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Kodali N, Bhattaru A, Blanchard I, Sharma Y, Lipner SR. Assessing melanoma prognosis: the interplay between patient profiles, survival, and BRAF, NRAS, KIT, and TWT mutations in a retrospective multi-study analysis. Melanoma Res 2024:00008390-990000000-00140. [PMID: 38564430 DOI: 10.1097/cmr.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The incidence and prevalence of melanoma are increasing globally, presenting a significant public health concern. The main genetic drivers of melanoma include BRAF, NRAS, KIT and triple wild-type (TWT) mutations. Little is known about the effects of these mutations on outcomes in terms of demographics and patient characteristics. We examined differences in melanoma mortality risk and mutation count across mutation type and patient disease profile. We extrapolated primary melanoma patient data from 14 studies via the cBioportal database. Patients were divided into demographic groups and classified according to BRAF, NRAS, KIT and TWT mutation status. Analyses included two-sample Student t-test and two-way analysis of variance tests analysis with Tukey's post hoc test. Survival outcomes were compared via Kaplan-Meier curve and Cox regression. NRAS-mutated patients exhibited decreased overall survival compared to BRAF-mutated patients. Male patients had higher mutation counts across all gene groups than females, with the fewest TWT mutations in comparison to BRAF, NRAS and KIT mutations. Males also exhibited increased mortality risk for NRAS, KIT and TWT mutations compared to BRAF mutations. An unknown primary melanoma was associated with increased mortality risk across all gene groups. NRAS-mutated acral melanoma patients had an increased mortality risk compared to NRAS-mutated cutaneous melanoma patients. Older patients had a higher mortality risk than younger patients. Patients with heavier versus lower weights had lower mortality risk, which was more pronounced for BRAF-mutated patients. These relationships highlight the importance of demographic and pathologic relationships to aid in risk assessment and personalize treatment plans.
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Affiliation(s)
- Nilesh Kodali
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Abhijit Bhattaru
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Isabella Blanchard
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yash Sharma
- Derpartment of Education, UT Southwestern Medical School, Dallas, Texas
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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2
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Manolakos D, Patrick G, Geisse JK, Rabinovitz H, Buchanan K, Hoang P, Rodriguez-Diaz E, Bigio IJ, Cognetta AB. Use of an elastic-scattering spectroscopy and artificial intelligence device in the assessment of lesions suggestive of skin cancer: A comparative effectiveness study. JAAD Int 2024; 14:52-58. [PMID: 38143790 PMCID: PMC10746496 DOI: 10.1016/j.jdin.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background Skin cancer is the most common form of cancer worldwide. As artificial intelligence (AI) expands its scope within dermatology, leveraging technology may aid skin cancer detection. Objective To assess the safety and effectiveness of an elastic-scattering spectroscopy (ESS) device in evaluating lesions suggestive of skin cancer. Methods This prospective, multicenter clinical validation study was conducted at 4 US investigational sites. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were clinically assessed by expert dermatologists and evaluated by a device using AI algorithms comparing current ESS lesion readings with training data sets. Statistical analyses included sensitivity, specificity, AUROC, negative predictive value (NPV), and positive predictive value (PPV). Results Overall device sensitivity was 97.04%, with subgroup sensitivity of 96.67% for melanoma, 97.22% for basal cell carcinoma, and 97.01% for squamous cell carcinoma. No statistically significant difference was found between the device and dermatologist performance (P = .8203). Overall specificity of the device was 26.22%. Overall NPV of the device was 89.58% and PPV was 57.54%. Conclusion The ESS device demonstrated high sensitivity in detecting skin cancer. Use of this device may assist primary care clinicians in assessing suspicious lesions, potentially reducing skin cancer morbidity and mortality through expedited and enhanced detection and intervention.
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Affiliation(s)
| | | | - John K. Geisse
- Departments of Dermatology and Pathology, University of California San Francisco, San Francisco, California
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Kendall Buchanan
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | | | | | - Irving J. Bigio
- Department of Electrical & Computer Engineering, Boston University, Boston, Massachusetts
| | - Armand B. Cognetta
- Florida State University College of Medicine, Tallahassee, Florida
- Dermatology Associates of Tallahassee, Tallahassee, Florida
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3
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Lai J, Bao A, McCaffrey T, Salman R, Gelderen EV, Rizk E, Thompson KG, Epstein JA, Bibee K, Scott J. Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study. Dermatol Surg 2024; 50:28-34. [PMID: 37962110 DOI: 10.1097/dss.0000000000003989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied. OBJECTIVE This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes. METHODS A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals. RESULTS Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383-14.304) or family history (aOR = 11.307, 95% CI 2.344-20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285-12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181-0.882). LIMITATIONS Single institution, retrospective study, limited surgical patients. CONCLUSION Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.
