Melanoma patterns of care in Ontario: A call for a strategic alignment of multidisciplinary care

Hong, Nicole J. Look; Cheng, Stephanie; Baxter, Nancy N.; Wright, Frances C.

doi:10.1002/jso.24936

Cited by 7 publications

(3 citation statements)

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“…Recent studies have identified that better organization of skin cancer clinical care could benefit Ontario residents. In a paper written by Look Hong et al, it was demonstrated that patients diagnosed with melanoma who only saw a family physician were more likely to receive an inadequate wide local excision of their primary lesion [ 5 ]. In another study, Ontario residents diagnosed with melanoma and who lived in rural communities or long distances from a cancer center were less likely to be seen by a dermatologist within a year before their diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

et al. 2021

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There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.

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Section: Introductionmentioning

confidence: 99%

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

et al. 2021

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“…Data from the US Surveillance Epidemiology and End Results database for 2004–2006 indicate that 53% of eligible patients received an SLNB,18 while data from a population-based study in the northeast of France indicated that 34% of patients with a melanoma >1 mm in thickness received an SLNB 19. Factors associated with having an SLNB included patient age <50 years,17 primary tumour on upper limb,17 treatment in an urban setting17 19–23 and hospital size (>50 beds) 24. Recent international data indicate that rates of SLNB are increasing: in the Netherlands, the SLNB rate increased from 39.0% in 2003 to 47.8% in 2014 25.…”

Section: Introductionmentioning

confidence: 99%

Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: protocol paper for a mixed methods study

et al. 2020

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IntroductionSentinel lymph node biopsy (SLNB) is a diagnostic procedure developed in the 1990s. It is currently used to stage patients with primary cutaneous melanoma, provide prognostic information and guide management. The Australian Clinical Practice Guidelines state that SLNB should be considered for patients with cutaneous melanoma >1 mm in thickness (or >0.8 mm with high-risk pathology features). Until recently, sentinel lymph node (SLN) status was used to identify patients who might benefit from a completion lymph node dissection, a procedure that is no longer routinely recommended. SLN status is now also being used to identify patients who might benefit from systemic adjuvant therapies such as anti-programmed cell death 1 (PD1) checkpoint inhibitor immunotherapy or BRAF-directed molecular targeted therapy, treatments that have significantly improved relapse-free survival for patients with resected stage III melanoma and improved overall survival of patients with unresectable stage III and stage IV melanoma. Australian and international data indicate that approximately half of eligible patients receive an SLNB.Methods and analysisThis mixed-methods study seeks to understand the structural, contextual and cultural factors affecting implementation of the SLNB guidelines. Data collection will include: (1) cross-sectional questionnaires and semistructured interviews with general practitioners and dermatologists; (2) semistructured interviews with other healthcare professionals involved in the diagnosis and early definitive care of melanoma patients and key stakeholders including researchers, representatives of professional colleges, training organisations and consumer melanoma groups; and (3) documentary analysis of documents from government, health services and non-government organisations. Descriptive analyses and multivariable regression models will be used to examine factors related to SLNB practices and attitudes. Qualitative data will be analysed using thematic analysis.Ethics and disseminationEthics approval has been granted by the University of Sydney. Results will be disseminated through publications and presentations to clinicians, patients, policymakers and researchers and will inform the development of strategies for implementing SLNB guidelines in Australia.

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“…We read with great interest the recent article entitled “Melanoma patterns of care in Ontario: a call for strategic alignment of multidisciplinary care” by Look Hong NJ et al…”

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Maruccia

Nacchiero

Vestita

et al. 2018

Journal of Surgical Oncology

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Melanoma patterns of care in Ontario: A call for a strategic alignment of multidisciplinary care

Abstract: 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.

Cited by 7 publications

References 35 publications

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: protocol paper for a mixed methods study

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