Compliance with Melanoma Treatment Guidelines in a Community Teaching Hospital: Time Trends and Other Variables

Erickson, Jennifer L.; Velasco, Josè M.; Hieken, Tina J.

doi:10.1245/s10434-007-9789-6

Cited by 34 publications

(22 citation statements)

References 14 publications

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“…The evidence on which this is based predominantly focuses on disease affecting the trunk and limbs [12,19,20], and their value in head and neck disease remains unknown [11]. Evidence in this area is particularly useful given the limited scope to achieve the recommended margins in the head and neck region [2,15,17,18]. Five-year survival rates in whole cohort (%)…”

Section: Discussionmentioning

confidence: 99%

“…In the head and neck region, however, excision of this amount of tissue is often not feasible, as it will substantially impair the form and function of the important adjacent structures [2,11,15,16]. Previous reports are of achievement of the desired margins in the range of 50-70% in this area [15,17,18]. The current consensus is that 'narrower margins should be considered as very reasonable in all those areas where a 2-cm margin would meet with anatomical, functional or cosmetic constraints', though there is very little published data to support such recommendations [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…The current consensus is that 'narrower margins should be considered as very reasonable in all those areas where a 2-cm margin would meet with anatomical, functional or cosmetic constraints', though there is very little published data to support such recommendations [11,12]. As such, lateral excision margins in the head and neck region are often smaller [15,17,18], but we are uncertain of the exact effect this has on recurrence rates and survival.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

Robertson

Senior

et al. 2011

Eur J Plast Surg

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Guidelines for the management of cutaneous melanoma suggest wide local excision of increasing margins for increasing Breslow thickness of the primary neoplasm. These guidelines are based on randomized controlled trial data from limb and trunk melanoma studies. We performed retrospective analysis of our institution's head and neck melanoma database to investigate the effect of narrow excision margins on survival and loco-regional recurrence. We identified 101 patients with node-negative head and neck melanoma from 1993 to 2001 who had prospectively gathered data. The overall 5-year loco-regional recurrence rate (LR) was 37%. The overall 5-year melanoma-specific survival rate (5y.s.) was 70%. When guidelines were followed (n036), LR was 19% and 5y.s. was 89%. When guidelines were not followed (n065), LR was 46% and 5y.s. was 60%. On univariate analysis, we found scalp location (p<0.001), male gender (p<0.025), advanced tumour T stage (p<0.005) and non-adherence to guidelines (p<0.003) were significantly associated with poorer 5y.s., whilst scalp location (p<0.004), advanced tumour T stage (p<0.030) and non-adherence to guidelines (p<0.010) were significantly associated with greater LR. On multivariate analysis, only scalp location (p<0.001; p<0.001) and advanced tumour T stage (p<0.020; p<0.014) remained significant predictors of 5y.s. and LR. We conclude it is often impossible to perform excision margins as recommended in published guidelines for cutaneous melanoma in the head and neck, given functional and aesthetic constraints. While such margins should be adhered to where possible, adherence is not the major factor in long-term recurrence and survival (level of evidence: IV).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

Robertson

Senior

et al. 2011

Eur J Plast Surg

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“…Variation in cancer management related to these factors has been studied in many malignancies including breast cancer, prostate cancer, colon cancer and pancreatic cancer [Blackman and Masi, 2006;Olopade et al 2006;Polite et al 2006;Chen et al 2008;Halpern et al 2008]. Prior studies in melanoma demonstrated that hospital type was one of the factors influencing compliance with National Comprehensive Cancer Network (NCCN) treatment guidelines [Erickson et al 2008;Bilimoria et al 2009]. These studies raise a possibility that the quality of care and possibly outcomes may differ by hospital type.…”

Section: Introductionmentioning

confidence: 99%

Demographic and other characteristics of nodal non-Hodgkin’s lymphoma managed in academic versus non-academic centers

Bhatt

Dhakal

Dahal

et al. 2015

Therapeutic Advances in Hematology

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Background: Cancer therapy and outcomes are known to be affected by various demographic features and hospital types. We aimed to identify the characteristics of non-Hodgkin's lymphoma (NHL) patients associated with receipt of care at academic centers. Method: This is a retrospective study of all patients diagnosed with nodal NHL between 2000 and 2011 in the National Cancer Database (NCDB), who received the diagnosis, and all or part of their initial therapy in the reporting hospital (n = 243,436). Characteristics of patients receiving care in academic versus nonacademic centers were compared using the Chi-square test.Results: Approximately 27% received care in academic centers. Patients receiving care in nonacademic centers, compared with academic centers, were more likely to be ⩾60 years (69% versus 58%, p < .0001), White (89% versus 80%, p < .0001) and have lower educational attainment (>12% without high school diploma: 72% versus 69%, p < .0001) and economic status (household income <$49,000: 66% versus 61%, p < 0.0001). Patients receiving care in nonacademic centers were less likely to travel ⩾25 miles (21% versus 26%, p < 0.0001). White patients, compared with non-Whites, were more likely to be ⩾60 years (70% versus <50%, p < 0.0001), which probably explains less care in academic centers. Conclusions: Patients ⩾60 years and those with poorer educational attainment and economic status were less likely to receive care in academic centers. Care in academic centers required a longer commute. Elderly patients frequently have inferior outcomes and may benefit from clinical trials with novel agents and expertise at academic centers.

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“…Earlier this year, Erickson et al 2 reviewed the charts of 252 clinically node-negative melanoma patients treated at a community teaching hospital and found a significant rate of noncompliance with NCCN guidelines. Excision margins conformed to the guideline standards in 87% of in situ and thin (T1) tumors but only 60% of thicker tumors (T2-4).…”

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confidence: 99%

How Well Are We Taking Care of Melanoma Patients in the USA?

Sondak

2008

Ann Surg Oncol

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Compliance with Melanoma Treatment Guidelines in a Community Teaching Hospital: Time Trends and Other Variables

Cited by 34 publications

References 14 publications

Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

Demographic and other characteristics of nodal non-Hodgkin’s lymphoma managed in academic versus non-academic centers

How Well Are We Taking Care of Melanoma Patients in the USA?

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