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Affiliation(s)
- Jonathan Lai
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Aaron Bao
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Tara McCaffrey
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Rumsha Salman
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | | | - Emanuelle Rizk
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | | | | | - Kristin Bibee
- Johns Hopkins Department of Medicine, Baltimore, Maryland
- Johns Hopkins Department of Dermatology, Baltimore, Maryland
| | - Jeffrey Scott
- Clinical Skin Center of Northern Virginia, Fairfax, Virginia
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4
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Dolcini J, Ponzio E, Campanati A, D'Errico MM, Barbadoro P. Gender, Socioeconomic, and Health Characteristics Associated to Dermatological Visits in Italy: Secondary Analysis of a National Cross-Sectional Survey. Dermatology 2023; 239:1013-1018. [PMID: 37769634 DOI: 10.1159/000534223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Very few studies have investigated possible role of sociodemographic factors in terms of differences in access to dermatologic visits, and almost all of them have been conducted in health system realities where insurance companies play an important role in terms of access to healthcare providers. To our knowledge in Italy, there is lack of studies carried out with the aim to investigate possible role of sociodemographic factors regarding differences in outpatient dermatologic use for a variety of dermatologic conditions. Indeed, some investigations have been focused on specific dermatologic conditions without analyzing the big and extremely wide picture of skin diseases. OBJECTIVE The aim of this study was to analyze possible variables associated with tendency to access dermatological visits. METHODS We analyzed data from the multipurpose Italian cross-sectional Health Interview Survey routinely carried out by the Italian National Institute of Statistics (ISTAT). Mixed effect logistic regression models have been built to evaluate factors independently associated with dermatological visit. RESULTS Of the 119,073 subjects, only 2.3% underwent a dermatological visit. People older than 44 years old are less likely of undergoing a dermatological visit as well as people married/cohabiting, separated/divorced, and widowed, with low economic resources and living in southern and islands areas. Upper education levels are associated to increased probability of having a dermatological visit as well as lowering class of self-perceived health status and living in northern and central areas. CONCLUSION This study shows an association between the odds of having dermatological visits and some sociodemographic factors. This could generate possible health disparities in dermatological disease outcomes.
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Affiliation(s)
- Jacopo Dolcini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Elisa Ponzio
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Anna Campanati
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
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Erlendsdottir M, Crawford FW. Randomized controlled trials of biomarker targets. Clin Trials 2023; 20:47-58. [PMID: 36373783 PMCID: PMC9974557 DOI: 10.1177/17407745221131820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Randomized controlled trials are used to estimate the causal effect of a treatment on a health outcome of interest in a patient population. Often the specified treatment in a randomized controlled trial is a medical intervention-such as a drug or procedure-experienced directly by the patient. Sometimes the "treatment" in a randomized controlled trial is a target-such as a goal biomarker measurement-that the patient's physician attempts to reach using available medications or procedures. Large randomized controlled trials of biomarker targets are common in clinical research, and trials have been conducted to compare targets in the management of hypertension, diabetes, anemia, and acute respiratory distress syndrome. However, different randomized controlled trials intended to evaluate the same biomarker targets have produced conflicting recommendations, and meta-analyses that aggregate results of trials of biomarker targets have been inconclusive. METHODS We use causal reasoning to explain why randomized controlled trials of biomarker targets can arrive at conflicting or misleading conclusions. We describe four key threats to the validity of trials of targets: (1) intention-to-treat analysis can be misleading when a direct effect of target assignment on the outcome exists due to lack of blinding; (2) incomparability in results across trials of targets; (3) time-varying adaptive treatment strategies; and (4) Goodhart's law, "when a measure becomes a target, it ceases to be a good measure." RESULTS We illustrate these findings using evidence from 15 randomized controlled trials of blood pressure targets for management of hypertension. Randomized trials of blood pressure targets exhibit substantial variation in the trial patient populations and antihypertensives used to achieve the blood pressure targets assigned in the trials. The trials did not compare or account for time-varying treatment strategies used to reach the randomized targets. Possible "off-target" effects of antihypertensive medications needed to reach lower blood pressure targets may explain the absence of a clear benefit from intensive blood pressure control. DISCUSSION Researchers should critically assess meta-analyses of trials of targets for variation in the types, distributions, and off-target effects of therapies studied. Trial investigators should release detailed information about the biomarker targets compared in new randomized trials, as well as confounders, treatments delivered, and outcomes. New randomized controlled trials should experimentally compare treatment algorithms incorporating biomarkers, rather than targets alone. Causal inference methodology that adjusts for time-varying confounding should be used to compare time-varying treatment strategies in observational settings.
