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

Lim, Wei-Yin; Turner, Robin; Morton, Rachael L.; Jenkins, Marisa C.; Irwig, Les; Webster, Angela C; Dieng, Mbathio; Saw, Robyn P.M.; Guitera, Pascale; Low, Donald E.; Low, Cynthia; Bell, Katy J.L.

doi:10.1186/s12913-018-3291-7

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…Accordingly, we invited participants with varying sex, residence, and melanoma stage from the 230 patients who had answered a telephone survey about their preferences for, and experience of, follow-up after treatment for localized melanoma (Ameri-can Joint Committee on Cancer stage 0, I, or II). 5,12 To match the intended clinical population in which patient-led surveillance might be used, we restricted selection to patients who had not developed a recurrence or a new primary melanoma. We sent invitations by postal mail and email in sequential rounds and continued recruiting participants until data saturation was achieved.…”

Section: Samplingmentioning

confidence: 99%

Patients’ Views About Skin Self-examination After Treatment for Localized Melanoma

et al. 2019

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IMPORTANCE Skin self-examination (SSE) is a key factor in the early detection of melanoma, and many new and recurrent melanomas are first detected by patients themselves or their family members. OBJECTIVE To explore the views of patients with melanoma regarding SSE in general, as well as their attitudes toward using novel digital technologies to support their own SSE. DESIGN, SETTING, AND PARTICIPANTS Qualitative study with semistructured interviews that were conducted from June 20 to December 12, 2016, with 37 individuals in Sydney, Australia, who were previously treated for a first primary localized melanoma during 2014 and had not had a recurrence or new primary melanoma in the time since treatment. MAIN OUTCOMES AND MEASURES Patients' views and experiences, analyzed thematically. RESULTS A total of 37 patients (11 women and 26 men; median age, 67 years [interquartile range, 59.5-72 years]) were interviewed. Participants perceived SSE as important for the early identification of local recurrence or new primary melanomas. Despite this belief, participants did not report undertaking full-body SSE on a regular basis. Factors that influenced their low engagement in thorough SSE included lack of self-efficacy, reliance on clinician consultations as the primary means of melanoma detection, and fear of cancer recurrence. Regarding the use of digital technology to assist with SSE, the key motivating factors in favor of such tools were the ability to track changes in lesions over time and the use of automated reminders to undertake SSE. Deterrents included a lack of confidence in undertaking SSE and in using new technology. CONCLUSIONS AND RELEVANCE Patients with melanoma are aware of the importance of thorough skin examinations. However, a lack of confidence in their ability to undertake SSE and reliance on clinicians as the primary means of melanoma detection may inhibit patients from undertaking regular and thorough SSE. Patients may benefit from new digital technologies that assist them in undertaking SSE, provided they have appropriate education and technical support.

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Section: Samplingmentioning

confidence: 99%

Patients’ Views About Skin Self-examination After Treatment for Localized Melanoma

et al. 2019

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“…Patients with one primary melanoma, whose 10‐year risk is at the lower end of the curve, say < 5%, might benefit psychologically and financially from fewer routine visits, for example every 2 years, without compromising other outcomes . These lower‐risk patients might also be more appropriately managed in primary care or in a shared primary care/specialist care arrangement, thus helping to ensure that patients at higher risk have timely access to specialist clinics and more advanced diagnostic equipment. Further research is needed to determine the risk cut‐points that represent the best balance of benefits, harms, resources and costs for different surveillance schedules, in different populations.…”

Section: Discussionmentioning

confidence: 99%

A risk prediction model for the development of subsequent primary melanoma in a population‐based cohort

et al. 2019

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Background Guidelines for follow-up of patients with melanoma are based on limited evidence. Objectives To guide skin surveillance, we developed a risk prediction model for subsequent primary melanomas, using demographic, phenotypical, histopathological, sun exposure and genomic risk factors. Methods Using Cox regression frailty models, we analysed data for 2613 primary melanomas from 1266 patients recruited to the population-based Genes, Environment and Melanoma study in New South Wales, Australia, with a median of 14 years' follow-up via the cancer registry. Discrimination and calibration were assessed. Results The median time to diagnosis of a subsequent primary melanoma decreased with each new primary melanoma. The final model included 12 risk factors. Harrell's C-statistic was 0Á73 [95% confidence interval (CI) 0Á68-0Á77], 0Á65 (95% CI 0Á62-0Á68) and 0Á65 (95% CI 0Á61-0Á69) for predicting second, third and fourth primary melanomas, respectively. The risk of a subsequent primary melanoma was 4Á75 times higher (95% CI 3Á87-5Á82) for the highest vs. the lowest quintile of the risk score. The mean absolute risk of a subsequent primary melanoma within 5 years was 8Á0 AE SD 4.1% after the first primary melanoma, and 46Á8 AE 15Á0% after the second, but varied substantially by risk score. Conclusions The risk of developing a subsequent primary melanoma varies considerably between individuals and is particularly high for those with two or more primary melanomas. The risk prediction model and its associated nomograms enable estimation of the absolute risk of subsequent primary melanoma, on the basis of on an individual's risk factors, and can be used to tailor surveillance intensity, communicate risk and provide patient education.What's already known about this topic?• Current guidelines for the frequency and length of follow-up to detect new primary melanomas in patients with one or more previous primary melanomas are based on limited evidence. A risk prediction model for subsequent primary melanomas, A.E. Cust et al. 1149 A risk prediction model for subsequent primary melanomas, A.E. Cust et al. 1153 A risk prediction model for subsequent primary melanomas, A.E. Cust et al. 1155

