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Lee HJ, Jin H, You HS, Shim WH, Kim JM, Kim GW, Mun JH, Kim HS, Ko HC, Kim BS, Kim MB. Various Dermatoses What the Patients with Cutaneous Melanoma Had Anxiety for the Recurrence during Postoperative Surveillance. Ann Dermatol 2017; 29:433-437. [PMID: 28761291 PMCID: PMC5500708 DOI: 10.5021/ad.2017.29.4.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The incidence and mortality rates associated with cutaneous melanoma (CM) have steadily increased over the last 20 years. Even with successful treatment, melanoma patients usually experience substantial anxiety regarding the development of terrible recurrence. To date, few studies have investigated various dermatoses what the patients with CM had anxiety for the recurrence during postoperative surveillance (Dw). OBJECTIVE To describe various Dw and to evaluate the risk of subsequent malignant skin disease in patients with CM. METHODS We performed a prospective study between August 2002 and August 2015. RESULTS Fifty-six patients presented with a total of 68 Dw. Among them, melanocytic nevus was the most common (n=27), followed by seborrheic keratosis (n=9) and CM recurrence (n=7). Approximately 5.6% of the lesions were diagnosed as malignant skin diseases. This was a single-center study, so the prevalence of malignant skin diseases following primary melanoma may not represent that of all patients with CM. CONCLUSION The results of this study can be referred by dermatologists dealing with melanoma especially when CM patients have too excessive or unrealistic anxiety for melanoma recurrence during postoperative surveillance of CM. However, the importance of postoperative surveillance must still be emphasized because of real risk of melanoma recurrence and other malignant skin.
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Affiliation(s)
- Hyun-Joo Lee
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Hyunju Jin
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Hyang-Suk You
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Woo-Haing Shim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Jeong-Min Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Gun-Wook Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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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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Speijers MJ, Francken AB, Hoekstra-Weebers JEHM, Bastiaannet E, Kruijff S, Hoekstra HJ. Optimal follow-up for melanoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Rychetnik L, McCaffery K, Morton R, Irwig L. Psychosocial aspects of post-treatment follow-up for stage I/II melanoma: a systematic review of the literature. Psychooncology 2012; 22:721-36. [PMID: 22431448 DOI: 10.1002/pon.3060] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients treated for melanoma are advised to have lifelong full body skin examinations. Extended intervals between examinations have been proposed, but although this may be clinically effective, psychosocial aspects of follow-up are not well understood. This systematic review summarised patient and clinician preferences, experiences and adherence with recommended follow-up of stage I/II melanoma. METHODS Medline, PsycINFO, CINAHL, Embase, Cochrane Library, ACP Journal Club and NHS Economic Evaluation Database were searched from database inception to week 3 April 2010, to identify original studies of psychosocial outcomes of follow-up after treatment of stage I/II primary cutaneous melanoma, as reported by patients or clinicians. The results were synthesised, and characteristics likely to maximise patients' well-being and adherence to follow-up schedules were proposed. RESULTS We found 15 studies that met the inclusion criteria. Anxiety with melanoma follow-up was common; patients valued reassurance, information and psychosocial support, but long-term adherence to schedules was variable. Some wanted more emotional support from their clinician than was provided. Clinicians sometimes ordered additional blood and imaging tests to reassure patients. GPs were hesitant to conduct melanoma follow-up, but a trial providing technical training and protocols reported positive outcomes. Both patients and GPs wanted prompt access to melanoma specialists when suspicious lesions were found. CONCLUSION Psychosocial aspects of follow-up impact on patient well-being and potential adherence to schedules, and may influence clinician practice. If follow-up schedules or personnel are to be revised, psychosocial impacts on patients must be explicitly addressed, as well as guidance and specialist support for clinicians.
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Affiliation(s)
- Lucie Rychetnik
- Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Camperdown, Australia.
