Abstract
Background
Patient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance
is costly and guideline recommendations vary substantially.
Methods
In this German nationwide study, information on surveillance and treatment of patients
diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was
prospectively collected over four years. Additionally, patient self-report questionnaires
were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic
information and use of disease specific health information sources at year 4 after
primary diagnosis.
Results
Complete data was available for 668 patients from 67 centres, of whom 96.0% were in
regular melanoma surveillance. In year 3–4 of surveillance, only 55.6% of locoregionary
metastases were detected during surveillance visits. Only 33.3% were self-detected
by the patient even though 69.4% were documented as being clinically visible or palpable.
Costs of 4 year surveillance of 550 patients without tumour recurrence (stage I–IIC and MMis)
accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node
ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately
60% in year 3–4 of surveillance. Multivariate regression analysis showed that certain
patient/tumour characteristics and regional differences were significantly associated
with guideline deviations. The percentage of patients who exceeded published cut-off
scores indicating clinically relevant symptoms of anxiety and depression were significantly
increased. Patients frequently reported lack of psychosocial support and education
but ascribed great importance to these.
Conclusions
We recommend further reduction of melanoma follow-up in low-risk melanoma patients
and improvement of psycho-social support and patient education for all melanoma patients.
Keywords
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References
- Comparison of melanoma guidelines in the U.S.A., Canada, Europe, Australia and New Zealand: a critical appraisal and comprehensive review.Br J Dermatol. 2014; 170: 20-30
- Final version of 2009 AJCC melanoma staging and classification.J Clin Oncol. 2009; 27: 6199-6206
Party ACNMGRW. Clinical practice guidelines for the management of melanoma in Australia and New Zealand. Available from URL: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp111.pdf.
- Malignant melanoma S3-guideline “Diagnosis, Therapy and Follow-up of Melanoma”.J Dtsch Dermatol Ges. 2013; 11: 1-116
- Updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma.Dermatology. 2005; 210: 39-44
Network NCC. NCCN clinical practice guidelines in oncology: melanoma. Available from URL: http://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf.
- Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology.J Am Acad Dermatol. 2011; 65: 1032-1047
- Hazard rates for recurrent and secondary cutaneous melanoma: an analysis of 33,384 patients in the German Central Malignant Melanoma Registry.J Am Acad Dermatol. 2012; 66: 37-45
Robert-Koch-Institut. Krebs in Deutschland 2007/2008. Berlin: Robert Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., 2012.
- Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma.Cancer. 1999; 86: 2252-2258
- Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy.J Clin Oncol. 2003; 21: 520-529
- Follow-up in patients with localised primary cutaneous melanoma.Lancet Oncol. 2005; 6: 608-621
- Follow-up schedules after treatment for malignant melanoma.Br J Surg. 2008; 95: 1401-1407
- Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma.J Clin Oncol. 2011; 29: 4641-4646
- Primary staging and follow-up in melanoma patients – monocenter evaluation of methods, costs and patient survival.Br J Cancer. 2002; 87: 151-157
- Cost-effectiveness of reduced follow-up in malignant melanoma.J Dtsch Dermatol Ges. 2007; 5: 898-907
- Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging.Ann Surg Oncol. 2009; 16: 941-947
- Compliance with follow-up among patients with melanoma and non-melanoma skin cancers.Dermatol Online J. 2014; 20
- 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: 1389-1395
- Follow-up of melanoma: a survey of Italian hospitals.Dermatology. 2013; 226: 32-38
- A global review of melanoma follow-up guidelines.J Clin Aesthet Dermatol. 2013; 6: 18-26
- Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review.Melanoma Res. 2012; 22: 376-385
- Short German guidelines: malignant melanoma.J Dtsch Dermatol Ges. 2008; 6: S9-S14
- A first prospective population-based analysis investigating the actual practice of melanoma diagnosis, treatment and follow-up.Eur J Cancer. 2011; 47: 1977-1989
- The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- International experiences with the Hospital Anxiety and Depression Scale – a review of validation data and clinical results.J Psychosom Res. 1997; 42: 17-41
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Anxiety and depression in cancer patients compared with the general population.Eur J Cancer Care (Engl). 2010; 19: 522-529
- Normative values for the hospital anxiety and depression scale (HADS) in the general German population.J Psychosom Res. 2011; 71: 74-78
Department EQoL. EORTC QLQ-C30 Reference Values Available from URL: http://groups.eortc.be/qol/sites/default/files/img/newsletter/reference_values_manual2008.pdf.