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Affiliation(s)
| | - Forrest W. Crawford
- Department of Biostatistics, Yale School of Public Health,Department of Statistics & Data Science, Yale University,Department of Ecology & Evolutionary Biology, Yale University,Yale School of Management
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6
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Jaklitsch E, Thames T, de Campos Silva T, Coll P, Oliviero M, Ferris LK. Clinical Utility of an AI-powered, Handheld Elastic Scattering Spectroscopy Device on the Diagnosis and Management of Skin Cancer by Primary Care Physicians. J Prim Care Community Health 2023; 14:21501319231205979. [PMID: 37933569 PMCID: PMC10631325 DOI: 10.1177/21501319231205979] [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] [Received: 08/16/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Patients with lesions suspicious for skin cancer often present to primary care physicians (PCPs), who may have limited training in skin cancer diagnosis. OBJECTIVE To measure the impact of an adjunctive handheld device for PCPs that employs elastic scattering spectroscopy (ESS) on the diagnosis and management of skin cancer. METHODS Fifty-seven PCPs evaluated 50 clinical images of skin lesions (25 malignant and 25 benign), first without and then with knowledge of the handheld ESS device output, and in each case indicated if a lesion was likely to be benign or malignant. RESULTS The diagnostic sensitivity of the PCPs with and without the use of the ESS device was 88% (95% CI, 84%-92%) and 67% (95% CI, 62%-72%), respectively (P < .0001). In contrast, no significant difference was observed in the diagnostic specificity. The management sensitivity of the physicians with and without the use of the ESS device was 94% (95% CI, 91%-96%) and 81% (95% CI, 77%-85%), respectively (P = .0009). Similarly, no significant difference was observed in the management specificity. CONCLUSION The use of the ESS device may have the potential to help improve skin cancer diagnosis and confidence in management decision-making in a primary care setting.
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Affiliation(s)
- Erik Jaklitsch
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Margaret Oliviero
- Dermatology Department, Skin and Cancer Associates, Plantation, FL, USA
| | - Laura Korb Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
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7
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Cortez JL, Fadadu RP, Konda S, Grimes B, Wei ML. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int 2022; 7:78-85. [PMID: 35373156 PMCID: PMC8968658 DOI: 10.1016/j.jdin.2022.02.008] [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] [Indexed: 11/25/2022] Open
Abstract
Background Early detection of melanoma is critical for positive outcomes. However, access for the diagnosis of melanoma remains problematic for segments of the general population. Objective To compare the rates of dermatology and family medicine practitioner acceptances for a public insurance (Medicaid) versus private insurance (Anthem Blue Cross) and clinic wait times for an appointment for a changing pigmented skin lesion concerning melanoma in rural and urban regions in California. Methods Cross-sectional audit study between June 2017 and March 2019; scripted phone calls were made to dermatology and family medicine practices (FMPs). Results Family medicine and dermatology practices in both regions had significantly decreased acceptance of Medicaid. Dermatology practices had 11.3% to 13.0% Medicaid acceptance rates that were less than FMP rates of 28% to 36%. In both regions, FMP wait times were 2.4- to 3.2-fold longer for public versus private insurance; there were little differences in wait times for the 2 insurance types in dermatology practices, in both regions. Limitations Assessment of only 2 regions in the state of California. Conclusion Delays at FMPs and insurance types limit access to melanoma screening in California for underserved segments of the general population, which has implications for melanoma outcomes and health policy.
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Affiliation(s)
- Jose Luis Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico.,Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Raj P Fadadu
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sailesh Konda
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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8
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Yang J, Chen S, Li Y, Wang B, Xin X, Xue X, Pan Z, Lyu J. Incidence rate and risk factors for suicide death in patients with skin malignant melanoma: a Surveillance, Epidemiology, and End Results analysis. Melanoma Res 2021; 30:402-409. [PMID: 30489483 DOI: 10.1097/cmr.0000000000000559] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to use the Surveillance, Epidemiology, and End Results database to identify the incidence rate and risk factors for suicide death in patients with skin malignant melanoma (MM) in the USA. We screened cases of skin MM in the SEER database. The balance of covariates between the two groups was examined by the χ-test and Fisher's exact test. Logistic regression was used to identify independent risk factors for committing suicide. A propensity 1: 2 matched analysis was applied to minimize the risk of bias. In total, 103 500 patients with skin MM were included in the study, of whom 623 had died of suicide. The rate of suicide death did not differ significantly between different time intervals. In logistic regression before propensity score matching, age, being divorced, separated, or widowed, receiving radiation or chemotherapy, and the elapsed time since diagnosis were independently associated with an increased rate of suicide death. Only age (P < 0.001) and being in the first year after a diagnosis (P < 0.001) significantly increased the risk of suicide death after propensity score matching. In addition, after the propensity score matching, age was a risk factor for localized, regional, and unstaged, and being the first year after a diagnosis was only a risk factor for regional. It is important to identify and treat people at risk of suicide as early as possible. These results can help clinicians to understand suicidal patients and provide them with appropriate support.
