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Shah H, Feustel P, Davis L. Adherence with surveillance schedule in patients with invasive melanoma. Surg Oncol 2023; 48:101943. [PMID: 37054530 DOI: 10.1016/j.suronc.2023.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Seven percent of patients develop melanoma recurrence after successful treatment, and 4-8% develop a second primary melanoma. This study aimed to assess how providing Survivorship Care Plans (SCPs) to patients may improve adherence to surveillance visits. METHODS All patients treated for invasive melanoma at our institution between 8/1/2018-2/29/2020 were included in this retrospective chart review. SCPs were delivered in-person to patients and sent to primary care providers and dermatologists. Logistic regression was performed to assess influences on adherence. RESULTS Of 142 patients, 73 (51.4%) received SCP regarding their follow-up care. Reception of SCP (p = 0.044) and shorter distance from clinic (p = 0.018) significantly improved rates of adherence. Seven patients developed melanoma recurrences, five were physician-detected. Three patients had primary site recurrence, six had lymph node recurrences, and three had distant recurrences. There were 5 second primaries, all physician-detected. CONCLUSION Our study is the first to investigate the impact of SCPs on patient adherence in melanoma survivors and the first to reveal a positive correlation between SCPs and adherence in any type of cancer. Melanoma survivors require close clinical follow-up, as demonstrated by our study finding that even with SCPs, most recurrences and all new primary melanomas were physician-detected.
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Affiliation(s)
- Hemali Shah
- Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA
| | - Paul Feustel
- Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA
| | - Lindy Davis
- Albany Medical College, Department of Surgery, 50 New Scotland Avenue, Albany, NY, 12208, USA.
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2
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Conventional versus Reduced-Frequency Follow-Up in Early-Stage Melanoma Survivors: A Systematic Review with Meta-Analysis. Curr Oncol 2023; 30:3366-3372. [PMID: 36975469 PMCID: PMC10046891 DOI: 10.3390/curroncol30030256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
To date, there have been multiple studies and clinical guidelines or recommendations for complex management of melanoma patients. The most controversial subjects included the frequency of follow-up. This study provides a coherent and comprehensive comparison of conventional vs. reduced-frequency follow-up strategies for early-stage melanoma patients. The value of our study consists in the precise analysis of a large collection of articles and the selection of the most valuable works in relation to the topic according to rigorous criteria, which allowed for a thorough study of the topic. The search strategy was implemented using multiple databases. The inclusion criteria were randomized clinical trial or cohort studies that compared the outcomes of a conventional follow-up schedule versus a reduced-frequency follow-up schedule for patients diagnosed with melanoma. In this study, authors analyzed recurrence and 3-year survival. Meta-analysis of outcomes presented by Deckers et al. and Moncrieff et. al. did not reveal a significant difference favoring one of the groups (OR 1.14; 95%CI: 0.65–2.00; p = 0.64). The meta-analysis of 3-year overall survival included two studies. The statistical analysis showed no significant difference in favor of the conventional follow-up group. (OR 1.10; 95%CI: 0.57–2.11; p = 0.79). Our meta-analysis shows that there is no advantage in a conventional follow-up regimen over a reduced-frequency regimen in early-stage melanoma patients.
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3
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Follow-up Schedule for Patients with Sentinel Node Negative Cutaneous Melanoma: an International Phase III Randomised Clinical Trial. Ann Surg 2022; 276:e208-e216. [PMID: 35866644 DOI: 10.1097/sla.0000000000005621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES DESIGN The MELFO (MELanoma FOllow-up) study is an international phase III RCT comparing an experimental low-intensity schedule against current national guidelines. BACKGROUND Evidence-based guidelines for the follow-up of sentinel node negative melanoma patients are lacking. METHODS Overall, 388 adult patients diagnosed with sentinel node negative primary melanoma patients were randomized in cancer centers in the Netherlands and UK between 2006 and 2016. The conventional schedule group (control: n=196) was reviewed as per current national guidelines. The experimental schedule group (n=192) was reviewed in a reduced-frequency schedule. QoL was the primary outcome measurement. Detection rates and survival outcomes were recorded. Patient satisfaction rates and compliance with allocated schedules were compared. RESULTS At five years, both arms expressed high satisfaction with their regimens (>97%). This study found no significant group effect on any PROMs scores between the follow-up protocols. In total, 75/388 (19.4%) patients recurred, with no difference in incidence found between the two arms (HR=0.87 (0.54-1.39), P=0.57). Self-examination was the method of detection for 25 experimental patients and 32 control patients (75.8% vs. 76.2%; P=0.41). This study found no difference in any survival outcomes between the two study arms (disease-free survival: HR=1.00 (0.49-2.07), P=0.99). CONCLUSIONS A reduced intensity, AJCC stage-adjusted follow-up schedule for sentinel node negative melanoma patients is a safe strategy and patient self-examination is effective for recurrence detection with no evidence of diagnostic delay. Patients' acceptance is very high.
