditional survival would reduce both direct and indirect costs in this cohort. The few recurrences were symptomatic and unlikely to have changed with more intensive surveillance.
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Affiliation(s)
- Moshim Kukar
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Emmanuel Gabriel
- Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, Jacksonville, Florida; and the
| | - Rebecca May
- Department of Surgery, State University of New York, Buffalo, New York
| | - Edward Cho
- Department of Surgery, State University of New York, Buffalo, New York
| | - Michelle Lichtenthal
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Joseph Skitzki
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Valerie Francescutti
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - John M. Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
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Lott JP, Wang Q, Titus LJ, Onega T, Nelson HD, Weinstock MA, Elmore JG, Tosteson ANA. Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries. Br J Dermatol 2017; 177:845-853. [PMID: 28369774 DOI: 10.1111/bjd.15530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. OBJECTIVES To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. METHODS We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits. RESULTS The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person-years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar. CONCLUSIONS Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.
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Affiliation(s)
- J P Lott
- Cornell Scott-Hill Health Center, New Haven, CT, U.S.A
| | - Q Wang
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.,Norris Cotton Cancer Center, Lebanon, NH, U.S.A
| | - L J Titus
- Norris Cotton Cancer Center, Lebanon, NH, U.S.A.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A
| | - T Onega
- Norris Cotton Cancer Center, Lebanon, NH, U.S.A.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A
| | - H D Nelson
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, OR, U.S.A.,Department of Medical Informatics, Oregon Health & Science University, Portland, OR, U.S.A.,Department of Clinical Epidemiology and Medicine, Oregon Health & Science University, Portland, OR, U.S.A.,Providence Cancer Center, Providence Health and Services, Portland, OR, U.S.A
| | - M A Weinstock
- Dermatoepidemiology Unit, US Department of Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A.,Department of Dermatology, Brown University School of Medicine, Providence, RI, U.S.A.,Department of Epidemiology, Brown University School of Medicine, Providence, RI, U.S.A
| | - J G Elmore
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, U.S.A
| | - A N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.,Norris Cotton Cancer Center, Lebanon, NH, U.S.A.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A
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Fernandes NC, Marinho FDS. Evaluation of outpatient discharge in patients with cutaneous melanoma. Rev Col Bras Cir 2017; 42:70-4. [PMID: 26176671 DOI: 10.1590/0100-69912015002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate discharge in a group of patients with cutaneous melanoma according to recently established criteria. METHODS we conducted an observational, cross-sectional study with 32 patients at the Hospital Universitário Clementino Fraga Filho (HUCFF) / Universidade Federal do Rio de Janeiro (UFRJ), between 1995 and 2013, in the following stages: IA (17 cases, 53.12%), IB (4 cases, 12.5%), IIA (3 cases, 9.37%), IIC (1 case, 3.12%), IIIB (1 case, 3.12%), IIIC (3 cases, 9.37%), melanomas in situ (2 cases, 6.25%), Tx (1 case, 3.12%). RESULTS the follow-up time varied from one to 20 years (stage IA), five to 15 years (stage IB), six to 17 years (stage IIA), 20 years (stage IIC), 23 years (stage IIIB) and 14 to 18 years (stage IIIC). One melanoma in situ (subungueal) was discharged in the fourth year of follow-up and the other was promptly discharged. The Tx melanoma was followed for 12 years. We observed no relapses or recurrences in the period. CONCLUSION although a controversial issue, it was possible to endorse the discharge of the patients since our follow-up time had already exceeded the one recommended by the other authors.
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Affiliation(s)
- Nurimar C Fernandes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flauberto de Sousa Marinho
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Spronk I, Korevaar JC, Burgers JS, Albreht T, Schellevis FG. Review of guidance on recurrence risk management for general practitioners in breast cancer, colorectal cancer and melanoma guidelines. Fam Pract 2017; 34:154-160. [PMID: 28207044 DOI: 10.1093/fampra/cmw140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. OBJECTIVE To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types. METHODS Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics. RESULTS We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs. CONCLUSION This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs.
