Melanoma patients' disease-specific knowledge, information preference, and appreciation of educational YouTube videos for self-inspection

The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review

BACKGROUND

The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma).

OBJECTIVE

Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention.

METHODS

We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer.

RESULTS

Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication's primary objective: misinformation (n=40, 36%), prevention campaign (n=19, 17%), engagement (n=16, 14%), research (n=12, 11%), education (n=11, 10%), demographics (n=10, 9%), and patient support (n=4, 3%), which were the most common identified themes.

CONCLUSIONS

Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem.

The Effects of Lack of Awareness in Age-Related Quality of Life, Coping with Stress, and Depression among Patients with Malignant Melanoma

Almost one-third of all malignant melanoma patients exhibit emotional stress indicating the need for professional care. Considering this, patients' psychological needs are routinely overlooked and unfulfilled, even though there is substantial evidence that psychological therapies may enhance psychosocial outcomes for melanoma patients, such as low mood, sadness, and anxiety. Among developing countries and some health systems in developed regions, the lack of awareness and screening methods for skin cancer creates a high risk of psychological issues associated with more advanced diseases. Therefore, the current study aimed to investigate and compare the impact of malignant melanoma awareness for screening, prevention, and treatment on the patient's quality of life and coping with stress and depression, based on patients' age. This cross-sectional study recruited 238 patients with malignant melanoma distributed into two groups, Group A patients between 18 and 65 years and Group B patients older than 65. There were no significant gender differences and cancer staging differences between groups, although self-reported depressed mood and anhedonia were significantly more frequent in younger adults with malignant melanoma (43.8% vs. 28.9%). From the unstandardized surveys, it was observed that significantly fewer patients from Group B knew that melanoma could be caused by sun exposure (34.2% vs. 52.2%), and they were less likely to use sunscreen or visit a doctor to evaluate their skin moles (25.9% vs. 14.5%). Elderly patients preferred television as the main source of information, and only 68.4% of patients from Group B were using smart devices. There was a significantly higher physical score on the SF-12 scale among Group A patients, although patients from Group B scored higher in the mental health assessment, and the perceived helplessness on the PSS-10 scale was significantly higher compared to younger adults with melanoma (2.97 vs. 2.71, p-value = 0.036). Lower scores on the physical and mental SF-12 questionnaire determined a higher presence of depressive symptoms (rho = -0.352, respectively rho = -0.273). Higher scores on the DLQI sexual difficulties and treatment difficulties also correlated significantly with the presence of depressive symptoms and anhedonia (rho = 0.341, respectively rho = 0.264). Awareness campaigns for malignant melanoma should focus on the elderly population, too, using the television as the main communication channel. On the other hand, the more informed and knowledgeable group of adults younger than 65 are more likely to experience psychological problems and should be targeted for psycho-oncological aid.

Benefits, drawbacks, and challenges of social media use in dermatology: A systematic review

The presence of dermatological information on social media has grown exponentially over the last two decades. Consequently, the recent literature on this topic is abundant. Many authors have highlighted that social media constitutes a unique opportunity for patient education. Additionally, numerous other benefits of these platforms have been reported. However, other authors have focused on the potential risks that these networks involve. The main concerns are patient confidentiality, legal considerations and ethical issues. Therefore, we stand at a crossroads where the many advantages of social media use in dermatology seem to be underestimated due to the presence of potential drawbacks. At this point, we propose that a systematic review of the positive and negative aspects of using social media in dermatology is necessary. We carried out a comprehensive systematic review dating from inception to July 2021. Finally, 161 articles were included. Fifteen benefits, 11 drawbacks and 10 challenges of social media use in dermatology were identified and discussed. Suggested strategies to address the identified drawbacks were provided. Overall, while there are risks to using social media, they are outnumbered by their benefits. Therefore, dermatologists should embrace this opportunity to educate patients and aim to create rigorous and engaging content.

Prevalence and Age-Related Patterns in Health Information-Seeking Behaviors and Technology Use Among Skin Cancer Survivors: Survey Study

Background

Information is an unmet need among cancer survivors. There is a paucity of population-based data examining the health information-seeking behaviors and attitudes of skin cancer survivors.

