3245.0: Monday, November 13, 2000 - 9:30 PM

Abstract #6325

Surveillance of melanoma patients after potentially curative treatment

Frank E. Johnson, MD, Barry S. Handler, MD, David Y. Johnson, and Kay Goshima, MD. Department of Surgery, St. Louis University & Department of Veterans Affairs Medical Center, 3635 Vista at Grand Blvd, St. Louis, MO 63110-0250, (314) 577-8312, frank.johnson@med.va.gov

Objectives: Recognize the current practices of surgeons managing patients after potentially curative surgery for cutaneous melanoma and identify factors which account for variation in self-reported follow-up practice patterns. Background: Overuse, underuse, and misuse of resources are common in medical care. Efforts to minimize inappropriate use of resources are widely advocated. We targeted the use of resources by surgeons caring for melanoma patients and measured the intensity of post-treatment follow-up via a survey of the membership of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Design: Standardized patient vignettes and a detailed questionnaire based on the vignettes were mailed to 3,032 ASPRS members chosen randomly from the 4,320 total members. The effect of TNM stage and surgeon age on the strategies chosen were analyzed by repeated-measures ANOVA. Results: 1,142 questionnaires were returned; 395 were evaluable. Non-evaluability was usually due to lack of melanoma patients receiving follow-up in the surgeonsí practices. Current surveillance practices rely heavily on office visit, chest x-ray, CBC and liver function tests; intensity varies substantially among surgeons. Imaging tests such as CT, MRI and PET scan are rarely used. TNM stage and surgeon age have little effect on intensity of follow-up. Conclusions: ASPRS members generally utilize simple, relatively inexpensive testing modalities to follow melanoma patients after surgery. There is considerable variation in the surveillance intensity recommended by these experts, however. This probably reflects the absence of high-quality evidence supporting any particular follow-up plan. Survey data permit the rational design of a randomized clinical trial of two alternative follow-up strategies.

Learning Objectives: At the conclusion of this session, the participant (learner) in this session will be able to discuss the current practices of surgeons managing patients after potentially curative surgery for cutaneous melanoma and identify factors which account for variation in self-reported follow-up practice patterns

Keywords: Cancer, Disease Management

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA