Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma

Abstract

The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients' skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance). OBJECTIVE To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up). DESIGN, SETTING, AND PARTICIPANTS This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed. MAIN OUTCOMES AND MEASURES Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices. RESULTS Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals. CONCLUSIONS AND RELEVANCE Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance).

Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study

“…An intervention study among patients with melanoma also showed that providing personalized information is more effective in increasing adherence to advice compared with giving generic information . Patients with melanoma were also found to accept fewer follow‐up visits from a nonspecialist under certain conditions, such as increased continuity of care and rapid clinical review of anything causing concern . These trade‐offs should be taken into account when developing future policies.…”

“…Evidence‐based medicine includes three components: research‐based evidence, professional expertise and patient values . Given that patient values are a core component of evidence‐based medicine, it is surprising that the experiences, needs and preferences of patients with KC have received limited attention and were focused mainly on patients with melanoma . A recently conducted qualitative review on the needs and experiences of patients with skin cancer found that only three of 16 studies included patients with KC .…”

Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma

“…As reported previously, of the 262 participants interviewed in total, at the time of their interview, 13 had a recurrence (5%) and 19 had a new primary melanoma (7%) [ 16 ] (the 30 people with a recurrence and/or new primary melanoma are not included in the current report on shared care and routine testing). An additional 62 people reported they had a non-melanoma skin cancer detected during follow-up (24%), and 79 (30%) people had at least one of these events by the time of the interview (note that some people had more than one of these events).…”

“…MIA is a non-profit tertiary referral centre which specialises in melanoma research treatment and education [ 14 ]. Details of how potential participants were selected are provided in separate reports on a self-administered questionnaire on fear of melanoma recurrence [ 15 ] and phone interview questions on preferences for scheduled follow-up frequency [ 16 ]. Briefly, we randomly selected 351 people without recurrent or additional new primary melanoma, from a total of 897 people diagnosed and treated for localised melanoma in 2014 who were alive at the time of data collection.…”

ASO Author Reflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, Until Biomarkers to Predict Prognosis Have Been Identified

“…3 Apart from recurrence detection, mental support and patient education are important after-care goals for melanoma patients with any stage of disease. 6,7 Now that several effective therapeutic adjuvant systemic treatment options with drug targeting and/or immunotherapy have become available, follow-up has become even more complex. 8 What is the best strategy to improve OS in stage IB-II melanoma?…”