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Affiliation(s)
- Jin Yang
- Clinical Research Center.,School of Public Health
| | - Siying Chen
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Yuanjie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center
| | - Bin Wang
- Outpatient Department, Qingdao Branch of Naval Aviation University, Qingdao, China
| | - Xiaojing Xin
- Outpatient Department, Qingdao Branch of Naval Aviation University, Qingdao, China
| | - Xia Xue
- Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an
| | - Zhenyu Pan
- Clinical Research Center.,School of Public Health.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an
| | - Jun Lyu
- Clinical Research Center.,School of Public Health
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9
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Shah P, Shao Y, Geller AC, Polsky D. Late-Stage Melanoma in New York State: Associations with Socioeconomic Factors and Healthcare Access at the County Level. J Invest Dermatol 2021; 141:1699-1706.e7. [PMID: 33516743 DOI: 10.1016/j.jid.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
A diagnosis of late-stage melanoma is associated with significant mortality. From a public health perspective, the knowledge of geographic disparities in late-stage diagnoses can inform efforts to facilitate the diagnosis of the earlier stage, highly curable melanomas. We conducted a county-level analysis of melanoma in New York state to identify communities that may benefit from pilot health interventions to reduce the burden of late-stage melanoma. From 1995 to 2016, late-stage melanoma incidence increased from 1.5 to 2.8 cases per 100,000 in New York state. We found statistically significant associations between decreased county-level health system access (including physician density and resident educational status) and increased county incidence and proportion of late-stage disease among diagnosed cases (P < 0.001 for both). Increased county-level socioeconomic status, including measures of resident wealth and medical insurance status, was positively associated with greater late-stage incidence (P < 0.001). However, decreased county-level socioeconomic status was positively associated with a greater proportion of late-stage disease among cases at diagnosis (P = 0.009). Counties with reduced access to physician services and lower socioeconomic status may be suitable for pilot interventions promoting the recognition and diagnosis of early-stage melanomas to reduce late-stage diagnoses and associated mortality.
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Affiliation(s)
- Payal Shah
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Polsky
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA.
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10
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Hartman RI, La J, Chang MS, Cheng D, Do N, Brophy M, Fillmore NR. Risk factors for thick melanoma among veterans: A cross-sectional study. J Am Acad Dermatol 2021; 84:1766-1769. [PMID: 33422630 DOI: 10.1016/j.jaad.2020.12.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, VA Integrated Service Network 1 (VISN-1), Jamaica Plain, Massachusetts.
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Michael S Chang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - David Cheng
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Nhan Do
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Mary Brophy
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Nathanael R Fillmore
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
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11
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Cortez JL, Vasquez J, Wei ML. The impact of demographics, socioeconomics, and health care access on melanoma outcomes. J Am Acad Dermatol 2020; 84:1677-1683. [PMID: 32783908 DOI: 10.1016/j.jaad.2020.07.125] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
Disparities in melanoma care exist in the United States. Disparities in provider type, patient demographics, place of residence, insurance status, socioeconomic status, race/ethnicity, and age impact melanoma outcomes. Melanomas detected by dermatologists are thinner, at an earlier stage, and have better survival outcomes compared with detection by primary care providers or patients. Lower socioeconomic status, race/ethnicity, and place of residence are associated with decreased access to or use of dermatologists, or both, and more advanced melanomas at diagnosis. Additionally, uninsured and publicly insured individuals are more likely to present with late-stage melanomas, resulting in worse outcomes. This review provides a comprehensive overview of how structural and patient-level characteristics influence melanoma outcomes in order to inform clinical care and health care policy as it relates to addressing gaps in melanoma care.
