Skip to main content

Advertisement

Log in

How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center?

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–2917.

    Article  PubMed  CAS  Google Scholar 

  2. Erdmann F, Lortet-Tieulent J, Schuz J, et al. International trends in the incidence of malignant melanoma 1953-2008: are recent generations at higher or lower risk? Int J Cancer. 2013;132(2):385–400.

    Article  PubMed  CAS  Google Scholar 

  3. Australian Institute of Health and Welfare & Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70 2012. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542353. Accessed 27 March 2014.

  4. Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–1933.

    Article  PubMed  Google Scholar 

  5. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol. 2005;6(8):608–621.

    Article  PubMed  Google Scholar 

  6. Turner RM, Bell KJL, Morton RL, et al. Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma. J Clin Oncol. 2011;29(35):4641–4646.

    Article  PubMed  Google Scholar 

  7. Rychetnik L, Morton RL, McCaffery K, Thompson JF, Menzies SW, Irwig L. Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care. BMC Health Serv Res. 2012;12:468.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–6206.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Australian National Health and Medical Research Council. Clinical practice guidelines for the management of melanoma in Australia and New Zealand. 2008. Available at: http://www.nhmrc.gov.au/guidelines/publications/cp111. Accessed 19 March 2014.

  10. Francken AB, Accortt NA, Shaw HM, et al. Follow-up schedules after treatment for malignant melanoma. Br J Surg. 2008;95(11):1401–1407.

    Article  PubMed  CAS  Google Scholar 

  11. Rueth NM, Xing Y, Chiang YJ, et al. Is surveillance imaging effective for detecting surgically treatable recurrences in patients with melanoma? A comparative analysis of stage-specific surveillance strategies. Ann Surg. 2014;259(6):1215–1222.

    Article  PubMed  Google Scholar 

  12. Holterhues C, van de Poll-Franse LV, de Vries E, Neumann HA, Nijsten TE. Melanoma patients receive more follow-up care than current guideline recommendations: a study of 546 patients from the general Dutch population. J Eur Acad Dermatol Venereol. 2012;26(11):1389–1395.

    Article  PubMed  CAS  Google Scholar 

  13. Morton RL, Rychetnik L, McCaffery K, Thompson JF, Irwig L. Patients’ perspectives of long-term follow-up for localised cutaneous melanoma. Eur J Surg Oncol. 2013;39(3):297–303.

    Article  PubMed  CAS  Google Scholar 

  14. 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. 2013;107(5):463–468.

    Article  PubMed  Google Scholar 

  15. 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. 2013;22(4):721–736.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin M. Turner MBioStat, PhD.

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.

Table 5 Number of follow-up visits in the specified years for patients with stage I and II melanoma
Table 6 All 3747 patients diagnosed with melanoma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4589-x

Keywords

Navigation