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Blake SC, Guitera P, Cust AE, Galea C, Lo SN, Scolyer RA, Armstrong BK, Thompson JF, Menzies SW, Madronio C, Morton RL, Mann GJ, Watts CG. The association of dermatologist demographic density with melanoma survival in New South Wales, Australia. Australas J Dermatol 2023; 64:425-429. [PMID: 37353974 PMCID: PMC10953459 DOI: 10.1111/ajd.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Stephanie C. Blake
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Pascale Guitera
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Sydney Melanoma Diagnostic CentreRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Anne E. Cust
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- The Daffodil CentreThe University of Sydney, A Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Claire Galea
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Serigne N. Lo
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Richard A. Scolyer
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred Hospital and NSW Health PathologySydneyNew South WalesAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Bruce K. Armstrong
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- School of Population and Global Health, Population and Public HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - John F. Thompson
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Scott W. Menzies
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Christine Madronio
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Rachael L. Morton
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Graham J. Mann
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- The John Curtin School of Medical ResearchAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Caroline G. Watts
- The Daffodil CentreThe University of Sydney, A Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Surveillance and Evaluation Research Program, Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Smith AL, Watts CG, Henderson M, Long GV, Rapport F, Saw RPM, Scolyer RA, Spillane AJ, Thompson JF, Cust AE. Factors influencing acceptance, adoption and adherence to sentinel node biopsy recommendations in the Australian Melanoma Management Guidelines: a qualitative study using an implementation science framework. Implement Sci Commun 2022; 3:103. [PMID: 36183121 PMCID: PMC9526940 DOI: 10.1186/s43058-022-00351-w] [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: 11/24/2021] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sentinel node biopsy (SN biopsy) is a surgical procedure used to accurately stage patients with primary melanoma at high risk of recurrence. Although Australian Melanoma Management Guidelines recommend SN biopsy be considered in patients with melanomas > 1 mm thick, SN biopsy rates in Australia are reportedly low. Our objective was to identify factors impacting the acceptance, adoption and adherence to the Australian SN biopsy guideline recommendations. METHODS Opinions of Australian key informants including clinicians, representatives from melanoma education and training providers, professional associations and colleges, and melanoma advocacy organisations were collected through semi-structured interviews (n = 29) and from publicly released statements (n = 14 news articles). Data analysis involved inductive and deductive thematic analysis using Flottorp's determinants framework. RESULTS A complex interplay of contemporary and historical factors was identified as influencing acceptance, adoption and adherence to the SN biopsy guideline recommendations at the individual, guideline, patient, organisational and social levels. Expert and peer opinion leaders have played an important role in facilitating or inhibiting adoption of guideline recommendations, as have financial incentives driven by healthcare-funding policies and non-financial incentives including professional identity and standing. Of critical importance have been the social and knowledge boundaries that exist between different professional groups to whom the guidelines apply (surgeons, dermatologists and primary care practitioners) with adherence to the guideline recommendations having the potential to shift work across professional boundaries, altering a clinician's workflow and revenue. More recently, the emergence of effective immunotherapies and targeted therapies for patients at high risk of recurrence, the emergence of new opinion leaders on the topic (in medical oncology), and patient demands for accurate staging are playing crucial roles in overcoming the resistance to change created by these social and knowledge boundaries. CONCLUSIONS Acceptance and adherence to SN biopsy guideline recommendations in Australia over the past 20 years has involved a process of renegotiation and reframing of the evidence for SN biopsy in melanoma by clinicians from different professional groups and networks. This process has helped to refine the evidence for SN biopsy and our understanding of appropriate adoption. New effective systemic therapies have changed the balance towards accepting guideline recommendations.