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Affiliation(s)
- Jose L Cortez
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Juan Vasquez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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12
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Nguyen KB, Read C, Wu KK, Armstrong AW. Where you live matters: Regional differences in health care resource use for psoriasis in the United States. J Am Acad Dermatol 2020; 82:1360-1367. [DOI: 10.1016/j.jaad.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/27/2019] [Accepted: 10/03/2019] [Indexed: 12/20/2022]
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13
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Tripathi R, Archibald LK, Mazmudar RS, Conic RRZ, Rothermel LD, Scott JF, Bordeaux JS. Racial differences in time to treatment for melanoma. J Am Acad Dermatol 2020; 83:854-859. [PMID: 32277971 PMCID: PMC7141633 DOI: 10.1016/j.jaad.2020.03.094] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
Background Longer time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although black patients present with later-stage melanoma and have worse survival than non-Hispanic white patients, the association between race and TTDS is unknown. Objective To investigate racial differences in time to melanoma treatment. Methods Retrospective review of the National Cancer Database (2004-2015). Multivariable logistic regression was used to evaluate the association of race with TTDS, controlling for sociodemographic/disease characteristics. Results Of the 233,982 patients with melanoma identified, 1221 (0.52%) were black. Black patients had longer TTDS for stage I to III melanoma (P < .001) and time to immunotherapy (P = .01), but not for TTDS for stage IV melanoma or time to chemotherapy (P > .05 for both). When sociodemographic characteristics were controlled for, black patients had over twice the odds of having a TTDS between 41 and 60 days, over 3 times the odds of having a TTDS between 61 and 90 days, and over 5 times the odds of having a TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean, 60.4 days), and those with private insurance had the shortest TTDS (mean, 44.6 days; P < .001 for both). Conclusions Targeted approaches to improve TTDS for black patients are integral in reducing racial disparities in melanoma outcomes.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Laura K Archibald
- University of Minnesota Medical Center, Department of Dermatology, Minneapolis, Minnesota
| | - Rishabh S Mazmudar
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rosalynn R Z Conic
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Luke D Rothermel
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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14
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Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States. JAMA Dermatol 2019; 154:1286-1291. [PMID: 30267073 DOI: 10.1001/jamadermatol.2018.3114] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Knowledge regarding differences in dermatologic care for patients with a broad range of dermatologic conditions is limited. Objective To elucidate nationwide differences in use of outpatient dermatologic care. Design, Setting, and Participants Retrospective analysis of nationally representative data from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS) provided by the Agency for Healthcare Research and Quality. Health care use outcomes for dermatologic conditions (skin cancers, infections, dermatologic inflammatory conditions/ulcers, and other skin disorders) were examined via multivariable logistic regression analyses of outpatient and office-based dermatologist visit rates accounting for sex, age, race/ethnicity, educational level, income, insurance status, region, self-reported condition, and self-reported health status. Participants were 183 054 MEPS respondents who visited a dermatologist from 2007 to 2015. Main Outcomes and Measures The primary outcome measure was whether the patient received outpatient care for any dermatologic condition (by payment). The secondary outcomes were annual health care use by individuals with dermatologic conditions (including per capita expenditure for the visit). Results Of 183 054 MEPS respondents (mean [SD] age, 34 [23] years; 52.1% female), 19 561 (10.7%) self-reported a dermatologic condition; 9645 patients had a total of 11 761 outpatient visits to dermatologists. Hispanic (adjusted odds ratio [aOR], 0.55; 95% CI, 0.49-0.61) and black (aOR, 0.42; 95% CI, 0.38-0.46) patients were both less likely to receive outpatient care for their dermatologic condition relative to non-Hispanic white patients. Male patients were less likely to receive outpatient dermatologic care than female patients (aOR, 0.66; 95% CI, 0.62-0.70), and Midwestern patients were less likely to receive outpatient dermatologic care than Northeastern patients (aOR, 0.80; 95% CI, 0.70-0.91). Patients with Medicaid or Medicare coverage (aOR, 0.75; 95% CI, 0.68-0.83) and uninsured patients (aOR, 0.39; 95% CI, 0.33-0.47) were both less likely to receive outpatient dermatologic care than privately insured patients. Increasing educational level and income were associated with increased odds of receiving outpatient care for the dermatologic condition. Conclusions and Relevance These findings highlight wide-ranging differences in use of dermatologic care in the United States across various demographic and socioeconomic lines. Results of this study suggest an urgent need to further characterize potential dermatologic health care differences and improve use of outpatient dermatologic care among disadvantaged populations.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Konrad D Knusel
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Harib H Ezaldein
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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15
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Pitre LD, Linford G, Pond GR, McWhirter E, Seow H. Is Access to Care Associated With Stage at Presentation and Survival for Melanoma Patients? J Cutan Med Surg 2019; 23:586-594. [PMID: 31462069 DOI: 10.1177/1203475419870177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Melanoma incidence increases with socioeconomic status but the effect of rurality and access to primary care or dermatology on patient outcomes is unclear. OBJECTIVES The objectives of this study were to determine whether access to care, rurality, or socioeconomic status are associated with melanoma stage at presentation and prognosis. METHODS Linked administrative databases from Ontario, Canada, were retrospectively analyzed to identify a population-based cohort of patients diagnosed with melanoma between 2004 and 2012. Rurality was assessed using the rural index of Ontario (RIO) score, and the number of visits to dermatology and primary care was used to evaluate access to care. RESULTS We identified 18 776 melanoma patients, of whom 9591 had completed pathological staging. Patients with higher RIO scores, living further from a cancer center or in a rural community, were less likely to see a dermatologist in the year prior to diagnosis (P < .001 for all). Patients seen by a dermatologist within 365 days prior to diagnosis were less likely to present with stage III or IV disease (odds ratio 0.63, P < .001) and had improved overall survival (hazard ratio [HR] for death 0.77, P < .001). There was a nonlinear association between number of family physician visits and melanoma prognosis, with patients who had 3 to 5 visits per year having the best overall survival (HR 0.88, P = .003). CONCLUSION Our findings strengthen the known association between access to dermatology and melanoma outcomes by linking individual patients' prediagnosis access to care to pathological stage at diagnosis and overall survival.