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Affiliation(s)
- Inge Spronk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Jako S Burgers
- Dutch College of General Practitioners, Utrecht, The Netherlands.,School CAPHRI, Department Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Tit Albreht
- Centre for Health System Analyses, National Institute of Public Health, Ljubljana, Slovenia
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine/EMGO Institute for health and care research, VU University Medical Center, Amsterdam, The Netherlands
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27
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Podlipnik S, Carrera C, Sánchez M, Arguis P, Olondo ML, Vilana R, Rull R, Vidal-Sicart S, Vilalta A, Conill C, Malvehy J, Puig S. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol 2016; 75:516-524. [PMID: 27183845 DOI: 10.1016/j.jaad.2016.02.1229] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma. OBJECTIVE We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier. METHODS This was a prospective cohort from 290 consecutive patients given a diagnosis of stage IIB, IIC, and III melanoma. Patients were followed up with an intensive protocol based on imaging studies (computed tomography of the chest, abdomen, and pelvis, and brain magnetic resonance imaging), periodic laboratory tests, regular physical examinations, and patient self-examinations. RESULTS A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%. LIMITATIONS Patients with stage III melanoma were not systematically classified into subgroups and overall survival was not evaluated. CONCLUSION We observed that this intensive monitoring is appropriate for early detection of recurrence in stage IIB, IIC, and III melanoma. Prompt diagnosis of metastasis and the recent development of new therapeutic targets may improve overall survival.
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Affiliation(s)
- Sebastian Podlipnik
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pedro Arguis
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria L Olondo
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Vilana
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Rull
- Surgery Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Vilalta
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carles Conill
- Radiotherapy Oncology, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain.
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29
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Damude S, Hoekstra-Weebers JEHM, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients-Results after 1 Year. Ann Surg Oncol 2016; 23:2762-71. [PMID: 27194552 PMCID: PMC4972865 DOI: 10.1245/s10434-016-5263-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 11/18/2022]
Abstract
Background Guidelines for evidence-based follow-up in melanoma patients are not available. This study examined whether a reduced follow-up schedule affects: patient-reported outcome measures, detection of recurrences, and follow-up costs. Methods This multicenter trial included 180 patients treated for AJCC stage IB-II cutaneous melanoma, who were randomized in a conventional follow-up schedule group (CSG, 4 visits first year, n = 93) or experimental follow-up schedule group (ESG, 1–3 visits first year, n = 87). Patients completed the State-Trait Anxiety Inventory, cancer worry scale, impact of events scale, and a health-related quality of life questionnaire (HRQoL, RAND-36). Physicians registered clinicopathologic features and the number of outpatient clinic visits. Results Sociodemographic and illness-related characteristics were equal in both groups. After 1-year follow-up, the ESG reported significantly less cancer-related stress response symptoms than the CSG (p = 0.01), and comparable anxiety, mental HRQoL, and cancer-related worry. Mean cancer-related worry and stress response symptoms decreased over time (p < 0.001), whereas mental HRQoL increased over time (p < 0.001) in all melanoma patients. Recurrence rate was 9 % in both groups, mostly patient-detected and not physician-detected (CSG 63 %, ESG 43 %, p = 0.45). Hospital costs of 1-year follow-up were reduced by 45 % in the ESG compared to the CSG. Conclusions
This study shows that the stage-adjusted, reduced follow-up schedule did not negatively affect melanoma patients’ mental well-being and the detection of recurrences compared with conventional follow-up as dictated by the Dutch guideline, at 1 year after diagnosis. Additionally, reduced follow-up was associated with significant hospital cost reduction. Electronic supplementary material The online version of this article (doi:10.1245/s10434-016-5263-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha Damude
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Groningen, The Netherlands
| | | | - Sylvia Ter Meulen
- Department of Dermatology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, University of Leiden, University Medical Center Leiden, Leiden, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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31
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Voss RK, Woods TN, Cromwell KD, Nelson KC, Cormier JN. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis. PATIENT-RELATED OUTCOME MEASURES 2015; 6:229-42. [PMID: 26609248 PMCID: PMC4644158 DOI: 10.2147/prom.s69351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new "apps" available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments).
