Nicole J Look Hong1, Stephanie Y Cheng2, Nancy N Baxter2,3, Frances C Wright1. 1. Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontorio, Canada. 2. Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada. 3. St. Michael's Hospital, Department of Surgery and Keenan Research Centre, Toronto, Ontorio, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population-level data. METHODS: Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003-2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis. Melanoma treatment was categorized as inadequate or adequate based on multidisciplinary clinical algorithms. Multivariable logistic regression was used to model factors associated with treatment adequacy. RESULTS: From 2003 to 2012, 22 918 patients with invasive melanoma were identified with annual age/sex standardized incidence rates of 11.7-14.3/100 000 for females and 13.4-15.9/100 000 for males. Melanoma occurred at median age of 62 and primarily on extremities (43.9%). Within 1 year after diagnosis, 86.7% of patients received surgery as primary therapy. A total of 2312 (10.6%) patients received inadequate or no treatment after diagnosis. Receiving adequate treatment was associated with consultation with dermatology (OR 1.92, CI 1.71-2.14), plastic surgery (OR 4.80, CI 4.32-5.34), or general surgery (OR 2.15, CI 1.94-2.38). CONCLUSIONS: Significant variation exists in melanoma management and nearly one in nine patients is inadequately treated. Referral to sub-specialized providers is critical for ensuring appropriate care.
BACKGROUND AND OBJECTIVES: Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population-level data. METHODS:Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003-2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis. Melanoma treatment was categorized as inadequate or adequate based on multidisciplinary clinical algorithms. Multivariable logistic regression was used to model factors associated with treatment adequacy. RESULTS: From 2003 to 2012, 22 918 patients with invasive melanoma were identified with annual age/sex standardized incidence rates of 11.7-14.3/100 000 for females and 13.4-15.9/100 000 for males. Melanoma occurred at median age of 62 and primarily on extremities (43.9%). Within 1 year after diagnosis, 86.7% of patients received surgery as primary therapy. A total of 2312 (10.6%) patients received inadequate or no treatment after diagnosis. Receiving adequate treatment was associated with consultation with dermatology (OR 1.92, CI 1.71-2.14), plastic surgery (OR 4.80, CI 4.32-5.34), or general surgery (OR 2.15, CI 1.94-2.38). CONCLUSIONS: Significant variation exists in melanoma management and nearly one in nine patients is inadequately treated. Referral to sub-specialized providers is critical for ensuring appropriate care.
Authors: Frances Rapport; Andrea L Smith; Anne E Cust; Graham J Mann; Caroline G Watts; David E Gyorki; Michael Henderson; Angela M Hong; John W Kelly; Georgina V Long; Victoria J Mar; Rachael L Morton; Robyn Pm Saw; Richard A Scolyer; Andrew J Spillane; John F Thompson; Jeffrey Braithwaite Journal: BMJ Open Date: 2020-02-27 Impact factor: 2.692
Authors: John Milkovich; Tim Hanna; Carolyn Nessim; Teresa M Petrella; Louis Weatherhead; An-Wen Chan; Jonathan C Irish; Christian Murray; Grace Bannerman; Claire Holloway; Katharina Forster; Laura Pazzano; Frances C Wright Journal: Curr Oncol Date: 2021-03-12 Impact factor: 3.677