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Affiliation(s)
- Andrea L. Smith
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia
| | - Caroline G. Watts
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, NSW Australia
| | - Michael Henderson
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Georgina V. Long
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia
| | - Frances Rapport
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia
| | - Robyn P. M. Saw
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Richard A. Scolyer
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia ,grid.416088.30000 0001 0753 1056NSW Health Pathology, Sydney, NSW Australia
| | - Andrew J. Spillane
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, NSW Australia
| | - John F. Thompson
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Anne E. Cust
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia
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Jobson D, Roffey B, Best R, Button-Sloan A, Cossio D, Evans S, Shang C, Moore J, Arnold C, Mann G, Shackleton M, Soyer HP, Morton RL, Zalcberg J, Mar V. Developing an Australian Melanoma Clinical Outcomes Registry (MelCOR): a protocol paper. BMJ Open 2022; 12:e062139. [PMID: 36691164 PMCID: PMC9442481 DOI: 10.1136/bmjopen-2022-062139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/29/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Australia has the highest incidence of melanoma in the world with variable care provided by a diverse range of clinicians. Clinical quality registries aim to identify these variations in care and provide anonymised, benchmarked feedback to clinicians and institutions to improve patient outcomes. The Australian Melanoma Clinical Outcomes Registry (MelCOR) aims to collect population-wide, clinical-level data for the early management of cutaneous melanoma and provide anonymised feedback to healthcare providers. METHODS AND ANALYSIS A modified Delphi process will be undertaken to identify key clinical quality indicators for inclusion in the MelCOR pilot. MelCOR will prospectively collect data relevant to these quality indicators, initially for all people over the age of 18 years living in Victoria and Queensland with a melanoma diagnosis confirmed by histopathology, via a two-stage recruitment and consent process. In stage 1, existing State-based cancer registries contact the treating clinician and provide an opportunity for them to opt themselves or their patients out of direct contact with MelCOR. After stage 1, re-identifiable clinical data are provided to the MelCOR under a waiver of consent. In stage 2, the State-based cancer registry will approach the patient directly and invite them to opt in to MelCOR and share identifiable data. If a patient elects to opt in, MelCOR will be able to contact patients directly to collect patient-reported outcome measures. Aggregated data will be used to provide benchmarked, comparative feedback to participating institutions/clinicians. ETHICS AND DISSEMINATION Following the successful collection of pilot data, the feasibility of an Australia-wide roll out will be evaluated. Key quality indicator data will be the core of the MelCOR dataset, with additional data points added later. Annual reports will be issued, first to the relevant stakeholders followed by the public. MelCOR is approved by the Alfred Ethics Committee (58280/127/20).
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Affiliation(s)
- Dale Jobson
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Roffey
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renee Best
- Monash University, Melbourne, Victoria, Australia
| | | | - Danica Cossio
- Cancer Alliance Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sue Evans
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Catherine Shang
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Julie Moore
- Cancer Alliance Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christopher Arnold
- Hodgson Associates, Melbourne, Victoria, Australia
- Biogrid Australia, Melbourne, Victoria, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark Shackleton
- Central Clinical School and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Victoria, Australia
| | - Rachel L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Melanoma risk assessment and management: a qualitative study among Australian general practitioners. Br J Gen Pract 2022. [PMCID: PMC9466957 DOI: 10.3399/bjgp.2021.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. To the authors’ knowledge, there has been no previous research into how all physicians approach the selection and management of high-risk individuals. Melanoma risk-prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically. Aim To examine how GPs assessed and managed melanoma risk, and the opportunities for using melanoma risk-prediction models in primary care. Design and setting Semi-structured telephone interviews were conducted with 20 Australian GPs. Method GPs who had completed a cross-sectional online questionnaire study on melanoma risk were purposively sampled and recruited. Semi-structured telephone interviews were conducted with Australian GPs between 9 July and 10 September 2019. Interviews were audiorecorded, professionally transcribed, and analysed using grounded theory. Results Melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between GPs on the identification of melanoma risk factors, melanoma risk estimation, management, and patient education because of intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk-prediction models, sharing facilitators for and barriers to their potential implementation. Conclusion Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk-assessment and management processes.