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Affiliation(s)
- Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tessa N Woods
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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32
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Memari N, Hayen A, Bell KJL, Rychetnik L, Morton RL, McCaffery K, Thompson JF, Irwig L, Turner RM. How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center? Ann Surg Oncol 2015; 22 Suppl 3:S1164-71. [PMID: 25963479 DOI: 10.1245/s10434-015-4589-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Post-treatment follow-up for patients with American Joint Committee on Cancer (AJCC) stage I/II melanoma is believed to be important for early detection of disease recurrence and new primary melanomas, but comes with costs to both patients and healthcare providers. We aimed to determine how frequently a cohort of patients attended follow-up after surgical treatment at one Specialist Center. METHODS We used prospectively collected data from the Melanoma Institute Australia (MIA) for patients with AJCC stage I/II melanoma diagnosed between January 2008 and December 2011. The distribution of the number of recorded follow-up visits per patient was analyzed and compared with the number of follow-up visits recommended in the 2008 Australian and New Zealand Melanoma Management Guidelines. RESULTS A total of 3813 patients with stage I/II melanoma were identified. During the first year of follow-up post-surgery, 34 % of stage I patients and 14 % of stage II patients had the number of follow-up visits recommended in the guidelines. A large proportion of melanoma patients did not appear to be routinely followed up at MIA, with 43.2 % of stage I patients and 28.7 % of stage II patients having either no visit or only one visit post-surgery. During all years of follow-up, 13.2 % of stage I patients and 4.1 % of stage II patients had the number of follow-up visits at the specialist center as recommended in the guidelines. CONCLUSIONS The large proportion of patients who had fewer follow-up visits than expected suggests (i) many patients are followed up in clinics elsewhere, and/or (ii) post-surgical surveillance is less frequent in practice.
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Affiliation(s)
- Niloofar Memari
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Katy J L Bell
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Rachael L Morton
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
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Livingstone E, Eigentler TK, Windemuth-Kieselbach C, Hauschild A, Rompel R, Trefzer U, Nashan D, Kilian K, Debus D, Kähler KC, Mauerer A, Möllenhoff K, Dippel E, Schadendorf D. Actual practice of melanoma follow-up and treatment in Germany: results of a prospective, longitudinal cohort study. Br J Dermatol 2015; 172:1646-1650. [PMID: 25495472 DOI: 10.1111/bjd.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Livingstone
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - T K Eigentler
- Department of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | | | - A Hauschild
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - R Rompel
- Department of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125, Kassel, Germany
| | - U Trefzer
- Department of Dermatology, Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - D Nashan
- Department of Dermatology, University Freiburg, Hauptstr. 7, 79104, Freiburg, Germany.,Department of Dermatology, Clinical Centre Mitte, Beurhausstraße 40, 44137, Dortmund, Germany
| | - K Kilian
- Department of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337, München, Germany
| | - D Debus
- Department of Dermatology, University Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Germany
| | - K C Kähler
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - A Mauerer
- Department of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K Möllenhoff
- Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - E Dippel
- Department of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073, Ludwigshafen, Germany
| | - D Schadendorf
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
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Livingstone E, Krajewski C, Eigentler TK, Windemuth-Kieselbach C, Benson S, Elsenbruch S, Hauschild A, Rompel R, Meiss F, Mauerer A, Kähler KC, Dippel E, Möllenhoff K, Kilian K, Mohr P, Utikal J, Schadendorf D. Prospective evaluation of follow-up in melanoma patients in Germany - results of a multicentre and longitudinal study. Eur J Cancer 2015; 51:653-67. [PMID: 25638778 DOI: 10.1016/j.ejca.2015.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance is costly and guideline recommendations vary substantially. METHODS In this German nationwide study, information on surveillance and treatment of patients diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was prospectively collected over four years. Additionally, patient self-report questionnaires were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic information and use of disease specific health information sources at year 4 after primary diagnosis. RESULTS Complete data was available for 668 patients from 67 centres, of whom 96.0% were in regular melanoma surveillance. In year 3-4 of surveillance, only 55.6% of locoregionary metastases were detected during surveillance visits. Only 33.3% were self-detected by the patient even though 69.4% were documented as being clinically visible or palpable. Costs of 4year surveillance of 550 patients without tumour recurrence (stage I-IIC and MMis) accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately 60% in year 3-4 of surveillance. Multivariate regression analysis showed that certain patient/tumour characteristics and regional differences were significantly associated with guideline deviations. The percentage of patients who exceeded published cut-off scores indicating clinically relevant symptoms of anxiety and depression were significantly increased. Patients frequently reported lack of psychosocial support and education but ascribed great importance to these. CONCLUSIONS We recommend further reduction of melanoma follow-up in low-risk melanoma patients and improvement of psycho-social support and patient education for all melanoma patients.
