Association between dermatology follow-up and melanoma survival: A population-based cohort study - 14/05/24
, Patrick Fleming, BSc, MSc, MD b, Kinwah Fung, MSc c, An-Wen Chan, MD, DPhil (Oxon) b, dAbstract |
Background |
Guidelines recommend that patients with melanoma undergo dermatologic examination at least annually. Adherence to follow-up and its impact on survival are unclear.
Objective |
To determine the level of adherence to annual dermatologic follow-up in patients with primary cutaneous melanoma, identify predictors for better adherence, and evaluate whether adherence was associated with melanoma-related mortality.
Methods |
Retrospective inception cohort analysis of adults with primary invasive melanoma in Ontario, Canada from 2010 to 2013 with follow-up until December 31, 2018.
Results |
Adherence to dermatologic follow-up was variable with only 28.0% of patients seeing a dermatologist at least annually (median follow-up 5.0 years). Younger age, female sex, higher income, greater access to dermatology care, stage 2/3 melanoma, prior keratinocyte carcinoma, fewer comorbidities, and any outpatient visit in the 12 months prior to melanoma diagnosis were predictors for adherence. Greater adherence to annual dermatology visits was associated with reduced melanoma-specific mortality compared with lower levels of adherence (adjusted hazard ratio 0.64, 95% CI 0.52-0.78).
Limitations |
Observational study design and inability to identify skin examinations performed by non-dermatologists.
Conclusion |
Adherence to annual dermatology visits after melanoma diagnosis was low. Greater adherence may promote better patient survival but warrants confirmation in further research including randomized trials.
Il testo completo di questo articolo è disponibile in PDF.Key words : adherence, follow-up, melanoma, mortality, oncology, survival
Abbreviations used : aRR, CI, ICES, IQR, RECORD, OHIP
Mappa
| Funding sources: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study was also funded by unrestricted research grants from the Canadian Dermatology Foundation, and Douglas Wright Melanoma Foundation. This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The study funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. |
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| Patient consent: Not applicable. |
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| IRB approval status: Not required (data used were authorized under section 45 of Ontario's Personal Health Information Protection Act). |
Vol 90 - N° 6
P. 1161-1169 - giugno 2024 Ritorno al numero
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