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“…Assuming that 6–8% of patients in the clinician-led surveillance group have a subsequent new primary or recurrent melanoma diagnosed within the 12 months follow up [ 21 , 45 ] and that 1% have a diagnosis through a fast-tracked unscheduled clinic visit, we will need to recruit at least 452 participants (226 to patient-led surveillance and 226 to clinician-led surveillance) in order to have at least 80% power to detect a 5% absolute increase in the patient-led surveillance group (i.e. 6% have new or recurrent melanoma diagnosed through unscheduled visit at treatment centre).…”

Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

“…This sample size will also ensure at least 80% power to detect a hazard ratio of 1.71 for time from randomisation to diagnosis of a skin cancer for the patient-led vs clinician-led surveillance groups (due to earlier and increased detection in the patient-led group). This calculation assumes a 20% event rate in the clinician-led surveillance group [ 21 , 45 ] (60 events among 300 control participants), a 32% event rate in the patient-led surveillance group (96 events among 300 intervention participants), and 26% event rate overall (156 events among 600 trial participants).…”

Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow-up? A protocol for the MEL-SELF randomised controlled trial

Ackermann

Smit

Janda

et al. 2021

Trials

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Background Most subsequent new primary or recurrent melanomas might be self-detected if patients are trained to systematically self-examine their skin and have access to timely medical review (patient-led surveillance). Routinely scheduled clinic visits (clinician-led surveillance) is resource-intensive and has not been shown to improve health outcomes; fewer visits may be possible if patient-led surveillance is shown to be safe and effective. The MEL-SELF trial is a randomised controlled trial comparing patient-led surveillance with clinician-led surveillance in people who have been previously treated for localised melanoma. Methods Stage 0/I/II melanoma patients (n = 600) from dermatology, surgical, or general practice clinics in NSW Australia, will be randomised (1:1) to the intervention (patient-led surveillance, n = 300) or control (usual care, n = 300). Patients in the intervention will undergo a second randomisation 1:1 to polarised (n = 150) or non-polarised (n = 150) dermatoscope. Patient-led surveillance comprises an educational booklet, skin self-examination (SSE) instructional videos; 3-monthly email/SMS reminders to perform SSE; patient-performed dermoscopy with teledermatologist feedback; clinical review of positive teledermoscopy through fast-tracked unscheduled clinic visits; and routinely scheduled clinic visits following each clinician’s usual practice. Clinician-led surveillance comprises an educational booklet and routinely scheduled clinic visits following each clinician’s usual practice. The primary outcome, measured at 12 months, is the proportion of participants diagnosed with a subsequent new primary or recurrent melanoma at an unscheduled clinic visit. Secondary outcomes include time from randomisation to diagnosis (of a subsequent new primary or recurrent melanoma and of a new keratinocyte cancer), clinicopathological characteristics of subsequent new primary or recurrent melanomas (including AJCC stage), psychological outcomes, and healthcare use. A nested qualitative study will include interviews with patients and clinicians, and a costing study we will compare costs from a societal perspective. We will compare the technical performance of two different models of dermatoscope (polarised vs non-polarised). Discussion The findings from this study may inform guidance on evidence-based follow-up care, that maximises early detection of subsequent new primary or recurrent melanoma and patient wellbeing, while minimising costs to patients, health systems, and society. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. Registered on 18 February 2021.

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

Cited by 7 publications

References 29 publications

Patients’ Views About Skin Self-examination After Treatment for Localized Melanoma

Patients’ Views About Skin Self-examination After Treatment for Localized Melanoma

A risk prediction model for the development of subsequent primary melanoma in a population‐based cohort

Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow-up? A protocol for the MEL-SELF randomised controlled trial

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