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Affiliation(s)
- E Livingstone
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany.
| | - C Krajewski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - T K Eigentler
- Dept. of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany
| | | | - S Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - S Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - A Hauschild
- Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany
| | - R Rompel
- Dept. of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125 Kassel, Germany
| | - F Meiss
- Dept. of Dermatology, University Medical Centre Freiburg, Hauptstr. 7, 79104 Freiburg, Germany
| | - A Mauerer
- Dept. of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - K C Kähler
- Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany
| | - E Dippel
- Dept. of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073 Ludwigshafen, Germany
| | - K Möllenhoff
- Dept. of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - K Kilian
- Dept. of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337 München, Germany
| | - P Mohr
- Dept. of Dermatology, Elbekliniken Stade-Buxtehude GmbH, Am Krankenhaus 1, 21614 Buxtehude, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Ruprecht-Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - D Schadendorf
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany
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35
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Rueth NM, Cromwell KD, Cormier JN. Long-term follow-up for melanoma patients: is there any evidence of a benefit? Surg Oncol Clin N Am 2015; 24:359-77. [PMID: 25769718 DOI: 10.1016/j.soc.2014.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As the incidence of melanoma and the number of melanoma survivors continues to rise, optimal surveillance strategies are needed that balance the risks and benefits of screening in the context of contemporary resource use. Detection of recurrences has important implications for clinical management. Most current surveillance recommendations for melanoma survivors are based on low-level evidence with wide variations in practice patterns and an unknown clinical impact for the melanoma survivor.
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Affiliation(s)
- Natasha M Rueth
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA.
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36
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Leiter U, Eigentler T, Garbe C. Follow-up in patients with low-risk cutaneous melanoma: is it worth it? Melanoma Manag 2014; 1:115-125. [PMID: 30190817 PMCID: PMC6094616 DOI: 10.2217/mmt.14.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Follow-up examinations in melanoma aim to detect recurrences or secondary melanomas in an early phase of development. Follow-up guidelines that have been developed in many European countries, the USA and Australia show varying recommendations and are controversial, especially in patients with melanomas of 1.0 mm tumor thickness or less. This group contains 50-70% of all melanoma patients and the majority is unlikely to develop recurrences. On the other hand, within this entity, subgroups at higher risk for recurrences can be defined who require a more intense follow-up. This article discusses recommendations for the frequency, duration and costs of follow-up in low-risk melanoma patients. Patient preferences are addressed and a risk-adapted follow-up scheme is proposed.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Thomas Eigentler
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Claus Garbe
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
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37
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Rutkowski P, Lugowska I. Follow-up in melanoma patients. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2014; 7:83-86. [PMID: 25089158 PMCID: PMC4101246 DOI: 10.1007/s12254-014-0151-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/10/2014] [Indexed: 10/31/2022]
Abstract
Due to lack of evidence from prospective clinical trials, the diagnostic procedures, their frequency, as well as the length of the follow-up period in cutaneous melanoma patients should be based on the individual risk of disease recurrence, which is strongly dependent on the stage of disease at the time of diagnosis. In the paper we propose the current recommendations for follow-up strategy. Nowadays, new effective treatment options with biological agents justify the closer monitoring of high risk melanoma patients.
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Affiliation(s)
- Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
| | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
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38
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Speijers MJ, Francken AB, Hoekstra-Weebers JEHM, Bastiaannet E, Kruijff S, Hoekstra HJ. Optimal follow-up for melanoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Abstract
Melanoma is the most life-threatening common form of skin cancer. While most cutaneous melanomas are cured by surgical resection, a minority will relapse locally, regionally, or distantly. Biomarkers have represented a focal point for research aimed at improving diagnostic accuracy as well as providing prognostic information that may help to guide therapeutic decisions. While systemic melanoma therapies were of extremely limited utility for patients with advanced disease in the past, two drugs have been approved the FDA within the past several years, and it is possible that they may provide even greater impact if employed earlier in the disease process. To optimally employ these therapies, prognostic biomarkers may offer significant value. This article reviews methodologies for both discovery and routine testing of melanoma biomarkers. It also focuses on specific commonly used markers, as well as approaches to studying their applications to specific clinical settings. As the armamentarium of melanoma drugs grows, it is hoped that specific biomarkers will aid in guiding the use of these agents for patients in the clinic.
