Abstract
BackgroundPatients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors.MethodsIn-depth qualitative study based on semi-structured interviews with 16 clinicians (surgical oncologists, dermatologists and melanoma unit GPs) who conduct post-treatment follow-up at two of Australia’s largest specialist referral melanoma treatment and diagnosis units. Interviews were recorded, transcribed and analysed to identify approaches to shared care in follow-up, variations in practice, and explanations of these.ResultsMelanoma unit clinicians utilised shared care in the follow-up of patients with early stage melanoma. Schedules were determined by patients’ clinical risk profiles. Final arrangements for delivery of those schedules (by whom and where) were influenced by additional psychosocial, professional and organizational considerations. Four models of shared care were described: (a) surgical oncologist alternating with dermatologist (in-house or local to patient); (b) melanoma unit dermatologist and other local doctor (e.g. family physician); (c) surgical oncologist and local doctor; or (d) melanoma physician and local doctor.ConclusionsThese models of shared care offer alternative solutions to managing the requirements for long-term follow-up of a growing number of patients with stage I/II melanoma, and warrant further comparative evaluation of outcomes in clinical trials, with detailed cost/benefit analyses.
Highlights
Patients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours
In this paper we describe approaches to shared care in the follow-up of patients with AJCC stage I/II melanoma among melanoma specialists and melanoma unit GPs (i.e. GPs based in a specialist melanoma unit and trained in melanoma follow-up); and outline four models of shared care as practiced in two of Australia’s largest tertiary referral melanoma diagnostic and treatment units
Shared responsibilities in melanoma follow-up Long term routine follow-up for stage I/II melanoma was often conducted as a form of shared care in which patients alternated between different clinicians at the melanoma units and/or their local / referring GP or skin cancer clinic.a The melanoma unit clinicians noted a paucity of evidence on best practice in melanoma follow-up, and follow-up schedules were primarily based on each patient’s expected risk of recurrence and of developing a new primary tumour, as well as on clinical guidelines [18]
Summary
Patients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors. There is growing awareness of the important role of general practitioners, both in cancer management and in post-treatment follow-up [5,6,7]. Patients with AJCC stage I/II melanoma have high survival rates [17], but require long-term follow-up to detect recurrences and/or new primary tumours [18,19]. In Australia, oncology specialists working in the field of breast cancer have reported high levels of willingness to share care with other health professionals, but only 15% of their patients attended GPs for post-treatment follow-up [28]. While GP and patient experiences of shared care in melanoma follow-up have been described [26,27], no studies have examined shared care from the perspective of melanoma clinicians
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