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Drabarek D, Habgood E, Janda M, Hersch J, Ackermann D, Low D, Low C, Morton RL, Dieng M, Cust AE, Morgan A, Smith E, Bell KLJ. Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study. JMIR DERMATOLOGY 2022; 5:e35916. [PMID: 37632893 PMCID: PMC10334928 DOI: 10.2196/35916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation. OBJECTIVE This study aims to explore patients' experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care. METHODS Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model. RESULTS We interviewed 20 patients (n=8, 40% women and n=12, 60% men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness. CONCLUSIONS Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.
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Affiliation(s)
- Dorothy Drabarek
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Habgood
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Jolyn Hersch
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Deonna Ackermann
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Don Low
- Cancer Voices NSW, Sydney, Australia
| | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Adelaide Morgan
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Elloise Smith
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Katy L J Bell
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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5
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Medcalf E, Taylor A, Turner R, Espinoza D, Bell KJL. Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow up? Statistical analysis plan for the MEL-SELF randomised controlled trial. Contemp Clin Trials 2022; 117:106761. [PMID: 35439647 DOI: 10.1016/j.cct.2022.106761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The MEL-SELF trial is a randomised controlled trial of patient-led surveillance compared to clinician-led surveillance in people treated for localised cutaneous melanoma (stage 0, I, II). The primary trial aim is to determine if patient led-surveillance compared to clinician-led surveillance increases the proportion of participants who are diagnosed with a new primary or recurrent melanoma at a fast-tracked unscheduled clinic visit. The secondary outcomes include time to diagnosis of any skin cancer, psychosocial outcomes, acceptability, and resource use. OBJECTIVE The objective of this report is to outline and publish the pre-determined statistical analysis plan before the database lock and the start of analysis. METHODS/DESIGN The statistical analysis plan describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes, and their respective analyses. In addition, we present the planned sensitivity and subgroup analyses. A separate analysis plan will be published for health economic outcomes. RESULTS The MEL-SELF statistical analysis plan has been designed to minimize bias in estimating effects of the intervention on primary and secondary outcomes. By pre-specifying analyses, we ensure the study's integrity and believability while enabling the reproducibility of the final analysis. CONCLUSION This detailed statistical analysis plan will help to ensure transparency of reporting of results from the MEL-SELF trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. Registered 18 February 2021, https://www.anzctr.org.au/ACTRN12621000176864.aspx.