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Affiliation(s)
- Danielle Levine
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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40
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Bechara GR, Schwindt ABDS, Ornellas AA, Silva DEAD, Lott FM, Campos FSD. Penile primary melanoma: analysis of 6 patients treated at Brazilian national cancer institute in the last eight years. Int Braz J Urol 2013; 39:823-31. [DOI: 10.1590/s1677-5538.ibju.2013.06.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/15/2013] [Indexed: 02/03/2023] Open
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41
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Scally CP, Wong SL. Intensity of follow-up after melanoma surgery. Ann Surg Oncol 2013; 21:752-7. [PMID: 24114053 DOI: 10.1245/s10434-013-3295-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Indexed: 11/18/2022]
Abstract
This contemporary review of melanoma surveillance strategies seeks to help practitioners examine and improve their surveillance protocols based on the currently available data. In general, there is no definitive benefit from increased screening or more aggressive use of interval imaging. Low-intensity surveillance strategies do not appear to adversely affect patient outcomes and should be the preferred approach compared with high-intensity strategies for most melanoma patients. All surveillance programs should emphasize education in order to maximize the effectiveness of patient-based detection of recurrent disease.
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42
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Multicohort model for prevalence estimation of advanced malignant melanoma in the USA: an increasing public health concern. Melanoma Res 2013; 22:454-9. [PMID: 22990665 DOI: 10.1097/cmr.0b013e328358d96f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to estimate the current prevalence of advanced cutaneous malignant melanoma in 2010 in the USA and to project prevalence estimates to the year 2015. An excel-based, multicohort natural disease history model was developed. It used incidence, recurrence, all-cause mortality, and US population data from the up-to-date surveillance, epidemiology, and end results program, the US census, and the literature. The prevalence was stratified by tumor stage, sex, and age. The model estimated that there were 800 735 malignant melanoma cases (258 per 100 000 individuals) in the USA in 2010, of which 10.4% were in advanced stages including stage III (22 per 100 000 individuals) and stage IV (four per 100 000 individuals). Among these advanced cases, 58.8% were men. In total, 42.1% of patients with advanced malignant melanoma were 65 years of age and older. Of these elderly patients with an advanced stage of the disease, 65.7% were men. The total number of cases and number of advanced cases were projected to increase from 2010 to 2015 by 24.4 and 21.0%, respectively. There will be approximately one million malignant melanoma cases (306 per 100 000 individuals) in the USA in 2015. The prevalence of advanced malignant melanoma is expected to increase in the next few years. Advanced malignant melanoma disproportionately affects men and the elderly in the USA.
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Birkeland E, Busch C, Berge EO, Geisler J, Jönsson G, Lillehaug JR, Knappskog S, Lønning PE. Low BRAF and NRAS expression levels are associated with clinical benefit from DTIC therapy and prognosis in metastatic melanoma. Clin Exp Metastasis 2013; 30:867-76. [PMID: 23673558 PMCID: PMC3837233 DOI: 10.1007/s10585-013-9587-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 04/30/2013] [Indexed: 12/26/2022]
Abstract
Metastatic melanoma is characterized by a poor response to chemotherapy. Furthermore, there is a lack of established predictive and prognostic markers. In this single institution study, we correlated mutation status and expression levels of BRAF and NRAS to dacarbazine (DTIC) treatment response as well as progression-free and overall survival in a cohort of 85 patients diagnosed with advanced melanoma. Neither BRAF nor NRAS mutation status correlated to treatment response. However, patients with tumors harboring NRAS mutations had a shorter overall survival (p < 0.001) compared to patients with tumors wild-type for NRAS. Patients having a clinical benefit (objective response or stable disease at 3 months) on DTIC therapy had lower BRAF and NRAS expression levels compared to patients progressing on therapy (p = 0.037 and 0.003, respectively). For BRAF expression, this association was stronger among patients with tumors wild-type for BRAF (p = 0.005). Further, low BRAF as well as NRAS expression levels were associated with a longer progression-free survival in the total population (p = 0.004 and <0.001, respectively). Contrasting low NRAS expression levels, which were associated with improved overall survival in the total population (p = 0.01), low BRAF levels were associated with improved overall survival only among patients with tumors wild-type for BRAF (p = 0.013). These findings indicate that BRAF and NRAS expression levels may influence responses to DTIC as well as prognosis in patients with advanced melanoma.