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Nguyen J, Ting S, Paul E, Smith AL, Watts CG, Kelly J, Cust AE, Mar V. Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists. Australas J Dermatol 2021; 62:300-309. [PMID: 33860932 DOI: 10.1111/ajd.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVE Diagnostic tools such as dermoscopy, sequential digital dermoscopy imaging (SDDI), total body photography (TBP) and automated diagnostic tools are available to assist in early melanoma diagnosis. The use, accessibility and barriers of dermoscopy have been well studied; however, there are few similar studies regarding SDDI, TBP and automated diagnostic tools. We aim to understand the use of these diagnostic aids amongst Australian general practitioners (GPs) and dermatologists. METHODS Between June 2019 and January 2020, GPs and dermatologists across Australia were invited to participate in an online survey. Surveys were distributed through GP and dermatology organisations. RESULTS A total of 227 survey responses were received, 175 from GPs and 52 from dermatologists. Amongst GPs, 44.6% worked in a skin cancer clinic. Dermoscopy was used at least occasionally by 98.9% of all GPs. SDDI was used by 93.6% of skin cancer GPs, 80.8% of dermatologists and 45.3% of generalist GPs. TBP was used or recommended by 77.1% of generalist GPs, 82.3% of skin cancer GPs and 86.5% of dermatologists. The most common barriers to the use of TBP were cost, limited accessibility, poor patient compliance, and time required for both patients and doctors. Very few clinicians reported using automated diagnostic tools. There was an interest in future diagnostic aids for melanoma in 88% of GPs and dermatologists. CONCLUSION Dermoscopy, SDDI and TBP were commonly used by responding Australian skin cancer GPs and dermatologists in this survey. Automated diagnostic tools were not reported to be used routinely. Several barriers were identified for use of TBP.
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Affiliation(s)
- Jennifer Nguyen
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarajane Ting
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,The Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea L Smith
- Macquarie University, Sydney, New South Wales, Australia
| | - Caroline G Watts
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - John Kelly
- The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anne E Cust
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Reyes-Marcelino G, Tabbakh T, Espinoza D, Sinclair C, Kang YJ, McLoughlin K, Caruana M, Fernández-Peñas P, Guitera P, Aitken JF, Canfell K, Dobbinson S, Cust AE. Prevalence of skin examination behaviours among Australians over time. Cancer Epidemiol 2020; 70:101874. [PMID: 33341599 DOI: 10.1016/j.canep.2020.101874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to examine the prevalence and correlates of opportunistic skin check behaviours among Australians and whether changes over time might explain increasing underlying rates of melanoma in situ. METHODS The National Sun Protection Survey involved periodic telephone-based cross-sectional surveys during summer since 2003. Skin checks by a doctor in the past 12 months was asked in four summers over 2006-2017, and responses from 23,374 Australians aged 12-69 years were analysed. Prevalence estimates were weighted to be representative of the Australian population. Chi-square tests compared the prevalence over time and by characteristics. RESULTS The overall proportion reporting whole-body skin checks in the past 12 months was 20 % in 2006-07 and 2010-11, 21 % in 2013-14, and 22 % in 2016-17; but increased from 29 % in 2006-07 to 37 % in 2016-17 for those aged 45-69 years (p < 0.0001). In 2016-17, 5% reported a skin check of part-body and 9% for a specific mole or spot. The proportion reporting no skin checks increased from 61 % to 64 % over time (p < 0.0001). Whole-body skin checks were more common among older respondents, females, and also varied by residence location, skin sensitivity, skin colour, risk perception, and socio-economic index (all p < 0.001). CONCLUSION Approximately one third of Australians had their skin checked by a doctor within a 12-month period, but this varied across population sub-groups. Skin check behaviours were relatively stable over time, with modest increases in the prevalence of skin checks for those aged 45-69 years. These findings do not explain underlying large increases in rates of melanoma in situ.