Objective

We aimed to identify the prevalence and patterns of health information-seeking behaviors and attitudes among skin cancer survivors across age groups.

Methods

We analyzed population-based data from the 2019 Health Information National Trends Survey 5 (Cycle 3).

Results

The 5438 respondents included 346 (6.4%) skin cancer survivors (mean age 65.8 years); of the 346 skin cancer survivors, the majority were White (96.4% [weighted percentages]), and 171 (47.8%) were men. Most reported having ever looked for health- (86.1%) or cancer-related (76.5%) information; 28.2% stated their last search took a lot of effort, and 21.6% were frustrated. The internet was most often cited as being the first source that was recently used for health or medical information (45.6%). Compared to skin cancer survivors younger than 65 years old, those 65 years of age or older were more likely to see a doctor first for important health information (≥65 years: 68.3%;<65 years: 36.2%; P<.001) and less likely to have health and wellness apps (≥65 years: 26.4%; <65 years: 54.0%, P=.10), to have watched a health-related YouTube video (≥65 years: 13.3%; <65 years: 27.4%; P=.02), and to have used electronic means to look for information (≥65 years: 61.4%;<65 years: 82.3%, P<.001).

Conclusions

Searches for health information are common among skin cancer survivors, but behaviors and attitudes are associated with age, which highlights the importance of access to doctors and personalized information sources.

Publicação de videoartigos como estratégia para impulsionar o consumo de Ciência

Resumo As novas tecnologias promoveram mudanças importantes nas relações sociais nos últimos anos, as quais estimularam o crescimento da produção de conteúdo científico em formato audiovisual, com destaque para os videoartigos. Assim, este artigo examina a aplicabilidade das novas tendências de publicações audiovisuais como estratégia para impulsionar o consumo de ciência dentro e fora do ecossistema acadêmico. Baseado em um survey exploratório-descritivo realizado com pesquisadores das áreas de Ciências da Saúde e Ciências Humanas, o estudo contribui para mitigar a carência de evidências empíricas, especificamente, sobre quatro pontos: visão de pesquisadores brasileiros acerca do acesso livre e consumo de ciência no Brasil; desconhecimento sobre videoartigo como formato de comunicação científica; grau de interesse em publicações científicas em formato audiovisual; e sentimentos relacionados à visibilidade e ao reconhecimento da ciência no Brasil. Resultados evidenciam o potencial estratégico dos recursos audiovisuais na valorização da comunicação científica, visto que pesquisadores se mostram interessados em publicar videoartigos pelo impacto direto em visibilidade, métricas de desempenho e disseminação da cultura científica com vistas a aumentar o consumo de ciência.

Impact of Social Media on Skin Cancer Prevention

Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today’s technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.

Plausibility of Using a Checklist With YouTube to Facilitate the Discovery of Acute Low Back Pain Self-Management Content: Exploratory Study

Background

Access to guideline-consistent effective care for acute low back pain (ALBP) is generally regarded as limited. Researchers have recognized the potential of YouTube as a clinical and patient education resource that may improve access to appropriate care. However, the heterogeneity of evaluation approaches and variable quality of health information have generally limited the potential of YouTube as a self-management intervention.

Objective

This study aims to increase the understanding of ALBP content available on YouTube in 2020 and to establish the plausibility of using a simple checklist to facilitate the discovery of YouTube content consistent with current guidelines. We examined the following 4 research questions: how was the data set defined, what are the metadata characteristics of the videos in the data set, what is the information quality of ALBP YouTube videos, and what are the characteristics of the YouTube data set based on an ALBP self-management checklist?

Methods

This was an exploratory, qualitative infodemiology study. We identified videos in our data set through YouTube search based on popular ALBP-relevant search terms identified through Google Trends for YouTube. We accessed YouTube metadata using the YouTube data tools developed by the University of Amsterdam. We used a modified Brief DISCERN checklist to examine the information quality. We developed a checklist based on the 2018 Lancet Low Back Pain guidelines to examine self-management content.

Results

We analyzed a data set of 202 YouTube videos authored by chiropractors, physicians, physiotherapists, and instructors of yoga and other disciplines. We identified clear differences in the ALBP videos in our data set based on the authors’ disciplines. We found that the videos authored by each discipline strongly featured a specific intervention domain, that is, education, treatment, or exercise. We also found that videos authored by physicians were consistently coded with the highest ALBP self-management content scores than all other disciplines.