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Affiliation(s)
- Einar Birkeland
- Section of Oncology, Institute of Medicine, University of Bergen, Bergen, Norway
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44
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van der Leest R, Nijsten T, de Vries E. Screening for second primary melanomas: is it efficient? Reply from authors. Br J Dermatol 2013; 168:1135. [DOI: 10.1111/bjd.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. Melanoma Res 2013; 22:376-85. [PMID: 22914178 DOI: 10.1097/cmr.0b013e328357d796] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There are no evidence-based guidelines for the surveillance of patients with melanoma following surgical treatment. We carried out a systematic review to identify by country and physician specialty the current stage-specific surveillance practices for patients with melanoma. Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published from January 1970 to October 2011 that included detailed information about the surveillance of patients with melanoma after the initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. One hundred and four articles from 10 countries and four physician specialties (dermatology, surgical oncology, medical oncology, and general practice) fulfilled the inclusion criteria, including 43 providing specific patient-level data. The articles showed a wide variation with respect to the surveillance intervals and recommended evaluations. The variation was greatest for patients with stage I disease, for whom the follow-up frequency ranged from one to six visits per year during years 1 and 2 after treatment. All four physician specialties agreed that for years 1-3, the follow-up frequency should be four times per year for all patients. For years 4 and 5, surgical oncologists recommended two follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended four visits per year. Recommended imaging and laboratory evaluations were most intense in the UK and most minimalist in the Netherlands. Although general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. There are significant intercountry and interspecialty variations in the surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.
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46
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47
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Rychetnik L, McCaffery K, Morton RL, Thompson JF, Menzies SW, Irwig L. Follow-up of early stage melanoma: specialist clinician perspectives on the functions of follow-up and implications for extending follow-up intervals. J Surg Oncol 2012; 107:463-8. [PMID: 23090908 DOI: 10.1002/jso.23278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/24/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is limited evidence on the relative effectiveness of different follow-up schedules for patients with AJCC stage I or II melanoma, but less frequent follow-up than is currently recommended has been proposed. OBJECTIVES To describe melanoma clinicians' perspectives on the functions of follow-up, factors that influence follow-up intervals, and important considerations for extending intervals. METHODS Qualitative interviews with 16 clinicians (surgical oncologists, dermatologists, melanoma unit physicians) who conduct follow-up at two of Australia's largest specialist centers. RESULTS Follow-up is conducted for early detection of recurrences or new primary melanomas, to manage patient anxiety, support patient self-care, and as part of shared care. Recommended intervals are based on guidelines but account for each patient's clinical risk profile, level of anxiety, patient education requirements, capacity to engage in skin self-examination, and how the clinician prefers to manage any suspicious lesions. CONCLUSIONS To revise guidelines and implement change it is important to understand the rationale underpinning existing practice. Extended follow-up intervals for early stage melanoma are more likely to be adopted after the first year when patients are less anxious and sufficiently prepared to conduct self-examination. Clinicians may retain existing schedules for highly anxious patients or those unable to examine themselves.
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Affiliation(s)
- Lucie Rychetnik
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia.
