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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Acknowledgment
Financial support for this study was provided entirely by an Australian National Health and Medical Research Council (NHMRC) Grant (633003) to the Screening and Test Evaluation Program. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. The following authors are supported by the sponsor: Katy Bell is supported by an NHMRC Early Career Fellowship (1013390); Rachael Morton is funded by an NHMRC Early Career Researcher Fellowship (1054216); Kirsten McCaffery is funded by an NHMRC Career Development Fellowship (1029241).
Disclosure
Niloofar Memari, Andrew Hayen, Lucie Rychetnik, John F. Thompson, Les Irwig and Robin M. Turner have no conflicts of interest.
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Appendix
Appendix
Routinely collected records at MIA are a combination of various consultations and do not distinguish routine follow-up visits from other types of records such as test results or updates to patient records from other sources. It is likely that a single follow-up visit may result in a number of follow-up records. To assess the impact of this we conducted a sensitivity analysis where we assumed that consecutive records that each fall less than 15 days apart were related to one follow-up visit. These records were then grouped together as one visit and the mean date was used as the date for that visit, with 15.2 % of patients and 9.3 % of all records having been grouped in this process. The largest number of records that were grouped together was 11 records, with 67 days between the first and last record in the group. Tables 5 and 6 are based on these grouped records of follow-up. There is little difference in interpretation between these tables and those presented in the main paper.
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Memari, N., Hayen, A., Bell, K.J.L. et al. How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center?. Ann Surg Oncol 22 (Suppl 3), 1164–1171 (2015). https://doi.org/10.1245/s10434-015-4589-x
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DOI: https://doi.org/10.1245/s10434-015-4589-x