Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners

Rat, Cédric; Quéreux, G.; Grimault, Charlotte; Fernandez, Jérémy; Poiraud, Mickael; Gaultier, Aurélie; Chaslerie, Anicet; Pivette, Jacques; Khammari, Amir; Dréno, Brigitte; Nguyen, Jean–Michel

doi:10.1080/02813432.2016.1207149

Cited by 5 publications

(6 citation statements)

References 36 publications

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“… 6 In a previous study, we demonstrated that men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening. 35 These new study findings suggest that physicians might be more strongly involved in these populations. However, skin cancer issues would not at all be part of the reasons for medical encounters reported by these patients.…”

Section: Discussionmentioning

confidence: 84%

General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care

Rat

Houd²,

Gaultier

et al. 2017

BMJ Open

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ObjectiveThe aim of this study was to assess general practitioner (GP) management practices related to skin cancer prevention and screening during standard medical encounters.SettingData on medical encounters addressing skin cancer issues were obtained from a French database containing information from 17 019 standard primary care consultations.ParticipantsData were collected between December 2011 and April 2012 by 54 trainees who reported the regular practice of 128 GPs using the International Classification of Primary Care.Outcome measuresReasons for encounters and the following care processes were recorded: counselling, clinical examinations and referral to a specialist. Medical encounters addressing skin cancer issues were compared with medical encounters that addressed other health problems using a multivariate analysis.ResultsOnly 0.7% of medical encounters addressed skin cancer issues. When patients did require management of a skin cancer-related issue, this was more likely initiated by the doctor than the patient (70.7% vs 29.3%; p<0.001). Compared with medical encounters addressing other health problems, encounters that addressed skin cancer problems required more tasks (3.7 vs 2.5; p<0.001) and lasted 1 min and 20 s longer (p=0.003). GPs were less involved in clinical examinations (67.5% vs 97.1%; p<0.001), both complete (7.3% vs 22.3%, p<0.001) and partial examinations (60.2% vs 74.9%), and were less involved in counselling (5.7% vs 16.9%; p<0.001). Patients presenting skin cancer issues were referred to a specialist more often than patients consulting for other health problems (39.0% vs 12.1%; p<0.001). GPs performed a biopsy in 6.7% of all skin cancer-related encounters.ConclusionsThis study demonstrates discrepancies between the high prevalence of skin cancer and the low rate of medical encounters addressing these issues in general practice. Our findings should be followed by qualitative interviews to better understand the observed practices in this field.

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Section: Discussionmentioning

confidence: 84%

General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care

Rat

Houd²,

Gaultier

et al. 2017

BMJ Open

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“…A similar association was found for melanoma screening in primary practice in France, where chronic disease was associated with non-participation. 26 A Danish population-based study showed interaction between comorbidity and cancer stage with an increased mortality among patients with advanced melanoma and high comorbidity, 27 underlining the importance of a focus on comorbidity in detection and treatment of melanoma.…”

Section: Discussionmentioning

confidence: 99%

Influence of socioeconomic factors and region of residence on cancer stage of malignant melanoma: a Danish nationwide population-based study

Ibfelt¹,

Steding-Jessen²,

Dalton

et al. 2018

CLEP

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BackgroundSocioeconomic differences in survival after melanoma may be due to late diagnosis of the disadvantaged patients. The aim of the study was to examine the association between educational level, disposable income, cohabitating status and region of residence with stage at diagnosis of melanoma, including adjustment for comorbidity and tumor type.MethodsFrom The Danish Melanoma Database, we identified 10,158 patients diagnosed with their first invasive melanoma during 2008–2014 and obtained information on stage, localization, histology, thickness and ulceration. Sociodemographic information was retrieved from registers of Statistics Denmark and data on comorbidity from the Danish National Patient Registry. We used logistic regression to analyze the associations between sociodemographic factors and cancer stage.ResultsShorter education, lower income, living without partner, older age and being male were associated with increased odds ratios for advanced stage of melanoma at time of diagnosis even after adjustment for comorbidity and tumor type. Residence in the Zealand, Central and Northern region was also associated with advanced cancer stage.ConclusionSocioeconomically disadvantaged patients and patients with residence in three of five health care regions were more often diagnosed with advanced melanoma. Initiatives to increase early detection should be directed at disadvantaged groups, and efforts to improve early diagnosis of nodular melanomas during increased awareness of the Elevated, Firm and Growing nodule rule and “when in doubt, cut it out” should be implemented. Further studies should investigate regional differences in delay, effects of number of specialized doctors per inhabitant as well as differences in referral patterns from primary to secondary health care across health care regions.

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“…Recent reviews have reported that melanoma screening is beneficial with regard to melanoma thickness, promoting screening in high-risk populations. 3–7 In addition, our team has experimented with a targeted screening programme using Self-Assessment of Melanoma Risk Score, 7 8 and the results were encouraging because many lesions were identified at an early stage. 9 10 …”

Section: Introductionmentioning

confidence: 99%

Anxiety, locus of control and sociodemographic factors associated with adherence to an annual clinical skin monitoring: a cross-sectional survey among 1000 high-risk French patients involved in a pilot-targeted screening programme for melanoma

Rat

Hild²,

Gaultier

et al. 2017

BMJ Open

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ObjectiveThe aim of the study was to assess whether adherence to annual clinical skin monitoring is dependent on patient sociodemographic characteristics or personality traits.DesignThe study was a questionnaire survey.Setting and participantsData were collected between February and April 2013 in a sample of 1000 patients at high risk of melanoma who participated in a pilot-targeted screening programme in western France.Outcome measuresSociodemographic data, overall anxiety level (State-Trait Anxiety Inventory questionnaire), locus of control (Multidimensional Health Locus of Control scale) and levels of anxiety specifically associated with screening and melanoma were collected. Actual participation in the skin monitoring examination was reported by 78 general practitioner investigators.Statistical analysisStatistical analysis was performed using R statistical software. Factors associated with non-adherence were identified by multivariate analysis.ResultsOur analysis included 687 responses (526 adherent patients and 161 non-adherent patients). Non-adherence was higher in younger patients and in men (OR=0.63 (0.41–0.99)). Viewing health status as dependent on external persons (OR=0.90, 95% CI 0.83 to 0.97) or determined by chance (OR=0.89, 95% CI 0.80 to 0.98) and overall anxiety (OR=0.98, 95% CI 0.97 to 0.99) were also factors associated with non-adherence. In contrast, there was no link between anxiety specifically associated with the screening performed or melanoma and patient adherence to monitoring. Adherence was higher in married patients (OR=1.68 95% CI 1.08 to 2.60).ConclusionsThe results of this study suggest that sociodemographic and psychological characteristics should be considered when including patients at elevated risk of melanoma in a targeted screening programme.Trial registration numberNCT01610531; Post-results.

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Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners

Cited by 5 publications

References 36 publications

General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care

General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care

Influence of socioeconomic factors and region of residence on cancer stage of malignant melanoma: a Danish nationwide population-based study

Anxiety, locus of control and sociodemographic factors associated with adherence to an annual clinical skin monitoring: a cross-sectional survey among 1000 high-risk French patients involved in a pilot-targeted screening programme for melanoma

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