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Affiliation(s)
- Ellie Medcalf
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Aiya Taylor
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robin Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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6
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Ackermann DM, Smit AK, Janda M, van Kemenade CH, Dieng M, Morton RL, Turner RM, Cust AE, Irwig L, Hersch JK, Guitera P, Soyer HP, Mar V, Saw RPM, Low D, Low C, Drabarek D, Espinoza D, Emery J, Murchie P, Thompson JF, Scolyer RA, Azzi A, Lilleyman A, Bell KJL. 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. Trials 2021; 22:324. [PMID: 33947444 PMCID: PMC8096155 DOI: 10.1186/s13063-021-05231-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/27/2021] [Indexed: 02/03/2023] Open
Abstract
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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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Amelia K Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Cathelijne H van Kemenade
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Les Irwig
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Division of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | - Dorothy Drabarek
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Division of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alister Lilleyman
- Newcastle Skin Check, Newcastle, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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7
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Moncrieff MD, Underwood B, Garioch JJ, Heaton M, Patel N, Bastiaannet E, Hoekstra-Weebers JEHM, Hoekstra HJ. The MelFo Study UK: Effects of a Reduced-Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma 1B to 2C Patients After 3-Years. Ann Surg Oncol 2020; 27:4109-4119. [PMID: 32623608 PMCID: PMC7497689 DOI: 10.1245/s10434-020-08758-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Background Evidence-based guidelines for follow-up treatment of American Joint Committee on Cancer (AJCC) stages 1B to 2C melanoma patients are lacking. The MELanoma FOllow-up study is an international phase 3 randomized trial, and the 3-year interim data were recently reported from the Netherlands. The study was undertaken concurrently with a British cohort for comparison and validation of the Dutch study. Methods The study enrolled and stratified 207 patients by AJCC stage. The conventional schedule group (CSG; n = 103) cohort was reviewed as per UK guidelines. The experimental schedule group (ESG; n = 104) cohort was reviewed in a reduced-frequency nurse-led, consultant-supervised clinic. Quality of life (QoL) was measured at baseline (T1), a 1 year (T2), and at 3 years (T3) using the State-Trait Anxiety Inventory, the Cancer Worry Scale, the Impact-of-Event Scale, and the Mental and Physical Component scales (PCS/MCS) of the RAND-36. Results Of the 207 QoL questionnaires, 170 (82.1%) were completed at T3. Both cohorts expressed high satisfaction (> 93%) with their regimens. At T3, no significant group effect was found on any patient-reported outcome measures scores, indicating no QoL difference between the follow-up protocols. Recurrence had developed in 33 patients Conventional follow-up (CFU), 16 [15.5%]; Experimental follow-up (EFU), 17 [16.3%]. Self-examination was the method of detection for 12 ESG patients (70.6%) and 11 CSG patients (68.8%). The melanoma-specific survival was identical. Conclusion The UK 3-year data were consistent with the previous Dutch report. The reduced follow-up strategy was shown to be safe, with significant resource usage benefits for national cancer services. Patient anxiety levels were not increased by a less-intensive follow-up regimen, and acceptance was high. The study data indicate that patient self-examination is very effective for recurrence detection.
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Affiliation(s)
- Marc D Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK. .,University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
| | - Beverly Underwood
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jennifer J Garioch
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Martin Heaton
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Nakul Patel
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Josette E H M Hoekstra-Weebers
- University Medical Center Groningen, Wenckebach Institute, University of Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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8
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Morton RL, Thompson JF. Evidence-Based Follow-Up Schedules After Primary Cancer Treatment. Ann Surg Oncol 2020; 27:4067-4069. [PMID: 32602061 DOI: 10.1245/s10434-020-08768-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, North Sydney, NSW, 2060, Australia.,NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, North Sydney, NSW, 2060, Australia. .,Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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9
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Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB-IIC Patients-Results After 3 Years. Ann Surg Oncol 2019; 27:1407-1417. [PMID: 31535302 PMCID: PMC7138761 DOI: 10.1245/s10434-019-07825-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/18/2022]
Abstract
Background This study compares well-being, recurrences, and deaths of early-stage cutaneous melanoma patients in follow-up, as recommended in the Dutch guideline, with that of patients in a stage-adjusted reduced follow-up schedule, 3 years after diagnosis, as well as costs. Methods Overall, 180 eligible pathological American Joint Committee on Cancer (AJCC) stage IB–IIC, sentinel node staged, melanoma patients (response rate = 87%, 48% male, median age 57 years), randomized into a conventional (CSG, n = 93) or experimental (ESG, n = 87) follow-up schedule group, completed patient-reported outcome measures (PROMs) at diagnosis (T1): State-Trait Anxiety Inventory–State version (STAI-S), Cancer Worry Scale (CWS), Impact of Event Scale (IES), and RAND-36 (Mental and Physical Component scales [PCS/MCS]). Three years later (T3), 110 patients (CSG, n = 56; ESG, n = 54) completed PROMs, while 42 declined (23%). Results Repeated measures analyses of variance (ANOVAs) showed a significant group effect on the IES (p = 0.001) in favor of the ESG, and on the RAND-36 PCS (p = 0.02) favoring the CSG. Mean IES and CWS scores decreased significantly over time, while those on the RAND-36 MCS and PCS increased. Effect sizes were small. Twenty-five patients developed a recurrence or second primary melanoma, of whom 13 patients died within 3 years. Cox proportional hazards models showed no differences between groups in recurrence-free survival (hazard ratio [HR] 0.71 [0.32–1.58]; p = 0.400) and disease-free survival (HR 1.24 [0.42–3.71]; p = 0.690). Costs per patient after 3 years (computed for 77.3% of patients) were 39% lower in the ESG. Conclusion These results seemingly support the notion that a stage-adjusted reduced follow-up schedule forms an appropriate, safe, and cost-effective alternative for pathological AJCC stage IB–IIC melanoma patients to the follow-up regimen as advised in the current melanoma guideline.