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Affiliation(s)
- Lacey D Pitre
- Department of Oncology, Northeast Cancer Center, Sudbury, ON, Canada
| | - Geordie Linford
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Gregory R Pond
- Department of Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada
| | - Elaine McWhirter
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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16
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Malhotra J, Rotter D, Jabbour SK, Aisner J, Lin Y, Manne S, Demissie K. Receipt of recommended surveillance with imaging in elderly survivors of early stage non-small cell lung cancer. Lung Cancer 2018; 125:205-211. [PMID: 30429021 PMCID: PMC10865993 DOI: 10.1016/j.lungcan.2018.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Early-stage lung cancer survivorsremain at high risk for recurrence or second cancers. We measured the rates and determinants of regular surveillance imaging in early-stage non-small cell lung cancer (NSCLC) survivors. METHODS Patients (diagnosed 2001-2011) with resected stage I and II NSCLC were identified from the Surveillance Epidemiology and End Results (SEER)-Medicare linked database. Patients were censored at recurrence/second cancer diagnosis, loss to follow-up or death. Receipt of a scan during the surveillance periods of 7-18, 19-30, 31-42 and 43-60 months from date of surgery was assessed. RESULTS Of 10,680 survivors assessed during the 18-month surveillance period, 71% received imaging in first 18 months. Only 56% and 43% continued to receive regular imaging by 30-month and 60-month of follow-up, respectively. Survivors were less likely to receive imaging if they were older, black, unmarried, received no adjuvant therapy, had stage I disease (vs. stage II) or were diagnosed before 2006. In adjusted analysis, survivors who received recommended imaging up to 18 months from surgery experienced better survival compared to survivors who did not (HR 0.92; 95% CI 0.85-0.99). Survival benefit was also observed in survivors who underwent regular imaging up to 5 years from surgery (HR 0.68; 95% CI 0.60-0.78). CONCLUSIONS More than half the lung cancer survivors received less than the recommended long-term surveillance imaging. Long-term adherence to surveillance is associated with improved survival. Our study provides evidence to support the current clinical guidelines for surveillance for lung cancer survivors that are primarily consensus-based at present.
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Affiliation(s)
- Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States.
| | - David Rotter
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Joseph Aisner
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Yong Lin
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Sharon Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Kitaw Demissie
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States; Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
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17
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Fleming NH, Grade MM, Bendavid E. Impact of primary care provider density on detection and diagnosis of cutaneous melanoma. PLoS One 2018; 13:e0200097. [PMID: 30005065 PMCID: PMC6044519 DOI: 10.1371/journal.pone.0200097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Early diagnosis of cutaneous melanoma is critical in preventing melanoma-associated deaths, but the role of primary care providers (PCPs) in diagnosing melanoma is underexplored. We aimed to explore the association of PCP density with melanoma incidence and mortality. METHODS All cases of cutaneous melanoma diagnosed in the United States from 2008-2012 and reported in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed in 2016. County-level primary care physician density was obtained from the Area Health Resources File (AHRF). We conducted multivariate linear regression using 1) average annual melanoma incidence or 2) average annual melanoma mortality by county as primary outcomes, adjusting for demographic confounders and dermatologist density. Cox proportional hazard regression was conducted using individual outcome data from SEER with the same covariates. RESULTS Across 611 counties, 167,305 cases of melanoma were analyzed. Per 100,000 people, an additional 10 PCPs per county was associated with 1.62 additional cases of melanoma per year (95% CI 1.06-2.18, p<0.001). This increased incidence occurred disproportionally in early-stage melanoma (Stage 0: 0.69 cases (0.38-1.00), p<0.001; Stage I: 0.63 cases (0.37-0.89), p<0.001; Stage II: 0.11 cases (0.03-0.19), p = 0.005). There was no statistically significant association between PCP density and incidence of stage III or IV melanoma, or with melanoma-specific mortality. Survival analysis demonstrated elimination of 5-year post-diagnosis mortality risk in medically underserved counties after adjusting for stage. CONCLUSIONS Higher densities of PCPs may be linked to increased diagnosis of early-stage melanoma without corresponding decreases in late-stage diagnoses or melanoma-associated mortality.