- A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group.Br J Dermatol. 1999; 140: 249-254
- Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines.Ann Surg Oncol. 2007; 14: 1924-1933
- Malignant melanoma of the skin: long-term follow-up and time to first recurrence.World J Surg. 2011; 35: 580-589
- Costs of the detection of metastases and follow-up examinations in cutaneous melanoma.Melanoma Res. 2009; 19: 50-57
- Impact on survival by method of recurrence detection in stage I and II cutaneous melanoma.Ann Surg Oncol. 1998; 5: 54-63
- Follow-up in stage I cutaneous malignant melanoma: an audit.Clin Oncol (R Coll Radiol). 1993; 5: 174-180
- Skin examination behavior: the role of melanoma history, skin type, psychosocial factors, and region of residence in determining clinical and self-conducted skin examination.Arch Dermatol. 2012; 148: 1142-1151
- Follow-up after melanoma resection is more extensive than recommended in the practice guidelines, primarily for reassurance of the patient.Ned Tijdschr Geneeskd. 1999; 143: 997-1001
- Psychosocial aspects of melanoma.Ann Plast Surg. 1992; 28: 17-21
- Psychosocial characteristics of individuals with non-stage IV melanoma.J Clin Oncol. 2001; 19: 2844-2850
- The prevalence of psychological distress by cancer site.Psychooncology. 2001; 10: 19-28
- Psychological stress and melanoma: are we meeting our patients’ psychological needs?.Clin Dermatol. 2013; 31: 41-46
- Psychological adjustment to the melanoma experience.Semin Oncol Nurs. 2003; 19: 70-77
- Cancer and depression.Br J Psychiatry Suppl. 1996; : 109-116
- Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.Arch Intern Med. 2000; 160: 2101-2107
- Psychosocial predictors of survival in metastatic melanoma.J Clin Oncol. 1999; 17: 2256-2263
- The effects of psychological distress and psychological well-being on use of medical services.Med Care. 1992; 30: 541-553
- Health care costs associated with depressive and anxiety disorders in primary care.Am J Psych. 1995; 152: 352-357
- Compliance with follow-up and prognosis among patients with thin melanomas.Eur J Cancer. 2001; 37: 1504-1509
- Interpreting the significance of changes in health-related quality-of-life scores.J Clin Oncol. 1998; 16: 139-144
- Health status of long-term cancer survivors: results from an Australian population-based sample.Cancer Epidemiol Biomarkers Prev. 2006; 15: 1969-1976
- The unmet supportive care needs of patients with cancer. Supportive Care Review Group.Cancer. 2000; 88: 226-237
- Psychological effects of being offered choice of surgery for breast cancer.BMJ. 1994; 309: 448
- Is there a cost to poor communication in cancer care? A critical review of the literature.Psychooncology. 2005; 14 ([discussion 885–876]): 875-884
- Psychological responses of patients receiving a diagnosis of cancer.Ann Oncol. 2003; 14: 48-56
- Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials.J Clin Oncol. 2008; 26: 527-534
Article info
Publication history
Published online: January 28, 2015
Accepted:
January 5,
2015
Received:
December 8,
2014
Footnotes
Joint project of the Arbeitsgemeinschaft Dermatologische Onkologie (Dermatologic Cooperative Oncology Group, DeCOG) the Deutsche Dermatologische Gesellschaft (German Society of Dermatologists DDG) and the Berufsverband der Deutschen Dermatologen (Professional Organization of German Dermatologists BVDD).
STROBE statement fulfilled.
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
