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Thompson JR, Fu H, Saw RPM, Sherman KA, Beedle V, Atkinson V, Boyle F, O'Sullivan NA, Martin LK, Bartula I. Supportive care needs in Australian melanoma patients and caregivers: results from a quantitative cross-sectional survey. Qual Life Res 2023; 32:3531-3545. [PMID: 37522941 PMCID: PMC10624748 DOI: 10.1007/s11136-023-03492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE This study aimed to investigate the supportive care needs of Australian melanoma patients and their caregivers to form the basis for improving services. METHODS General and melanoma-related supportive care needs in melanoma patients were measured using the SCNS-SF34 and SCNS-M12 respectively, whereas caregivers completed the SCNS-P&C. Patients also completed the MCQ-28 and FCRI-9, with all participants completing the QLQ-C30, DASS-21, and questions measuring utilisation and preference for supportive health services. Multivariable stepwise logistic regression was used to identify variables associated with unmet needs in melanoma patients. RESULTS A total of 56 early-stage patients, 100 advanced-stage patients, and 37 caregivers participated. At least three-quarters ([Formula: see text] 75%) of each participant group reported at least one unmet need. Of the ten most reported unmet needs in each participant group, at least six ([Formula: see text] 60%) were related to psychological and emotional well-being, with access to a psychologist the most desired service (> 25%). Fear of cancer recurrence was equally prevalent in both patient groups at a level indicative of need for intervention. Advanced-stage patients reported significantly (p < 0.05) more unmet psychological, physical and daily living, and sexuality needs, and significantly (p < 0.05) worse functioning than early-stage patients. CONCLUSION Australian melanoma patients and caregivers report substantial unmet supportive care needs, particularly regarding their psychological and emotional well-being. Psychological and emotional well-being services, such as access to a clinical psychologist or implementation of patient-reported outcome measures, should be incorporated into routine melanoma care to address unmet patient and caregiver needs and improve well-being.
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Affiliation(s)
- Jake R Thompson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia.
| | - Hong Fu
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kerry A Sherman
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | | | - Victoria Atkinson
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Frances Boyle
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, NSW, Australia
| | - Niamh A O'Sullivan
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
| | - Linda K Martin
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Iris Bartula
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
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2
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Marchetti MA, Sar-Graycar L, Dusza SW, Nanda JK, Kurtansky N, Rotemberg VM, Hay JL. Prevalence and Age-Related Patterns in Health Information-Seeking Behaviors and Technology Use Among Skin Cancer Survivors: Survey Study. JMIR DERMATOLOGY 2022; 5:e36256. [PMID: 36776536 PMCID: PMC9910806 DOI: 10.2196/36256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Stephen W Dusza
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Japbani K Nanda
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Dieng M, Khanna N, Nguyen MTH, Turner R, Lord SJ, Menzies AM, Allen J, Saw R, Nieweg OE, Thompson J, Morton RL. Cost-effectiveness analysis of PET/CT surveillance imaging to detect systemic recurrence in resected stage III melanoma: study protocol. BMJ Open 2020; 10:e037857. [PMID: 33154047 PMCID: PMC7646332 DOI: 10.1136/bmjopen-2020-037857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the new era of effective systemic therapies for advanced melanoma, early detection of lower volume recurrent disease using surveillance imaging can improve survival. However, intensive imaging follow-up strategies are likely to increase costs to health systems and may pose risks to patients. The objective of this study is to estimate from the Australian health system perspective the cost-effectiveness of four follow-up strategies in resected stage III melanoma over a 5-year period following surgical treatment with curative intent. METHODS AND ANALYSIS A decision-analytic model will be built to estimate the costs and benefits of (1) 12 monthly, (2) 6 monthly, (3) 3-4 monthly positron emission tomography/CT imaging for 5 years, compared with (4) no imaging follow-up. The model will be populated with probabilities of disease recurrence, test performance measures using data from >1000 consecutive resected stage III melanoma patients from Melanoma Institute Australia diagnosed between 2000 and 2017. Healthcare resource use, including surveillance imaging, doctor's visits, subsequent tests and procedures to investigate suspicious findings, will be quantified from detailed patient records and valued using Australian reference pricing. Economic outcomes include cost per new distant melanoma recurrence detected and cost per diagnostic error avoided, for no imaging compared with the other strategies.Deterministic sensitivity analyses will examine the robustness of model results. ETHICS AND DISSEMINATION This study was approved by the Sydney Local Health District, Sydney Local Health District Ethics Review Committee (RPAH Zone), AU/1/830638 and the Australian Institute of Health and Welfare (EO2019-1-454). The results of this study will be published in peer-reviewed medical and health economics journals and will inform melanoma management guidelines.