Conclusions

The results returned by YouTube in response to a search for back pain–related content were highly variable. We suggest that a simple checklist may facilitate the discovery of guideline-concordant ALBP self-management content on YouTube. Further research may identify the clinical contexts in which the use of an ALBP checklist with YouTube is feasible.

Internet and social media use in dermatology patients: Search behavior and impact on patient-physician relationship

The traditional patient-physician relationship is being changed by the patients' searches for medical information on the Internet and in social media (SM). Freely available medical information online bears enormous potential but also holds dangers. In this cross-sectional, questionnaire-based study, the patients' motivation, preferences and unmet needs when searching for medical information online and the impact on the patient-physician relationship were assessed using Spearman's correlation coefficients, χ² -tests and paired t-tests. Among 460 participants, 82.4% had already used the Internet/SM to gain medical information, but in only 9.4% their dermatologists had raised this topic. Online search for medical information was associated with female gender (P = .048), a higher skin-related burden (P = .020), higher level of education (P = .072), higher income (P = .019), anxiety (P = .004), and adnexal skin diseases (P = .043). For 16.1% of patients, "the Internet/SM" was their most important source of medical information; 81.4% deemed the impact of their online searches on their patient-physician relationship as neutral, 16.0% as positive, 2.6% as negative. The patients' top three unmet needs were "Online consultations", "Professional content on YouTube" and "Chat opportunities". Online search for medical information is a very important topic for most dermatology patients but it may not be adequately addressed by dermatologists. Our results indicate that from the patients`perspective such online searches do not have a significant impact on patient-physician relationship.

Harnessing Digital Videos to Promote Cancer Prevention and Education: a Systematic Review of the Literature from 2013-2018

Social media has transformed the way cancer patients search for information about their chronic health problems. The purpose of this systematic review is to identify the use of online digital videos to increase cancer knowledge and to understand information preference, behavioral changes, and attitudes towards online cancer education videos. The databases used for this review included MedLine, PsychINFO, and PubMed. These medical databases were used to locate peer-reviewed academic journals from 2013-2018 using the following MeSH terms: "cancer education videos," "cancer prevention videos," and "cancer education digital videos." A total of 4996 articles were retrieved from the initial search, and 33 articles were reviewed. Articles were excluded if videos did not (1) focus on cancer education and prevention; (2) posted on an online platform; and (3) assessed participants' knowledge, attitude, or beliefs about cancer. Eleven articles were found to meet inclusion criteria for final review. All of the studies focused on increasing education on preventive health behaviors (i.e., sunscreen use, smoking, and diet) and/or early detection strategies (i.e., screening testing and/or self-skin exams). While online digital health videos have the potential to improve health outcomes, issues related to technology access and health literacy must be considered when developing online health education videos.

The MelFo Study UK: Effects of a Reduced-Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma 1B to 2C Patients After 3-Years

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.

Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities

Melanoma claims annually more than 20,000 lives in Europe and is an important public health burden through its continuously increasing incidence and with its high mortality, costs, and complexity of care in advanced stages. Epidemiological surveillance is indispensable for the research into its causes, new prognostic markers, and innovative therapies, as well as for the building of efficient cancer control plans. However, important differences in the sources and availability of accurate epidemiological data exist among European countries and regions, contributing to a heterogeneous picture with 20-fold differences in the reported national melanoma incidence rates, divergent mortality trends, and solid disparities in survival across the Continent. Countries in the eastern half of Europe report the lowest incidence rates, but high case fatality, persisting and increasing mortality, a higher proportion of thicker tumors and late diagnosis, and lower survival rates. They are the least well equipped with quality cancer registration and reporting, and they lag behind in efficient cancer control plans implementation. This review highlights the main differences in melanoma epidemiology across Europe, together with an insight into their underlying causes in the areas of melanoma registration, early diagnosis, and prevention. These differences should be acknowledged and understood by physicians, researchers, and all stakeholders involved in improving melanoma care and outcomes, as no one-size-fits-all solution can tackle the melanoma problem in Europe. Instead, there is a need for nuanced strategies, adapted to the heterogeneous national and regional contexts, that would build on European diversity to eliminate the outcome disparities.

