Journey of the Patient With Melanoma: Understanding Resource Use and Bridging the Gap Between Dermatologist, Surgeon, and Oncologist in Different Health Care Systems

Abstract

PURPOSE New scientific evidence has led to modifications in the clinical practice of handling melanoma. In health care systems, there is currently a wide variety of clinical procedures to treat cancer, and the various routes have different effects on the survival of patients with cancer. Thus, this article aimed to evaluate the journey of patients with melanoma in the public and private health care systems in Brazil from the viewpoint of different medical professionals involved in the diagnosis and treatment of the disease. The study also considers the resources used for the complete delivery cycle of health care at different stages of the evolution of melanoma. METHODS We conducted a behavioral study by applying a questionnaire to a group of medical professionals. A nonprobabilistic sampling method for convenience was used, justified by the heterogeneous national incidence and the limited availability of medical professionals who diagnose and treat melanoma. RESULTS The questionnaire was answered by 138 doctors, including doctors from the Brazilian states with the highest concentration of medical specialists and regions with a higher melanoma incidence. The results of this study have the potential to enrich our understanding of the reality of Brazilian health care systems and, at the same time, allow us to discuss the multiple ways in which professionals from diverse specialist fields understand and explain decision making in health care. CONCLUSION Health care decision making is complex and, among other factors, depends on the diversity of available health resources and the knowledge of which treatments provide the greatest benefit to patients and greatest value to the system as a whole. This work can inform debates and reflection that are applicable not only in Brazil, but also in various other countries with similar realities.

Factors influencing treatment decision‐making for cancer patients in low‐ and middle‐income countries: A scoping review

“…The decision‐making process in this circumstance was also reported in articles from the physician or healthcare system perspective 47,50,55,58,74,77,79,80,89,93,94,98,102,104,109,113 . Financial barriers were also described to impact decision‐making 50,74,77,89,94,106,109 .…”

“…One study described gender bias in the treatment of osteosarcoma and the neglect of female patients 66 . Other factors included treatment toxicities, 46,48,49,51,53,54,56,57,63,66,70,74,79,80,85,87,89,93,98,100–103 specific disease features, 50,51,56,57,59,64,76,77,80,96,98,104 the results of diagnostic workup, 65,75,77,80 and access to cancer‐directed treatment and supportive care resources and personnel 46,49–51,54–56,61,62,65,66,68,70,73–75,77,78,80–84,86–88,94,98,102–105 …”

“…Physicians report variable access to resources and information to help guide decision‐making, including treatment guidelines or protocols, 68,77,80 multidisciplinary tumor boards 65,68,72,77,78,80 or knowledgeable colleagues 68,74 . A country's economic status may further limit resource allocation, directly and indirectly impacting treatment decision‐making 50,77,79,80,98,105,113 …”

Multidisciplinary Care ofBRAF-MutantStageIIIMelanoma: A Physicians Perspective Review

“…These measures have the potential to improve outcomes, preserve quality of life, and increase overall patient satisfaction [32,33]. Newer MDT approaches focus on interdisciplinary physician and patient engagement throughout the course of disease to enhance communication, share decision-making, improve comorbidity and AE management, and increase touchpoints to individually monitor patients [36].…”

“…Patient care has increasingly relied on MDTs comprising various physician specialists (e.g., dermatologists, surgeons, pathologists, oncologists, and/or radiologists) who discuss patient cases at regularly occurring panels or tumor boards [28][29][30][31][32][33][34][35][36][37][38][39]. MDTs can optimize patient care in multiple ways, including increasing accuracy of diagnosis, personalizing treatment selection, and being proactive in adverse event (AE) management [32].…”