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nikita Khanna
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mai Thi Hoang Nguyen
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Robin Turner
- Biostatistics, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Jay Allen
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Robyn Saw
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Thompson
- Surgical Oncology, Melanoma Institute of Australia, North Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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4
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Fu H, Teleni L, Crichton M, Chan RJ. Supportive care and unmet needs in patients with melanoma: a mixed-methods systematic review. Support Care Cancer 2020; 28:3489-3501. [DOI: 10.1007/s00520-020-05464-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
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Brütting J, Bergmann M, Garzarolli M, Rauschenberg R, Weber C, Berking C, Tilgen W, Schadendorf D, Meier F. Informationssuche und Nutzung von Informationsquellen durch Melanompatienten deutscher Hautkrebszentren. J Dtsch Dermatol Ges 2019; 16:1093-1102. [PMID: 30179323 DOI: 10.1111/ddg.13630_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Brütting
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Maike Bergmann
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Marlene Garzarolli
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Ricarda Rauschenberg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Christiane Weber
- Arbeitsgemeinschaft Dermatologische Onkologie (ADO), Saarbrücken, Deutschland
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, München, Deutschland
| | - Wolfgang Tilgen
- Nationale Versorgungskonferenz Hautkrebs (NVKH), Neckargemünd, Deutschland
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Friedegund Meier
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Abstract
There is a scarcity of available data on unmet information needs (UINs) of melanoma patients (MPs) from Germany and of MPs with clinical stage IV. In a multicenter cross-sectional survey, we explored the UINs of 529 MPs by applying a standardized questionnaire. Subgroup differences in scope and contents of UINs were determined by univariate analyses. Predictors of the presence of UINs were identified by binary logistic regression. Overall, 55% of MPs reported UINs. Most MPs felt poorly or not informed about psychosocial support (24-31%). In MPs currently receiving medical treatment [odds ratio (OR): 1.9; P=0.017], MPs aging of at least 55 years (OR: 1.7; P=0.029), and in MPs who generally had a high need for information on their condition (OR: 2.4; P=0.001), the presence of UINs was significantly more likely than in post-treatment MPs, MPs more than 55 years of age, and those whose general information need was low. Most UINs concerned treatment-related information and were reported by MPs with tumor progression. Presence and scope of UINs did not differ significantly between metastatic and nonmetastatic MPs (57 vs. 53%; P=0.436). We highlighted differences in the presence, scope, and contents of UINs between MP subgroups, which should be considered when educating them in medical consultations and providing information via media. In particular, MPs felt insufficiently informed about psychosocial support and desired more treatment information.
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7
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Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L, Webster AC, Dieng M, Saw RPM, Low D, Low C, Bell KJL. Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma. JAMA Dermatol 2019; 154:420-427. [PMID: 29490373 DOI: 10.1001/jamadermatol.2018.0021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients' skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance). Objective To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up). Design, Setting, and Participants This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed. Main Outcomes and Measures Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices. Results Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals. Conclusions and Relevance Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance).