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Affiliation(s)
- Nathaniel H. Fleming
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Madeline M. Grade
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Eran Bendavid
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America
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18
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Rat C, Hild S, Rault Sérandour J, Gaultier A, Quereux G, Dreno B, Nguyen JM. Use of Smartphones for Early Detection of Melanoma: Systematic Review. J Med Internet Res 2018; 20:e135. [PMID: 29653918 PMCID: PMC5923035 DOI: 10.2196/jmir.9392] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background The early diagnosis of melanoma is associated with decreased mortality. The smartphone, with its apps and the possibility of sending photographs to a dermatologist, could improve the early diagnosis of melanoma. Objective The aim of our review was to report the evidence on (1) the diagnostic performance of automated smartphone apps and store-and-forward teledermatology via a smartphone in the early detection of melanoma, (2) the impact on the patient’s medical-care course, and (3) the feasibility criteria (focusing on the modalities of picture taking, transfer of data, and time to get a reply). Methods We conducted a systematic search of PubMed for the period from January 1, 2007 (launch of the first smartphone) to November 1, 2017. Results The results of the 25 studies included 13 concentrated on store-and-forward teledermatology, and 12 analyzed automated smartphone apps. Store-and-forward teledermatology opens several new perspectives, such as it accelerates the care course (less than 10 days vs 80 days), and the related procedures were assessed in primary care populations. However, the concordance between the conclusion of a teledermatologist and the conclusion of a dermatologist who conducts a face-to-face examination depended on the study (the kappa coefficient range was .20 to .84, median κ=.60). The use of a dermoscope may improve the concordance (the kappa coefficient range was .29 to .87, median κ=.74). Regarding automated smartphone apps, the major concerns are the lack of assessment in clinical practice conditions, the lack of assessment in primary care populations, and their low sensitivity, ranging from 7% to 87% (median 69%). In this literature review, up to 20% of the photographs transmitted were of insufficient quality. The modalities of picture taking and encryption of the data were only partially reported. Conclusions The use of store-and-forward teledermatology could improve access to a dermatology consultation by optimizing the care course. Our review confirmed the absence of evidence of the safety and efficacy of automated smartphone medical apps. Further research is required to determine quality criteria, as there was major variability among the studies.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.,Unit 1232 - Team 2, Centre de Recherche en Cancérologie, French National Institute of Health and Medical Research, Nantes, France
| | - Sandrine Hild
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Julie Rault Sérandour
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, CHU Nantes, Nantes, France
| | - Gaelle Quereux
- Unit 1232 - Team 2, Centre de Recherche en Cancérologie, French National Institute of Health and Medical Research, Nantes, France.,Oncodermatology Department, Nantes University Hospital, CHU Nantes, Nantes, France
| | - Brigitte Dreno
- Unit 1232 - Team 2, Centre de Recherche en Cancérologie, French National Institute of Health and Medical Research, Nantes, France.,Oncodermatology Department, Nantes University Hospital, CHU Nantes, Nantes, France
| | - Jean-Michel Nguyen
- Unit 1232 - Team 2, Centre de Recherche en Cancérologie, French National Institute of Health and Medical Research, Nantes, France.,Department of Epidemiology and Biostatistics, Nantes University Hospital, CHU Nantes, Nantes, France
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19
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Look Hong NJ, Cheng SY, Baxter NN, Wright FC. Melanoma patterns of care in Ontario: A call for a strategic alignment of multidisciplinary care. J Surg Oncol 2018; 117:597-617. [PMID: 29228470 DOI: 10.1002/jso.24936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population-level data. METHODS Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003-2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis. Melanoma treatment was categorized as inadequate or adequate based on multidisciplinary clinical algorithms. Multivariable logistic regression was used to model factors associated with treatment adequacy. RESULTS From 2003 to 2012, 22 918 patients with invasive melanoma were identified with annual age/sex standardized incidence rates of 11.7-14.3/100 000 for females and 13.4-15.9/100 000 for males. Melanoma occurred at median age of 62 and primarily on extremities (43.9%). Within 1 year after diagnosis, 86.7% of patients received surgery as primary therapy. A total of 2312 (10.6%) patients received inadequate or no treatment after diagnosis. Receiving adequate treatment was associated with consultation with dermatology (OR 1.92, CI 1.71-2.14), plastic surgery (OR 4.80, CI 4.32-5.34), or general surgery (OR 2.15, CI 1.94-2.38). CONCLUSIONS Significant variation exists in melanoma management and nearly one in nine patients is inadequately treated. Referral to sub-specialized providers is critical for ensuring appropriate care.