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Turner RM, Bell KJ, Morton RL, Hayen A, Francken AB, Howard K, Armstrong B, Thompson JF, Irwig L. Optimizing the Frequency of Follow-Up Visits for Patients Treated for Localized Primary Cutaneous Melanoma. J Clin Oncol 2011; 29:4641-6. [DOI: 10.1200/jco.2010.34.2956] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop more evidence-based guidelines for the frequency of patient follow-up after treatment of localized (American Joint Committee on Cancer [AJCC] stage I or II) melanoma. Methods We used data from Melanoma Institute Australia on an inception cohort of 3,081 consecutive patients first diagnosed with stage I or II melanoma between January 1985 and December 2009. Kaplan-Meier curves and Cox models were used to characterize the time course and predictors for recurrence and new primaries. We modeled the delay in diagnosis of recurrence or new primary as well as the number of monitoring visits required using two monitoring schedules: first, according to 2008 Australian and New Zealand guidelines and, second, with fewer visits, especially for those at lowest risk of recurrence. Results For every 1,000 patients beginning follow-up, 229 developed recurrence and 61 developed new primary within 10 years. There was only a small difference in modeled delay in diagnosis (extra 44.9 and 9.6 patients per 1,000 for recurrence and new primary, respectively, with delay greater than 2 months) using a schedule that requires far fewer visits (3,000 fewer visits per 1,000 patients) than recommended by current guidelines. AJCC substage was the most important predictor of recurrence, whereas age and date of primary diagnosis were important predictors of developing new primary. Conclusion By providing less intensive monitoring, more efficient follow-up strategies are possible. Fewer visits with a more focused approach may address the needs of patients and clinicians to detect recurrent or new melanoma.
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Affiliation(s)
- Robin M. Turner
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Katy J.L. Bell
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Rachael L. Morton
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Andrew Hayen
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Anne Brecht Francken
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Kirsten Howard
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Bruce Armstrong
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - John F. Thompson
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
| | - Les Irwig
- Robin M. Turner, Katy J.L. Bell, Rachael L. Morton, Andrew Hayen, Kirsten Howard, Bruce Armstrong, John F. Thompson, and Les Irwig, School of Public Health, The University of Sydney; John F. Thompson, Melanoma Institute Australia, Sydney, New South Wales, Australia; and Anne Brecht Francken, Isala Klinieken, Zwolle, the Netherlands
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Family doctor-driven follow-up for adult childhood cancer survivors supported by a web-based survivor care plan. J Cancer Surviv 2011; 6:163-71. [PMID: 22124938 PMCID: PMC3321136 DOI: 10.1007/s11764-011-0207-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/31/2011] [Indexed: 11/11/2022]
Abstract
Purpose To facilitate family doctor-driven follow-up for adult childhood cancer survivors, we developed a survivor care plan (SCP) for adult survivors and their family doctors. Methods The SCP was accessible for survivors and their family doctors on a secure website and as a printed booklet. It included data on diagnosis, treatment and potential risks as well as recommendations for follow-up. Childhood cancer survivors who were off-treatment ≥5 years, aged ≥18 years and not involved in a long-term follow-up program were eligible. They were advised to visit their family doctor. The endpoints were numbers of participants, adherence of family doctors to the guidelines and satisfaction ratings. Results The eligibility criteria were fulfilled by 108 survivors. Three family doctors and 15 survivors refused, 10 survivors were non-responders. Of the remaining 80 survivors, 73 survivors visited 72 family doctors. Sixty-nine (96%) family doctors returned data of whom 60 (83%) fully adhered to the recommended tests. The majority of survivors and family doctors were satisfied about the SCP. Conclusions A (web-based) SCP for survivors and family doctors can serve as an effective communication vehicle to provide adequate shared care by the long-term follow-up clinic and family doctors.
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Hall SJ, Samuel LM, Murchie P. Toward shared care for people with cancer: developing the model with patients and GPs. Fam Pract 2011; 28:554-64. [PMID: 21467132 DOI: 10.1093/fampra/cmr012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The number of people surviving cancer for extended periods is increasing. Consequently, due to workload and quality issues, there is considerable interest in alternatives to traditional secondary care-led cancer follow-up. OBJECTIVE To explore the views of potential recipients of shared follow-up of cancer. To conduct a modelling exercise for shared follow-up and to explore the opinions and experiences of both the patients and GPs involved. METHODS Semi-structured audio-taped telephone or face-to-face interviews were conducted with 18 patients with a range of cancers currently attending for structured follow-up in secondary care. Six GPs and five patients (four with melanoma and one with stable metastatic colorectal cancer) took part in a shared follow-up modelling exercise. During the modelling exercise, the GPs attended 4 review meetings, which included brief training seminars, and at the conclusion 10 individuals took part in semi-structured audio-taped telephone or face-to-face interviews. RESULTS Many rural patients, and some urban patients, would appreciate follow-up being available nearer to home with the associated benefits of time saved and easier parking and continuity of care. Patients have concerns related to the level of extra training received by the GP and loss of contact with their consultant. GPs have concerns about gaining and maintaining the clinical skills needed to conduct follow-up, especially if the numbers of patients seen are small. They also have concerns about lack of support from other GPs, and some administrative and organizational issues. CONCLUSIONS Many patients would be willing to have GPs share their cancer follow-up with the caveat that they had received extra training and were appropriately supported by secondary care specialists. Patients attending shared care clinics appreciated a local service and longer appointment times. GPs stress the importance of maintaining their own clinical skills and reliable clinical and administrative support from secondary care.