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak, Malaysia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Marisa C Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Discipline of Dermatology, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.,Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Cynthia Low
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Katy J L Bell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia
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8
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Brütting J, Bergmann M, Garzarolli M, Rauschenberg R, Weber C, Berking C, Tilgen W, Schadendorf D, Meier F. Information-seeking and use of information resources among melanoma patients of German skin cancer centers. J Dtsch Dermatol Ges 2018; 16:1093-1101. [PMID: 30091517 DOI: 10.1111/ddg.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Julia Brütting
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maike Bergmann
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marlene Garzarolli
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ricarda Rauschenberg
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christiane Weber
- Arbeitsgemeinschaft Dermatologische Onkologie (ADO), Saarbrücken, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital Munich, Munich, Germany
| | - Wolfgang Tilgen
- Nationale Versorgungskonferenz Hautkrebs (NVKH), Neckargemünd, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Friedegund Meier
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
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9
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Lamprell K, Braithwaite J. When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients' Journeys in Four Countries. QUALITATIVE HEALTH RESEARCH 2018; 28:1564-1583. [PMID: 29173015 DOI: 10.1177/1049732317742623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Malignant melanoma is an aggressive, recalcitrant disease. Its impact on people can be compounded by the physical and psychosocial consequences of medical management. Providing melanoma patients with patient-centered care that is effective, safe, and supportive throughout their journey requires knowledge of patients' progressive experiences and evolving perspectives. With ethical approval, we undertook a meta-narrative study of 214 experiential accounts of melanoma collected from the personal story sections of melanoma and cancer support websites. Using a narrative approach, we qualitatively examined the care experiences represented in these accounts and identified needs for supportive care in a framework reflective of the personal patient journey. We differentiate these across three key periods: lead-up to diagnosis; diagnosis, treatment, and recovery; and posttreatment and recurrence, and provide a visual representation of the patient journey. This article contributes to the growing body of work that utilizes Internet content as sources of qualitative, experiential health care data.
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Affiliation(s)
- Klay Lamprell
- 1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- 1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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10
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Lim WY, Turner RM, Morton RL, Jenkins MC, Irwig L, Webster AC, Dieng M, Saw RPM, Guitera P, Low D, Low C, Bell KJL. Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma. BMC Health Serv Res 2018; 18:477. [PMID: 29925350 PMCID: PMC6011416 DOI: 10.1186/s12913-018-3291-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. METHODS We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. RESULTS Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%). CONCLUSIONS The majority of people treated for a first primary localised melanoma at a specialist centre, without recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine diagnostic imaging as part of their melanoma surveillance.
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak Malaysia
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Robin M. Turner
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Marisa C. Jenkins
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Angela C. Webster
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW Australia
- Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Dermatology, The University of Sydney, Sydney, NSW Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, NSW Australia
| | | | - Katy J. L. Bell
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- Centre for Evidence Based Practice, Bond University, Gold Coast, QLD Australia
- The University of Sydney, Rm 333 Edward Ford Building (A27), Sydney, NSW 2006 Australia
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11
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Read RL, Madronio CM, Cust AE, Goumas C, Watts CG, Menzies S, Curtin AM, Mann G, Thompson JF, Morton RL. Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia. Ann Surg Oncol 2018; 25:617-625. [PMID: 29299710 DOI: 10.1245/s10434-017-6319-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 12/17/2023]
Abstract
BACKGROUND Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
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Affiliation(s)
- Rebecca L Read
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Calvary Health Care, Bruce, ACT, Australia
| | - Christine M Madronio
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Goumas
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Scott Menzies
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Austin M Curtin
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Graham Mann
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
- NHMRC Clinical Trials Centre, The University of Sydney, Level 6, Medical Foundation Building92-94 Parramatta Road, Camperdown, NSW, Australia.
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12
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Wouters MW, Michielin O, Bastiaannet E, Beishon M, Catalano O, Del Marmol V, Delgado-Bolton R, Dendale R, Trill MD, Ferrari A, Forsea AM, Kreckel H, Lövey J, Luyten G, Massi D, Mohr P, Oberst S, Pereira P, Prata JPP, Rutkowski P, Saarto T, Sheth S, Spurrier-Bernard G, Vuoristo MS, Costa A, Naredi P. ECCO essential requirements for quality cancer care: Melanoma. Crit Rev Oncol Hematol 2018; 122:164-178. [PMID: 29458785 DOI: 10.1016/j.critrevonc.2017.12.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. MELANOMA ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma.