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Affiliation(s)
- Gillian Reyes-Marcelino
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia.
| | - Tamara Tabbakh
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia.
| | - Craig Sinclair
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Yoon-Jung Kang
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Kirstie McLoughlin
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Michael Caruana
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Pablo Fernández-Peñas
- Department of Dermatology, Westmead Clinical School, The University of Sydney, NSW 2006, Australia.
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia; Department of Dermatology, Central Clinical School, The University of Sydney, NSW 2006, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, NSW 2050, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, QLD 4006, Australia.
| | - Karen Canfell
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Suzanne Dobbinson
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Anne E Cust
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia; Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia.
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Smith AL, Watts CG, Robinson S, Schmid H, Goumas C, Mar VJ, Thompson JF, Rapport F, Cust AE. Knowledge and attitudes of Australian dermatologists towards sentinel lymph node biopsy for melanoma: a mixed methods study. Australas J Dermatol 2020; 62:168-176. [PMID: 33277693 DOI: 10.1111/ajd.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES In melanoma management, sentinel lymph node biopsy (SLNB) is used to stage patients and to indicate prognosis. More recently, it has been used to select patients for adjuvant therapy. This study aimed to report knowledge of and attitudes towards SLNB for patients with melanoma among Australian dermatologists. METHODS Mixed methods study using cross-sectional questionnaires (n = 88) and semi-structured interviews (n = 13), May-September 2019. RESULTS Of the dermatologists surveyed, 56% thought SLNB had an important role in melanoma management, 26% were unsure and 18% thought SLNB unimportant. Of the 92% who would discuss SLNB with their patients, the main stated value of SLNB was for assessing eligibility for adjuvant therapies (79%); only 60% indicated SLNB was of value for providing prognostic information, and just over half (53%) thought it could improve staging. Interview data indicated that attitudes towards SLNB are shifting among dermatologists, driven by data from landmark clinical trials and the influence of professional networks. Accordingly, interviewees adopted one of three positions in relation to SLNB: (a) believed in utility of SLNB and adhered to the guidelines; (b) were unconvinced about utility of SLNB but adhered to the guidelines; and (c) were unconvinced about utility of SLNB and did not adhere to the guidelines. CONCLUSION Although most of the dermatologists surveyed were familiar with and follow the SLNB recommendations, some disagreement with and distrust of the recommendations was evident. Greater acceptance of the SLNB recommendations appeared to be driven by the improved outcomes demonstrated in stage III patients receiving adjuvant systemic therapy.
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Affiliation(s)
- Andrea L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Surveillance, Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Samuel Robinson
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Helen Schmid
- Centre for Cancer Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Chris Goumas
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Mater Hospital, Sydney, NSW, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | | | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Petty AJ, Ackerson B, Garza R, Peterson M, Liu B, Green C, Pavlis M. Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting. J Am Acad Dermatol 2020; 82:1158-1165. [PMID: 31931085 DOI: 10.1016/j.jaad.2019.12.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To provide a formal statistical comparison of the efficacy of melanoma detection among different clinical settings. METHODS A systematic review and meta-analysis of all relevant observational studies on number needed to treat (NNT) in relation to melanoma was performed in MEDLINE. We performed a random-effects model meta-analysis and reported NNTs with 95% confidence intervals (CIs). The subgroup analysis was related to clinical setting. RESULTS In all, 29 articles including a total of 398,549 biopsies/excisions were analyzed. The overall NNT was 9.71 (95% CI, 7.72-12.29): 22.62 (95% CI, 12.95-40.10) for primary care, 9.60 (95% CI, 6.97-13.41) for dermatology, and 5.85 (95% CI, 4.24-8.27) for pigmented lesion specialists. LIMITATIONS There is heterogeneity in data reporting and the possibility of missing studies. In addition, the incidence of melanoma varies among clinical settings, which could affect NNT calculations. CONCLUSION Pigmented lesion specialists have the lowest NNT, followed by dermatologists, suggesting that involving specialists in the diagnosis and treatment of pigmented skin lesions can likely improve patient outcomes.