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Affiliation(s)
- Susan J Hall
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK
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Fields RC, Coit DG. Evidence-Based Follow-up for the Patient with Melanoma. Surg Oncol Clin N Am 2011; 20:181-200. [DOI: 10.1016/j.soc.2010.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Murchie P, Nicolson MC, Hannaford PC, Raja EA, Lee AJ, Campbell NC. Patient satisfaction with GP-led melanoma follow-up: a randomised controlled trial. Br J Cancer 2010; 102:1447-55. [PMID: 20461089 PMCID: PMC2869159 DOI: 10.1038/sj.bjc.6605638] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There are no universally accepted guidelines for the follow-up of individuals with cutaneous melanoma. Furthermore, to date, there have been no randomised controlled trials of different models of melanoma follow-up care. This randomised controlled trial was conducted to evaluate the effects of GP-led melanoma follow-up on patient satisfaction, follow-up guideline compliance, anxiety and depression, as well as health status. METHODS A randomised controlled trial of GP-led follow-up of cutaneous melanoma was conducted over a period of 1 year with assessment by self-completed questionnaires and review of general practice-held medical records at baseline and 12 months later. It took place in 35 general practices in North-east Scotland. Subjects were 142 individuals (51.4% women 48.6% men; mean (s.d.) age 59.2 (15.2) years previously treated for cutaneous melanoma and free of recurrent disease. The intervention consisted of protocol-driven melanoma reviews in primary care, conducted by trained GPs and supported by centralised recall, rapid access pathway to secondary care and a patient information booklet. The main outcome measure was patient satisfaction measured by questionnaire. Secondary outcomes were adherence to guidelines, health status measured by Short Form-36 and the Hospital Anxiety and Depression Scale. RESULTS There were significant improvements in 5 out of 15 aspects of patient satisfaction during the study year in those receiving GP-led melanoma follow-up (all P<or=0.01). The intervention group was significantly more satisfied with 7 out of 15 aspects of care at follow-up after adjustment for potential confounders. There was significantly greater adherence to guidelines in the intervention group during the study year. There was no significant difference in health status or anxiety and depression between intervention and control groups at either baseline or outcome. CONCLUSIONS GP-led follow-up is feasible, engenders greater satisfaction in those patients who receive it, permits closer adherence to guidelines and does not result in adverse effects on health status or anxiety and depression when compared with traditional hospital-based follow-up for melanoma.
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Affiliation(s)
- P Murchie
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, UK.
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Murchie P, Delaney EK, Campbell NC, Hannaford PC. GP-led melanoma follow-up: the practical experience of GPs. Fam Pract 2009; 26:317-24. [PMID: 19535735 DOI: 10.1093/fampra/cmp035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To explore how GP-led melanoma follow-up had actually worked from the perspective of GPs by exploring in detail the practical experience of GPs running the programme. DESIGN Semi-structured audio-taped telephone interviews with GPs delivering a GP-led follow-up programme for people with cutaneous malignant melanoma. SUBJECTS Seventeen GPs currently delivering structured GP-led routine follow-up for people with cutaneous melanoma. RESULTS GP-led melanoma follow-up worked well from the perspectives of GPs. The GPs felt that they were well equipped and supported in undertaking the follow-up consultations and recognized that they were freeing up hospital consultant time. They felt that patients appreciated the convenience of GP-led follow-up. The GPs felt that a robust recall system, initial training with regular refreshers and effective consultant backup were vital components of a successful long-term programme. CONCLUSIONS GP-led melanoma follow-up is feasible and, provided certain concerns can be addressed, GPs are willing to provide it.
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Affiliation(s)
- Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK.