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Affiliation(s)
- Eric A Deckers
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Samantha Damude
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sylvia Ter Meulen
- Skin-Melanoma Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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10
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Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L, Webster AC, Dieng M, Saw RPM, Low D, Low C, Bell KJL. Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma. JAMA Dermatol 2019; 154:420-427. [PMID: 29490373 DOI: 10.1001/jamadermatol.2018.0021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance 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).
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak, Malaysia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Marisa C Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Discipline of Dermatology, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.,Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Cynthia Low
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Katy J L Bell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia
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11
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Nijhuis AAG, Dieng M, Khanna N, Lord SJ, Dalton J, Menzies AM, Turner RM, Allen J, Saw RPM, Nieweg OE, Thompson JF, Morton RL. False-Positive Results and Incidental Findings with Annual CT or PET/CT Surveillance in Asymptomatic Patients with Resected Stage III Melanoma. Ann Surg Oncol 2019; 26:1860-1868. [DOI: 10.1245/s10434-019-07311-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 11/18/2022]
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12
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Lim WY, Turner RM, Morton RL, Jenkins MC, Irwig L, Webster AC, Dieng M, Saw RPM, Guitera P, Low D, Low C, Bell KJL. Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma. BMC Health Serv Res 2018; 18:477. [PMID: 29925350 PMCID: PMC6011416 DOI: 10.1186/s12913-018-3291-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. METHODS We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. RESULTS Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%). CONCLUSIONS The majority of people treated for a first primary localised melanoma at a specialist centre, without recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine diagnostic imaging as part of their melanoma surveillance.
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak Malaysia
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Robin M. Turner
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Marisa C. Jenkins
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Angela C. Webster
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW Australia
- Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Dermatology, The University of Sydney, Sydney, NSW Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, NSW Australia
| | | | - Katy J. L. Bell
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- Centre for Evidence Based Practice, Bond University, Gold Coast, QLD Australia
- The University of Sydney, Rm 333 Edward Ford Building (A27), Sydney, NSW 2006 Australia
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13
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Read RL, Madronio CM, Cust AE, Goumas C, Watts CG, Menzies S, Curtin AM, Mann G, Thompson JF, Morton RL. Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia. Ann Surg Oncol 2018; 25:617-625. [PMID: 29299710 DOI: 10.1245/s10434-017-6319-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 12/17/2023]
Abstract
BACKGROUND Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
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Affiliation(s)
- Rebecca L Read
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Calvary Health Care, Bruce, ACT, Australia
| | - Christine M Madronio
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Goumas
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Scott Menzies
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Austin M Curtin
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Graham Mann
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
- NHMRC Clinical Trials Centre, The University of Sydney, Level 6, Medical Foundation Building92-94 Parramatta Road, Camperdown, NSW, Australia.