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Affiliation(s)
- Amy J Petty
- School of Medicine, Duke University, Durham, North Carolina
| | - Bradley Ackerson
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | | | - Michael Peterson
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Cynthia Green
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Michelle Pavlis
- Department of Dermatology, Duke University, Durham, North Carolina.
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Primiero CA, McInerney-Leo AM, Betz-Stablein B, Whiteman DC, Gordon L, Caffery L, Aitken JF, Eakin E, Osborne S, Gray L, Smithers BM, Janda M, Soyer HP, Finnane A. Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: protocol for a randomised controlled trial. BMJ Open 2019; 9:e032969. [PMID: 31712348 PMCID: PMC6858160 DOI: 10.1136/bmjopen-2019-032969] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Melanoma is Australia's fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies. However, a skin surveillance approach targeting high-risk individuals could improve the cost-benefit ratio. METHODS AND ANALYSIS This paper describes a 2-year longitudinal randomised controlled trial (RCT) to compare routine clinical care (control) with an intensive skin surveillance programme (intervention) consisting of novel three-dimensional (3D) total-body photography (TBP), sequential digital dermoscopy and melanoma-risk stratification, in a high-risk melanoma cohort. Primary outcomes will evaluate clinical, economic and consumer impact of the intervention. Clinical outcomes will evaluate differences in the rate of lesion excisions/biopsies per person, benign to malignant ratio for excisions and thickness of melanomas diagnosed. A health economic analysis using government data repositories will capture healthcare utilisation and costs relating to skin surveillance. Consumer questionnaires will examine intervention acceptability, the psychological impact, and attitudes towards melanoma risk and sun protective behaviour. Secondary outcomes include the development of a holistic risk algorithm incorporating clinical, phenotypic and genetic factors to facilitate the identification of those most likely to benefit from this surveillance approach. Furthermore, the feasibility of integrating the intervention with teledermatology to enhance specialist care in remote locations will be evaluated. This will be the first RCT to compare a targeted surveillance programme utilising new 3D TBP technology against current routine clinical care for individuals at high risk of melanoma. ETHICS AND DISSEMINATION This study has received Human Research Ethics Committee (HREC) approval from both Metro South Health HREC (HREC/17/QPAH/816) and The University of Queensland HREC (2018000074). TRIAL REGISTRATION NUMBER ANZCTR12618000267257; Pre-results.
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Affiliation(s)
- Clare Amy Primiero
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Brigid Betz-Stablein
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David C Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Louisa Gordon
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Liam Caffery
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Institute for Resilient Religions, University of Southern Queensland, Springfield, Queensland, Australia
| | - Elizabeth Eakin
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sonya Osborne
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Len Gray
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Monika Janda
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anna Finnane
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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10
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Morton RL, Thompson JF. Sentinel lymph node biopsy for in situ melanoma is unlikely in Australia. BMJ Qual Saf 2019; 28:253-254. [PMID: 30606805 DOI: 10.1136/bmjqs-2018-009138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia .,Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
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11
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Watts CG, Wortley S, Norris S, Menzies SW, Guitera P, Askie L, Mann GJ, Morton RL, Cust AE. A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:235-242. [PMID: 29305821 DOI: 10.1007/s40258-017-0368-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective. OBJECTIVES We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system. METHODS A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017-2021. RESULTS When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5 million Australian dollars ($AU) ($US 64 million) for specialised surveillance compared with $AU 120.7 million ($US 82.7 million) for routine care, delivering savings of $AU 27.2 million ($US 18.6 million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5 years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6 million ($US 15.5 million) compared with routine care. CONCLUSIONS Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.
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Affiliation(s)
- Caroline G Watts
- Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
| | - Sally Wortley
- Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Norris
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Dermatology Department, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
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