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Absolom K, Eiser C, Michel G, Walters SJ, Hancock BW, Coleman RE, Snowden JA, Greenfield DM. Follow-up care for cancer survivors: views of the younger adult. Br J Cancer 2009; 101:561-7. [PMID: 19638979 PMCID: PMC2736810 DOI: 10.1038/sj.bjc.6605213] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Since the launch of the National Cancer Survivorship Initiative, there has been a surge of interest surrounding the value and organisation of long-term follow-up care after cancer treatment. We report the views of 309 adult cancer survivors (aged 18–45 years) on provision of follow-up and preferences for care. Methods: A total of 207 survivors completed questionnaires before and after routine consultant-led follow-up appointments and 102 were recruited by post. Measures of health status (including late effects, perceived vulnerability to late effects and quality of life), reasons for attending follow-up (clinical and supportive), issues to be discussed at follow-up and preferences for different models of care were assessed. Results: In all, 59% of the survivors reported experiencing one or more cancer-related health problems. Survivors rated clinical reasons for attending follow-up more highly than supportive reasons (P<0.001), although nutritional advice and counselling were considered useful (60 and 47%, respectively). Those still receiving scheduled follow-up appointments did not discuss the range of issues intended with ‘late effects’ and ‘fertility’, which were particularly under-discussed. Hospital rather than GP follow-up was more highly rated. Conclusion: Survivors value the clinical reassurance currently provided by consultant-led care. However, supportive needs are not systematically addressed. Multi-disciplinary services are recommended to meet supportive needs in addition to clinical care.
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Affiliation(s)
- K Absolom
- Department of Psychology, University of Sheffield, Sheffield S10 2SJ, UK
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13
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GP-led melanoma follow-up: views and feelings of patient recipients. Support Care Cancer 2009; 18:225-33. [DOI: 10.1007/s00520-009-0648-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Shared care guidelines and protocols in the United kingdom. J Ambul Care Manage 2008; 31:239-43. [PMID: 18574382 DOI: 10.1097/01.jac.0000324669.91153.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The divide between primary and secondary care in the United Kingdom's National Health Service is becoming increasingly blurred, leading to the development of shared care guidelines and protocols. These often contain measurable performance and outcome measures, and aim to encourage joint working between specialists and primary care physicians. Shared care will become an increasingly important part of healthcare in the United Kingdom, supported by information systems that provide patients and professionals with the information they need to optimize the management of patient's health.
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Abstract
INTRODUCTION Recent advances in treatment of childhood cancer have resulted in overall survival rates approaching 75%, but approximately two-thirds experience late-effects related to the disease or treatment. Consequently, recommendations for comprehensive follow-up have been made. As the number of survivors of adult cancers increase, similar concerns about how to provide follow-up and achieve optimal quality of life are being raised. In this paper we propose that management of cancer survivors diagnosed in young adulthood (18-45 years) could benefit from experience gained treating survivors of childhood cancer. MATERIALS AND METHODS We reviewed research relating to differences in survival rates and late-effects; current arrangements for follow-up; effectiveness; and problems in organization of follow-up separately for survivors of child and adult cancers. RESULTS A number of models of follow-up were identified. Rationale for follow-up included early identification and treatment of second cancer and late-effects, health promotion and screening. Increasing numbers of survivors and range of late-effects were identified as problems in organizing services. A possible solution is risk-stratified follow-up, currently being developed in pediatrics. CONCLUSIONS New models of follow-up are needed that take account of financial costs for health services and survivors' concerns about their current and future health. Implications for continuing refinement of treatment protocols must be an integral part of the service. IMPLICATIONS FOR CANCER SURVIVORS International standards are needed to ensure all survivors have access to expert follow-up care and can benefit from new information that might lead to earlier treatment of late-effects.
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Murchie P, Campbell NC. Pigmented lesions, cutaneous melanoma, and future challenges for primary care. Eur J Gen Pract 2008; 13:151-4. [PMID: 17957586 DOI: 10.1080/13814780701627354] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The incidence of cutaneous melanoma is increasing amongst Caucasian populations worldwide. There are calls for melanoma to be regarded as a growing public health problem, with public and professional education to tackle it. Such programmes will increase public awareness of malignant melanoma and of pigmented lesions generally. In the UK, general practitioners face challenges in terms of primary prevention and education, diagnosis, primary treatment, and aftercare of patients with melanoma. Organizational changes are required to meet the increasing challenge posed to primary care by melanoma and should be based on the most rigorous evidence.
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Affiliation(s)
- Peter Murchie
- Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, Scotland, UK.
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