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Affiliation(s)
- Nicole J Look Hong
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontorio, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada
- St. Michael's Hospital, Department of Surgery and Keenan Research Centre, Toronto, Ontorio, Canada
| | - Frances C Wright
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontorio, Canada
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20
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Creating a National Provider Identifier (NPI) to Unique Physician Identification Number (UPIN) Crosswalk for Medicare Data. Med Care 2017; 55:e113-e119. [PMID: 29135774 DOI: 10.1097/mlr.0000000000000462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Many health services researchers are interested in assessing long term, individual physician treatment patterns, particularly for cancer care. In 2007, Medicare changed the physician identifier used on billed services from the Unique Physician Identification Number (UPIN) to the National Provider Identifier (NPI), precluding the ability to use Medicare claims data to evaluate individual physician treatment patterns across this transition period. METHODS Using the 2007-2008 carrier (physician) claims from the linked Surveillance, Epidemiology and End Results (SEER) cancer registry-Medicare data and Medicare's NPI and UPIN Directories, we created a crosswalk that paired physician NPIs included in SEER-Medicare data with UPINs. We evaluated the ability to identify an NPI-UPIN match by physician sex and specialty. RESULTS We identified 470,313 unique NPIs in the 2007-2008 SEER-Medicare carrier claims and found a UPIN match for 90.1% of these NPIs (n=423,842) based on 3 approaches: (1) NPI and UPIN coreported on the SEER-Medicare claims; (2) UPINs reported on the NPI Directory; or (3) a name match between the NPI and UPIN Directories. A total of 46.6% (n=219,315) of NPIs matched to the same UPIN across all 3 approaches, 34.1% (n=160,277) agreed across 2 approaches, and 9.4% (n=44,250) had a match identified by 1 approach only. NPIs were paired to UPINs less frequently for women and primary care physicians compared with other specialists. DISCUSSION National Cancer Institute has created a crosswalk resource available to researchers that links NPIs and UPINs based on the SEER-Medicare data. In addition, the documented process could be used to create other NPI-UPIN crosswalks using data beyond SEER-Medicare.
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21
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Berg SA, Ming ME. Recent Advances in Our Understanding of the Epidemiology of Melanoma. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Rat C, Quereux G, Grimault C, Fernandez J, Poiraud M, Gaultier A, Chaslerie A, Pivette J, Khammari A, Dreno B, Nguyen JM. Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners. Scand J Prim Health Care 2016; 34:286-94. [PMID: 27467203 PMCID: PMC5036019 DOI: 10.1080/02813432.2016.1207149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The study objective was to measure the rates of inclusion of populations at risk of advanced melanoma in a pilot targeted screening project involving general practitioners. DESIGN This cross-sectional database study compared the inclusion rates of patients who signed inclusion in a targeted screening project with those of patients who did not, during a period in which both groups of patients consulted investigators. SETTING Data were extracted from the national healthcare insurance records in western France from 11 April to 30 October 2011. PATIENTS Patients, older than 18, considered for the data extraction had consulted one of the 78 participating GPs during the study period, and were affiliated with the national healthcare insurance. MAIN OUTCOME MEASURES Inclusion in the screening was the main outcome measure. Patients at risk of advanced melanoma were characterized by male gender, age over 50, low income, rural residence, farmer, and presence of chronic disease. RESULTS A total of 57,279 patients consulted GPs during the inclusion period and 2711 (4.73%) were included in the targeted screening. Populations at risk of advanced melanoma were less included: men (OR = 0.67; 95%CI [0.61-0.73]; p < 0.001), older than 50 (OR = 0.67; 95%CI [0.60-0.74]; p < 0.001), low income (OR = 0.65; 95%CI [0.55-0.77]; p < 0.001), farmer (OR = 0.23; 95%CI [0.17-0.30]; p < 0.001) and presence of a chronic disease (OR = 0.87; 95%CI [0.77-0.98]; p < 0.028). CONCLUSION This study demonstrated inequalities in the inclusion of patients in a melanoma screening. Patients at risk of advanced cancer were screened less often. Further studies should focus on GPs ability to identify and screen these patients. KEY POINTS Advanced melanoma is more frequently diagnosed in men, older patients and socioeconomically disadvantaged populations, which leads to survival inequalities. • Despite the involvement of general practitioners, the implementation of targeted melanoma screening did not avoid inclusion inequalities. • Men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening. • The display of a conventional or an alarmist poster in the waiting room did not statistically reduce these inclusion inequalities.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- CONTACT Cédric Rat Department of General Practice, Faculty of Medicine of Nantes, 1 rue Gaston Veil, 44035 Nantes, France
| | - Gaelle Quereux
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Charlotte Grimault
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jérémy Fernandez
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Mickael Poiraud
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Anicet Chaslerie
- Medical Department of the French Health Insurance System, Nantes, France
| | - Jacques Pivette
- Medical Department of the French Health Insurance System, Nantes, France
| | - Amir Khammari
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Brigitte Dreno
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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23
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Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015; 72:717-23. [PMID: 25698455 DOI: 10.1016/j.jaad.2015.01.025] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/11/2022]
Abstract
Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.
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Affiliation(s)
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeannette M Olazagasti
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Susan C Taylor
- Society Hill Dermatology and Cosmetic Center, Philadelphia, Pennsylvania
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois
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