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14
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Damude S, Hoekstra-Weebers JEHM, van Leeuwen BL, Hoekstra HJ. Melanoma patients' disease-specific knowledge, information preference, and appreciation of educational YouTube videos for self-inspection. Eur J Surg Oncol 2017; 43:1528-1535. [PMID: 28684059 DOI: 10.1016/j.ejso.2017.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/02/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Informing and educating melanoma patients is important for early detection of a recurrence or second primary. This study aimed to investigate Dutch melanoma patients' disease-specific knowledge, and their opinions on information provision and the value of e-Health videos. METHODS All AJCC stage I-II melanoma patients in follow-up between March 2015 and March 2016 at a single melanoma center were invited to complete 19 online questions, addressing respondents' characteristics, knowledge on melanoma, and opinions on melanoma-specific information received and the educational YouTube videos. RESULTS In total, 100 patients completed the survey (response = 52%); median age was 60 years and 51% were female. Breslow tumor thickness was unknown by 34% and incorrectly indicated by 19%, for presence of ulceration this was 33% and 11%, for mitosis 65% and 14%, and for AJCC stage 52% and 23%, respectively. Only 5% correctly reproduced all four tumor characteristics. Orally delivered information regarding warning signs, severity, treatment possibilities, and importance of self-inspection was clearest for patients, compared to information in the melanoma brochure. According to 77% of patients, YouTube videos regarding self-inspection of the skin and regional lymph nodes had additional value. Altogether, 63% preferred receiving information in multiple ways; 92% orally by their physician, 62% through videos, and 43% through brochures. CONCLUSIONS Patients' melanoma-specific knowledge appears to be limited. There is an urgent need for further improvement of providing information and patient education. In addition to oral and written information, e-Health videos seem to be a convenient supplemental and easy accessible method for patient education.
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Affiliation(s)
- S Damude
- University of Groningen, University Medical Center Groningen, Department of Surgical Oncology, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - B L van Leeuwen
- University of Groningen, University Medical Center Groningen, Department of Surgical Oncology, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - H J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Surgical Oncology, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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15
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Farberg AS, Rigel DS. A comparison of current practice patterns of US dermatologists versus published guidelines for the biopsy, initial management, and follow up of patients with primary cutaneous melanoma. J Am Acad Dermatol 2016; 75:1193-1197.e1. [DOI: 10.1016/j.jaad.2016.07.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
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16
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McKinn S, Bonner C, Jansen J, Teixeira-Pinto A, So M, Irwig L, Doust J, Glasziou P, McCaffery K. Factors influencing general practitioners' decisions about cardiovascular disease risk reassessment: findings from experimental and interview studies. BMC FAMILY PRACTICE 2016; 17:107. [PMID: 27495325 PMCID: PMC4974805 DOI: 10.1186/s12875-016-0499-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/21/2016] [Indexed: 11/25/2022]
Abstract
Background Guidelines on cardiovascular disease (CVD) risk reassessment intervals are unclear, potentially leading to detrimental practice variation: too frequent can result in overtreatment and greater strain on the healthcare system; too infrequent could result in the neglect of high risk patients who require medication. This study aimed to understand the different factors that general practitioners (GPs) consider when deciding on the reassessment interval for patients previously assessed for primary CVD risk. Methods This paper combines quantitative and qualitative data regarding reassessment intervals from two separate studies of CVD risk management. Experimental study: 144 Australian GPs viewed a random selection of hypothetical cases via a paper-based questionnaire, in which blood pressure, cholesterol and 5-year absolute risk (AR) were systematically varied to appear lower or higher. GPs were asked how they would manage each case, including an open-ended response for when they would reassess the patient. Interview study: Semi-structured interviews were conducted with a purposive sample of 25 Australian GPs, recruited separately from the GPs in the experimental study. Transcribed audio-recordings were thematically coded, using the Framework Analysis method. Results Experiment: GPs stated that they would reassess the majority of patients across all absolute risk categories in 6 months or less (low AR = 52 % [CI95% = 47–57 %], moderate AR = 82 % [CI95% = 76–86 %], high AR = 87 % [CI95% = 82–90 %], total = 71 % [CI95% = 67–75 %]), with 48 % (CI95% = 43–53 %) of patients reassessed in under 3 months. The majority (75 % [CI95% = 70–79 %]) of patients with low-moderate AR (≤15 %) and an elevated risk factor would be reassessed in under 6 months. Interviews: GPs identified different functions for reassessment and risk factor monitoring, which affected recommended intervals. These included perceived psychosocial benefits to patients, preparing the patient for medication, and identifying barriers to lifestyle change and medication adherence. Reassessment and monitoring intervals were driven by patient motivation to change lifestyle, patient demand, individual risk factors, and GP attitudes. Conclusions There is substantial variation in reassessment intervals for patients with the same risk profile. This suggests that GPs are not following reassessment recommendations in the Australian guidelines. The use of shorter intervals for low-moderate AR contradicts research on optimal monitoring intervals, and may result in unnecessary costs and over-treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0499-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shannon McKinn