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Affiliation(s)
- Michel W Wouters
- European Society of Surgical Oncology (ESSO); Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olivier Michielin
- European Society for Medical Oncology (ESMO); Department of Oncology, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Esther Bastiaannet
- International Society of Geriatric Oncology (SIOG); Department of Surgery/Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Orlando Catalano
- European Society of Radiology (ESR); Department of Radiology, National Cancer Institute Fondazione Pascale, Naples, Italy
| | - Veronique Del Marmol
- Association of European Cancer Leagues (ECL); Euromelanoma, European Academy of Dermatology and Venereology (EADV); Department of Dermatology and Venereology, Erasme Hospital, ULB, Brussels, Belgium
| | - Roberto Delgado-Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Rémi Dendale
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Institut Curie, Paris, France
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Andrea Ferrari
- European Society for Paediatric Oncology (SIOPE); Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ana-Maria Forsea
- European Association of Dermato Oncology (EADO); Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hannelore Kreckel
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, University Hospital Giessen and Marburg, Giessen, Germany
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Gre Luyten
- Ocular Oncology Group (OOG); Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniela Massi
- European Society of Pathology (ESP); Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Mohr
- European Society of Skin Cancer Prevention (EUROSKIN); Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cambridge Cancer Centre, Cambridge, UK
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Clinics Heilbronn, Karl-Ruprecht-University of Heidelberg, Heilbronn, Germany
| | - João Paulo Paiva Prata
- European Oncology Nursing Society (EONS); Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Piotr Rutkowski
- European Organisation for Research and Treatment of Cancer (EORTC); Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Comprehensive Cancer Center, Department of Palliative Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sapna Sheth
- European CanCer Organisation, Brussels, Belgium
| | - Gilly Spurrier-Bernard
- European CanCer Organisation (ECCO) Patient Advisory Committee; Melanoma Patient Network Europe; Paris, France
| | - Meri-Sisko Vuoristo
- Association of European Cancer Leagues (ECL); Pirkanmaa Cancer Society, Tampere, Finland
| | | | - Peter Naredi
- European CanCer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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13
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Beesley VL, Smithers BM, O'Rourke P, Janda M, Khosrotehrani K, Green AC. Variations in supportive care needs of patients after diagnosis of localised cutaneous melanoma: a 2-year follow-up study. Support Care Cancer 2017; 25:93-102. [PMID: 27562298 DOI: 10.1007/s00520-016-3378-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to describe variations in unmet supportive care needs of patients diagnosed with localised melanoma at high risk of recurrence and factors associated with initial and persisting moderate-to-high needs. METHODS We ascertained 386 patients diagnosed with clinical stage IB-II melanoma and administered surveys every 6 months for 2 years. The proportion experiencing at least one moderate-to-high need was assessed among salient subgroups: 306 patients with no previous melanoma and 80 with previous melanoma at enrolment, 30 who experienced disease recurrence during follow-up and 31 who developed another primary. Baseline factors associated with (a) needs at enrolment and (b) persistent needs over 2 years (or as long as disease-free) were identified by logistic regression analyses. RESULTS The proportion of patients with needs substantially declined over the first 6 months (if no previous melanoma, from 48 to 22 %, p < 0.001; previous melanoma, 35 to 17 %, p = 0.007), and in those remaining disease-free, needs declined further by 24 months (to 14 and 6 % respectively). By contrast, 50 % of those experiencing recurrence, and 39 % of those who developed another primary, reported needs. Stressful life events and anxiety were associated with needs at enrolment. At least one need, mainly fear of recurrence, persisted in 22 % of disease-free participants. Persistent needs were predicted by age, depression, anxiety and other stressful life events. CONCLUSIONS Melanoma patients' needs peak when first diagnosed and if disease recurs. Younger people or those experiencing additional stressful events, anxiety or depression are more likely to experience persistent needs and may benefit from tailored support.
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Affiliation(s)
- Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, QLD, 4029, Australia.
| | - B Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Peter O'Rourke
- Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, QLD, 4029, Australia
| | - Monika Janda
- Institute for Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, QLD, 4029, Australia
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
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