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48
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Rychetnik L, McCaffery K, Morton R, Irwig L. Psychosocial aspects of post-treatment follow-up for stage I/II melanoma: a systematic review of the literature. Psychooncology 2012; 22:721-36. [PMID: 22431448 DOI: 10.1002/pon.3060] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients treated for melanoma are advised to have lifelong full body skin examinations. Extended intervals between examinations have been proposed, but although this may be clinically effective, psychosocial aspects of follow-up are not well understood. This systematic review summarised patient and clinician preferences, experiences and adherence with recommended follow-up of stage I/II melanoma. METHODS Medline, PsycINFO, CINAHL, Embase, Cochrane Library, ACP Journal Club and NHS Economic Evaluation Database were searched from database inception to week 3 April 2010, to identify original studies of psychosocial outcomes of follow-up after treatment of stage I/II primary cutaneous melanoma, as reported by patients or clinicians. The results were synthesised, and characteristics likely to maximise patients' well-being and adherence to follow-up schedules were proposed. RESULTS We found 15 studies that met the inclusion criteria. Anxiety with melanoma follow-up was common; patients valued reassurance, information and psychosocial support, but long-term adherence to schedules was variable. Some wanted more emotional support from their clinician than was provided. Clinicians sometimes ordered additional blood and imaging tests to reassure patients. GPs were hesitant to conduct melanoma follow-up, but a trial providing technical training and protocols reported positive outcomes. Both patients and GPs wanted prompt access to melanoma specialists when suspicious lesions were found. CONCLUSION Psychosocial aspects of follow-up impact on patient well-being and potential adherence to schedules, and may influence clinician practice. If follow-up schedules or personnel are to be revised, psychosocial impacts on patients must be explicitly addressed, as well as guidance and specialist support for clinicians.
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Affiliation(s)
- Lucie Rychetnik
- Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Camperdown, Australia.
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49
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Turner RM, Bell KJ, Morton RL, Hayen A, Francken AB, Howard K, Armstrong B, Thompson JF, Irwig L. Optimizing the Frequency of Follow-Up Visits for Patients Treated for Localized Primary Cutaneous Melanoma. J Clin Oncol 2011; 29:4641-6. [DOI: 10.1200/jco.2010.34.2956] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop more evidence-based guidelines for the frequency of patient follow-up after treatment of localized (American Joint Committee on Cancer [AJCC] stage I or II) melanoma. Methods We used data from Melanoma Institute Australia on an inception cohort of 3,081 consecutive patients first diagnosed with stage I or II melanoma between January 1985 and December 2009. Kaplan-Meier curves and Cox models were used to characterize the time course and predictors for recurrence and new primaries. We modeled the delay in diagnosis of recurrence or new primary as well as the number of monitoring visits required using two monitoring schedules: first, according to 2008 Australian and New Zealand guidelines and, second, with fewer visits, especially for those at lowest risk of recurrence. Results For every 1,000 patients beginning follow-up, 229 developed recurrence and 61 developed new primary within 10 years. There was only a small difference in modeled delay in diagnosis (extra 44.9 and 9.6 patients per 1,000 for recurrence and new primary, respectively, with delay greater than 2 months) using a schedule that requires far fewer visits (3,000 fewer visits per 1,000 patients) than recommended by current guidelines. AJCC substage was the most important predictor of recurrence, whereas age and date of primary diagnosis were important predictors of developing new primary. Conclusion By providing less intensive monitoring, more efficient follow-up strategies are possible. Fewer visits with a more focused approach may address the needs of patients and clinicians to detect recurrent or new melanoma.
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Affiliation(s)
- Robin M. Turner
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Katy J.L. Bell
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Rachael L. Morton
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Andrew Hayen
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Anne Brecht Francken
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Kirsten Howard
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Bruce Armstrong
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - John F. Thompson
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Les Irwig
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
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50
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Bichakjian CK, Halpern AC, Johnson TM, Foote Hood A, Grichnik JM, Swetter SM, Tsao H, Barbosa VH, Chuang TY, Duvic M, Ho VC, Sober AJ, Beutner KR, Bhushan R, Smith Begolka W. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. J Am Acad Dermatol 2011; 65:1032-47. [PMID: 21868127 DOI: 10.1016/j.jaad.2011.04.031] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 04/16/2011] [Accepted: 04/20/2011] [Indexed: 12/29/2022]
Abstract
The incidence of primary cutaneous melanoma has been increasing dramatically for several decades. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is nearly always curative with early detection of disease. In this update of the guidelines of care, we will discuss the treatment of patients with primary cutaneous melanoma. We will discuss biopsy techniques of a lesion clinically suspicious for melanoma and offer recommendations for the histopathologic interpretation of cutaneous melanoma. We will offer recommendations for the use of laboratory and imaging tests in the initial workup of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, we will provide recommendations for surgical margins and briefly discuss nonsurgical treatments. Finally, we will discuss the value and limitations of sentinel lymph node biopsy and offer recommendations for its use in patients with primary cutaneous melanoma.
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Affiliation(s)
- Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System and Comprehensive Cancer Center, Ann Arbor, Michigan, USA
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