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

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.

Patient Attitudes and Their Awareness Towards Skin Cancer-Related Apps: Cross-Sectional Survey

BACKGROUND

In the emerging era of digitalization and electronic health, skin cancer-related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps.

OBJECTIVE

The aim of this study was to investigate patient attitudes and their awareness toward skin cancer-related apps.

METHODS

A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer-related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire.

RESULTS

A total of 98.9% (195/197) of patients had never used skin cancer-related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app.

CONCLUSIONS

The experience and knowledge of skin cancer-related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source.

Exploring the Most Visible German Websites on Melanoma Immunotherapy: A Web-Based Analysis

Background

Patients diagnosed with melanoma frequently search the internet for treatment information, including novel and complex immunotherapy. However, health literacy is limited among half of the German population, and no assessment of websites on melanoma treatment has been performed so far.

Objective

The aim of this study was to identify and assess the most visible websites in German language on melanoma immunotherapy.

Methods

In accordance with the common Web-based information-seeking behavior of patients with cancer, the first 20 hits on Google, Yahoo, and Bing were searched for combinations of German synonyms for “melanoma” and “immunotherapy” in July 2017. Websites that met our predefined eligibility criteria were considered for assessment. Three reviewers independently assessed their quality by using the established DISCERN tool and by checking the presence of quality certification. Usability and reliability were evaluated by the LIDA tool and understandability by the Patient Education Materials Assessment Tool (PEMAT). The Flesch Reading Ease Score (FRES) was calculated to estimate the readability. The ALEXA and SISTRIX tools were used to investigate the websites’ popularity and visibility. The interrater agreement was determined by calculating Cronbach alpha. Subgroup differences were identified by t test, U test, or one-way analysis of variance.

Results

Of 480 hits, 45 single websites from 30 domains were assessed. Only 2 website domains displayed a German quality certification. The average assessment scores, mean (SD), were as follows: DISCERN, 48 (7.6); LIDA (usability), 40 (2.0); LIDA (reliability), 10 (1.6); PEMAT, 69% (16%); and FRES, 17 (14), indicating mediocre quality, good usability, and understandability but low reliability and an even very low readability of the included individual websites. SISTRIX scores ranged from 0 to 6872 and ALEXA scores ranged from 17 to 192,675, indicating heterogeneity of the visibility and popularity of German website domains providing information on melanoma immunotherapy.

Conclusions

Optimization of the most accessible German websites on melanoma immunotherapy is desirable. Especially, simplification of the readability of information and further adaption to reliability criteria are required to support the education of patients with melanoma and laypersons, and to enhance transparency.

Digital Health in Melanoma Posttreatment Care in Rural and Remote Australia: Systematic Review

Background

The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services.

Objective

The aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas.

Methods

A systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes.

Results

Five studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers’ acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare.

Conclusions

Digital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations.

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

BACKGROUND

Despite the high and rising incidence rate of keratinocyte cancer (KC) and the importance of incorporating patient values into evidence-based care, few studies have focused on the perspectives of patients with KC.

OBJECTIVES

To identify the needs and preferences of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) regarding care.

METHODS

A qualitative study was conducted consisting of three focus groups with patients with BCC and three focus groups with patients with SCC. In total 42 patients participated. In each focus group, the patients' needs and preferences regarding treatment and follow-up were discussed, using a predefined topic list. All sessions were transcribed verbatim and analysed by two researchers.

RESULTS

The following needs and preferences were identified: (i) the need to receive all relevant, tailored information; (ii) a physician who takes you seriously and communicates well; (iii) a short waiting period and the best treatment with direct results; (iv) to be seen by the same physician; a preference for a dermatologist during (v) treatment and (vi) follow-up; (vii) a general need for structured follow-up care and (viii) a full-body skin examination during follow-up. Patients with BCC additionally expressed the need for openness and transparency and wanting to participate in shared decision making.

CONCLUSIONS

It is advocated to organize skin cancer care that is better tailored to the needs of patients with KC, providing patient-centred care. This should include investing in the patient-physician relationship, and personalizing the type and form of information and the follow-up schedules. Adding the patient's perspective to current guidelines could facilitate this process.

