Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma

• Published in: BMC health services research Vol. 18; no. 1; p. 477
• Main Authors: Lim, Wei-Yin, Turner, Robin M, Morton, Rachael L, Jenkins, Marisa C, Irwig, Les, Webster, Angela C, Dieng, Mbathio, Saw, Robyn P M, Guitera, Pascale, Low, Donald, Low, Cynthia, Bell, Katy J L
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.06.2018; BioMed Central; BMC
• Subjects: Aftercare - methods; Aged; Care and treatment; Diagnostic Imaging; Female; Follow-Up Studies; General Practitioners; Health services; Humans; Interdisciplinary communication; Interviews; Interviews as Topic; Investigations; Male; Medical diagnosis; Medical tests; Melanoma; Melanoma - pathology; Melanoma, Cutaneous Malignant; Metastasis; Middle Aged; Neoplasm Staging; Patient care; Physicians; Practice patterns, general practitioners; Practice Patterns, Physicians; Qualitative Research; Questionnaires; Response rates; Schedules; Skin cancer; Skin Neoplasms - pathology; Surveys and Questionnaires; Ultrasonic imaging; Australia; Interdisciplinary communication; Surveys and questionnaires; Diagnostic imaging; Follow-up studies; Melanoma; Practice patterns, general practitioners
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3291-7

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. 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. 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%). 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.