NEW YORK (Reuters Health) – The number of monitoring visits for patients treated for localized primary melanoma can be reduced considerably, without having much effect on spotting any recurrent or new melanomas, according to an Australian study reported in the Journal of Clinical Oncology online November 7.
“Current guidelines on the frequency of follow-up after treatment for localized melanoma probably provide rather small gains (in terms of earlier diagnosis of recurrence or new primary) at the expense of a large number of additional clinic visits,” the authors conclude. “A less frequent monitoring schedule … may decrease unnecessary visits substantially, with only a small consequent delay in the detection of recurrent or new primary melanoma.”
Dr. Robin M. Turner, at the School of Public Health of the University of Sydney, and colleagues base their conclusions on an analysis of the time course of recurrence and new primaries in a cohort of 3081 consecutive patients first diagnosed with stage I or II melanoma over a 25-year period.
Cumulative 10-year rates of recurrent or new melanomas in the cohort were 229 and 61 per 1000 patients, respectively, the team found. They then modeled the delay in diagnosis of recurrent or new melanomas based on two monitoring schedules.
The first schedule, recommended in 2008 guidelines, involved follow-up every 6 months for 5 years and then annually for 5 years for patients with stages IA and IB disease, or every 3 months for 5 years and then annually for 5 years for patients with stages IIA, IIB, and IIC.
The second, reduced-frequency schedule, suggested by previous studies, involved follow-up annually for 10 years for stage I melanoma; every 6 months for 2 years and then annually for 8 years for patients with stage IIA disease; or every 4 months for 2 years, every 6 months during year 3, and then annually for 5 years for those with stages IIB and IIC melanoma.
Compared to the standard follow-up protocol, the second schedule resulted in a delay of 2 months or more in the diagnosis of recurrence in an extra 44.9 patients per 1000 patients, the investigators report. The corresponding number with a delayed diagnosis of a new primary was 9.6 per 1000 patients.
“The differences between the two strategies were not large, particularly when we assumed patient self-detection at previously reported rates of 75% for recurrence and 50% for new primary,” Dr. Turner and colleagues comment.
Furthermore, they point out, the revised monitoring schedule resulted in about 7000 fewer visits for every 1000 newly diagnosed patients, assuming no loss to follow-up.
“Not only would these fewer monitoring visits reduce the burden on patients in terms of time and expense in attendance and possible unnecessary anxiety, but they would also represent substantial savings for the health care system,” the authors conclude.