Information-seeking and use of information resources among melanoma patients of German skin cancer centers

BACKGROUND

This study aimed to explore the information-seeking behavior (ISB) of melanoma patients (MPs) and MP subgroups, in order to provide data for needs-based adaptation of information provision.

METHODS

In a cross-sectional survey in 27 German skin cancer centers, we explored characteristics of the ISB of MPs with the aid of a standardized questionnaire. Sub-group differences were determined with the chi-squared test and predictors of media preferences with logistic regression.

RESULTS

67 % of the 529 participating MPs had clinical stage III or IV melanoma. Most of the participants (81 %) reported medical consultations as their regularly or frequently used information resource (IR). 58 % wished to have more advice about IRs from their physician. Only 8 % of MPs used the services of self-help groups and 12 % of MPs took advantage of the services of cancer counseling centers. The internet (63 %) and booklets (58 %) were reported to be the preferred media. Age, educational level, general need for information and lack of awareness of their own condition proved to be predictors for media preferences.

CONCLUSIONS

Most MPs expected their physician to advise them about IRs they could use in addition to medical consultations. Peer support services were quite underused by MPs. The various preferences of media by MPs should be considered when deve-loping and providing IRs.

Unmet digital health service needs in dermatology patients

BACKGROUND

Digital health services are rapidly gaining acceptance in healthcare systems. Dermatology as an image-centric specialty is particularly well suited for telemedical services. However, dermatology patients' demands of electronic services remain largely unexplored.

METHODS

This study investigated patients' views in primary, secondary, and tertiary referral centers. In August 2017, 841 questionnaires were filled in by dermatology patients.

RESULTS

76.34% expressed interest in using digital healthcare services as part of medical consultations. 84.41% of all patients would complete their initial registration form electronically. Fewer patients were comfortable with sending pictures of skin changes to their doctors using email (40.89%) or mobile health applications (40.61%). Specific interest was indicated for arranging appointments online (90.80%) and electronically-placed prescriptions (76.56%), rather than online learning videos (42.03%), and actual online consultations (34.53%). 65.37% of patients would pay for online consultations themselves.

CONCLUSIONS

Taken together, interest in electronic health services is high in dermatology patients. Our data suggest that readily understandable electronic services such as online-arranged appointments and electronic prescriptions are of higher interest to patients than the current type of online consultations. Therefore, the full potential of teledermatology still remains to be tapped by newer, more attractive forms of services closely adapted to patients' demands.

Practice variation in Sentinel Lymph Node Biopsy for melanoma patients in different geographical regions in the Netherlands

BACKGROUND

Due to the lack of solid evidence for treatment benefit of Sentinel Lymph Node Biopsy (SLNB) as part of loco-regional surgical treatment of non-distant metastatic melanoma, there might be variation in surgical treatment strategies in the Netherlands. The objective of the current study was to assess differences in the performance of SLNB, in geographical regions in the Netherlands, of non-distant metastatic melanoma patients (American Joint Committee on Cancer (AJCC) stage I-III).

MATERIALS AND METHODS

A total of 28 550 melanoma patients, diagnosed between 2005 and 2013, were included in this population based retrospective study. Data were retrieved from the Netherlands Cancer Registry (NCR). Treatment strategies in 8 regions of the Netherlands were compared according to stage, excluding patients with distant metastasis (AJCC stage IV).

RESULTS

Throughout the Netherlands, there was substantial practice variation across the regions. The performance of SLNB in patients with clinically unsuspected lymph nodes and Breslow thickness >1.0 mm was significantly different between the regions. In a post hoc analysis, we observed that patients aged over 60 years, female patients and patients with a melanoma located in head and neck have lower odds to receive a SLNB.

CONCLUSION

There is considerable loco-regional practice variation which cannot completely be explained by the patient and tumor characteristics, in the surgical treatment of non-distant metastatic melanoma patients in the Netherlands. Although national guidelines recommend considering SLNB in all patients with a melanoma thicker than 1 mm, only half of the patients received a SLNB. Future research should assess whether this practice variation leads to unwanted variations in clinical outcome.