Rebecca L Read1,2, Christine M Madronio3, Anne E Cust1,3, Chris Goumas1, Caroline G Watts3, Scott Menzies4, Austin M Curtin4, Graham Mann4, John F Thompson1,5, Rachael L Morton6,7. 1. Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. 2. Calvary Health Care, Bruce, ACT, Australia. 3. Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia. 4. Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 5. Department of Surgery, The University of Sydney, Camperdown, NSW, Australia. 6. Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. rachael.morton@ctc.usyd.edu.au. 7. NHMRC Clinical Trials Centre, The University of Sydney, Level 6, Medical Foundation Building92-94 Parramatta Road, Camperdown, NSW, Australia. rachael.morton@ctc.usyd.edu.au.
Abstract
BACKGROUND: Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS: The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS: Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS: Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
BACKGROUND: Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS: The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS: Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS: Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
Authors: Marc D Moncrieff; Beverly Underwood; Jennifer J Garioch; Martin Heaton; Nakul Patel; Esther Bastiaannet; Josette E H M Hoekstra-Weebers; Harald J Hoekstra Journal: Ann Surg Oncol Date: 2020-07-04 Impact factor: 5.344