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - Carissa Bonner
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Matthew So
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jenny Doust
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Paul Glasziou
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Kirsten McCaffery
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
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17
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Damude S, Hoekstra-Weebers JEHM, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients-Results after 1 Year. Ann Surg Oncol 2016; 23:2762-71. [PMID: 27194552 PMCID: PMC4972865 DOI: 10.1245/s10434-016-5263-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 11/18/2022]
Abstract
Background Guidelines for evidence-based follow-up in melanoma patients are not available. This study examined whether a reduced follow-up schedule affects: patient-reported outcome measures, detection of recurrences, and follow-up costs. Methods This multicenter trial included 180 patients treated for AJCC stage IB-II cutaneous melanoma, who were randomized in a conventional follow-up schedule group (CSG, 4 visits first year, n = 93) or experimental follow-up schedule group (ESG, 1–3 visits first year, n = 87). Patients completed the State-Trait Anxiety Inventory, cancer worry scale, impact of events scale, and a health-related quality of life questionnaire (HRQoL, RAND-36). Physicians registered clinicopathologic features and the number of outpatient clinic visits. Results Sociodemographic and illness-related characteristics were equal in both groups. After 1-year follow-up, the ESG reported significantly less cancer-related stress response symptoms than the CSG (p = 0.01), and comparable anxiety, mental HRQoL, and cancer-related worry. Mean cancer-related worry and stress response symptoms decreased over time (p < 0.001), whereas mental HRQoL increased over time (p < 0.001) in all melanoma patients. Recurrence rate was 9 % in both groups, mostly patient-detected and not physician-detected (CSG 63 %, ESG 43 %, p = 0.45). Hospital costs of 1-year follow-up were reduced by 45 % in the ESG compared to the CSG. Conclusions
This study shows that the stage-adjusted, reduced follow-up schedule did not negatively affect melanoma patients’ mental well-being and the detection of recurrences compared with conventional follow-up as dictated by the Dutch guideline, at 1 year after diagnosis. Additionally, reduced follow-up was associated with significant hospital cost reduction. Electronic supplementary material The online version of this article (doi:10.1245/s10434-016-5263-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha Damude
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Groningen, The Netherlands
| | | | - Sylvia Ter Meulen
- Department of Dermatology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, University of Leiden, University Medical Center Leiden, Leiden, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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18
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Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect 2016; 20:243-259. [PMID: 27075246 PMCID: PMC5354019 DOI: 10.1111/hex.12453] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled. OBJECTIVE To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management. DESIGN Critical interpretive synthesis using systematic searches of literature published 2000-2014. FINDINGS We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice. DISCUSSION AND CONCLUSION Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.
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Affiliation(s)
| | | | - Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Simon Christmas
- Centre for Public Policy Research, King's College London, London, UK
| | - John Owens
- Centre for Public Policy Research, King's College London, London, UK
| | - Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian S Watt
- Department of Health Sciences/Hull York Medical School, Faculty of Science, University of York, Heslington, York, UK
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19
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Memari N, Hayen A, Bell KJL, Rychetnik L, Morton RL, McCaffery K, Thompson JF, Irwig L, Turner RM. How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center? Ann Surg Oncol 2015; 22 Suppl 3:S1164-71. [PMID: 25963479 DOI: 10.1245/s10434-015-4589-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- Niloofar Memari
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Katy J L Bell
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Rachael L Morton
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
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20
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Leiter U, Eigentler T, Garbe C. Follow-up in patients with low-risk cutaneous melanoma: is it worth it? Melanoma Manag 2014; 1:115-125. [PMID: 30190817 PMCID: PMC6094616 DOI: 10.2217/mmt.14.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Follow-up examinations in melanoma aim to detect recurrences or secondary melanomas in an early phase of development. Follow-up guidelines that have been developed in many European countries, the USA and Australia show varying recommendations and are controversial, especially in patients with melanomas of 1.0 mm tumor thickness or less. This group contains 50-70% of all melanoma patients and the majority is unlikely to develop recurrences. On the other hand, within this entity, subgroups at higher risk for recurrences can be defined who require a more intense follow-up. This article discusses recommendations for the frequency, duration and costs of follow-up in low-risk melanoma patients. Patient preferences are addressed and a risk-adapted follow-up scheme is proposed.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Thomas Eigentler
