Adherence to treatment guidelines for melanoma as a measure of quality care

Introduction: Melanoma, a malignancy of melanocytes, is the most deadly and aggressive form of skin cancer. Although science has led to much advancement in melanoma treatment, significant disparities and practice variation exist in the United States. The objective of this study are to: examine Natio...

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Bibliographic Details
Main Author Pavlis, Janelle Marshall
Format Dissertation
LanguageEnglish
Published ProQuest Dissertations & Theses 01.01.2013
Subjects
Medicine
Public health
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Summary:Introduction: Melanoma, a malignancy of melanocytes, is the most deadly and aggressive form of skin cancer. Although science has led to much advancement in melanoma treatment, significant disparities and practice variation exist in the United States. The objective of this study are to: examine National Comprehensive Cancer Network (NCCN) guidelines adherence rates in the state of California, determine what patient and provider level characteristics predict receiving NCCN adherent care, and to measure the association between guideline directed treatment and improved patient outcomes. Methods: This is a retrospective, population-based study of invasive melanoma diagnosed between 2000 and 2006, using the California Cancer Registry (CCR). Patients were classified as having received NCCN adherent or non-adherent treatment. Multivariate analysis was used to identify patient and provider characteristics associated with non-adherence. Finally, melanoma specific and overall survival was analyzed. Results: A total of 29,533 patient cases were analyzed. NCCN recommended treatment for both surgical margins and lymph procedures was achieved in 73.2% of patient cases. Adherence to surgical margins was observed in 84.8% of all patient cases and lymph node adherence was 61%. NCCN Surgical guidelines were correlated with improved survival. Conclusion: Compliance with NCCN guidelines is suboptimal in California, especially regarding lymph node procedures. Patients with more advanced stage, difficult tumor location, treated by less experienced physicians, of non-white race, with non-private insurance and advanced age had a higher risk of non-adherent treatment. NCCN guidelines are correlated with improved survival and represent a valid measure of quality for patients diagnosed with melanoma.
ISBN:1303462052
9781303462054