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Claus Garbe
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
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21
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Cutaneous melanoma: Medical specialists' opinions on follow-up and sentinel lymph node biopsy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:1276-83. [DOI: 10.1016/j.ejso.2014.02.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 11/15/2022]
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22
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Mrazek AA, Chao C. Surviving cutaneous melanoma: a clinical review of follow-up practices, surveillance, and management of recurrence. Surg Clin North Am 2014; 94:989-1002, vii-viii. [PMID: 25245963 DOI: 10.1016/j.suc.2014.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The number of melanoma survivors in the United States continues to steadily increase 2.6% per year, while death rates have remained stable over time. Although controversy exists regarding optimal surveillance strategies, recommendations for clinical monitoring are based on tumor stage, tumor phenotype, likelihood of recurrence, prognosis, risk factors, psychosocial impact of disease, and patient well-being. Management guidelines for recurrent disease depend on the type of recurrence: local, satellite/in-transit, regional, or distant metastasis. This article is a current review of the literature concerning melanoma survivorship.
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Affiliation(s)
- Amy A Mrazek
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Route 0534, Galveston, TX 77555, USA
| | - Celia Chao
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Route 0737, Galveston, TX 77555, USA.
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23
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Rutkowski P, Lugowska I. Follow-up in melanoma patients. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2014; 7:83-86. [PMID: 25089158 PMCID: PMC4101246 DOI: 10.1007/s12254-014-0151-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/10/2014] [Indexed: 10/31/2022]
Abstract
Due to lack of evidence from prospective clinical trials, the diagnostic procedures, their frequency, as well as the length of the follow-up period in cutaneous melanoma patients should be based on the individual risk of disease recurrence, which is strongly dependent on the stage of disease at the time of diagnosis. In the paper we propose the current recommendations for follow-up strategy. Nowadays, new effective treatment options with biological agents justify the closer monitoring of high risk melanoma patients.
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Affiliation(s)
- Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
| | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
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24
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Patients' perspectives of long-term follow-up for localised cutaneous melanoma. Eur J Surg Oncol 2013; 39:297-303. [DOI: 10.1016/j.ejso.2012.12.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/28/2012] [Accepted: 12/17/2012] [Indexed: 11/20/2022] Open
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25
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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. [PMID: 23253951 PMCID: PMC3537530 DOI: 10.1186/1472-6963-12-468] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 12/11/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors. METHODS In-depth qualitative study based on semi-structured interviews with 16 clinicians (surgical oncologists, dermatologists and melanoma unit GPs) who conduct post-treatment follow-up at two of Australia's largest specialist referral melanoma treatment and diagnosis units. Interviews were recorded, transcribed and analysed to identify approaches to shared care in follow-up, variations in practice, and explanations of these. RESULTS Melanoma unit clinicians utilised shared care in the follow-up of patients with early stage melanoma. Schedules were determined by patients' clinical risk profiles. Final arrangements for delivery of those schedules (by whom and where) were influenced by additional psychosocial, professional and organizational considerations. Four models of shared care were described: (a) surgical oncologist alternating with dermatologist (in-house or local to patient); (b) melanoma unit dermatologist and other local doctor (e.g. family physician); (c) surgical oncologist and local doctor; or (d) melanoma physician and local doctor. CONCLUSIONS These models of shared care offer alternative solutions to managing the requirements for long-term follow-up of a growing number of patients with stage I/II melanoma, and warrant further comparative evaluation of outcomes in clinical trials, with detailed cost/benefit analyses.
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Affiliation(s)
- Lucie Rychetnik
- Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Sydney, Australia
- School of Public Health, The University of Sydney, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia
| | - Rachael L Morton
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Sydney, Australia
| | - John F Thompson
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia (formerly Sydney Melanoma Unit), Sydney, Australia
- The Mater Hospital, North Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Scott W Menzies
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Les Irwig
- Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Sydney, Australia
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