Compliance with melanoma treatment guidelines in a community teaching hospital: Time trends and other variables

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

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines. Methods: We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports. Results: Documented margins of excision conformed to NCCN guidelines in 87% of Tis-T1 tumors and 60% of T2-T4 tumors. Lymph node staging was performed in 11% of T1a, 64% of T1b, 74% of T2, 63% of T3, and 47% of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95% and 92% of cases versus other practitioners in 38% and 67%, respectively (P < .0001). Documented compliance with margin guidelines improved from 46% to 73% for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74% to 84% (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05). Conclusions: Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.

Original languageEnglish (US)
Pages (from-to)1211-1217
Number of pages7
JournalAnnals of Surgical Oncology
Volume15
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Community Hospital
Teaching Hospitals
Melanoma
Guidelines
Neoplasms
Therapeutics
Lymph Nodes
Quality of Health Care
Upper Extremity
Compliance
Registries
Pathology
Morbidity
Costs and Cost Analysis

Keywords

  • Excision margins
  • Guideline compliance
  • Melanoma
  • Sentinel lymph node biopsy
  • Surgical treatment

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Compliance with melanoma treatment guidelines in a community teaching hospital : Time trends and other variables. / Erickson, Jennifer L.; Velasco, Josè M.; Hieken, Tina J.

In: Annals of Surgical Oncology, Vol. 15, No. 4, 04.2008, p. 1211-1217.

Research output: Contribution to journalArticle

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abstract = "Background: Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines. Methods: We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports. Results: Documented margins of excision conformed to NCCN guidelines in 87{\%} of Tis-T1 tumors and 60{\%} of T2-T4 tumors. Lymph node staging was performed in 11{\%} of T1a, 64{\%} of T1b, 74{\%} of T2, 63{\%} of T3, and 47{\%} of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95{\%} and 92{\%} of cases versus other practitioners in 38{\%} and 67{\%}, respectively (P < .0001). Documented compliance with margin guidelines improved from 46{\%} to 73{\%} for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74{\%} to 84{\%} (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05). Conclusions: Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.",
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N2 - Background: Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines. Methods: We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports. Results: Documented margins of excision conformed to NCCN guidelines in 87% of Tis-T1 tumors and 60% of T2-T4 tumors. Lymph node staging was performed in 11% of T1a, 64% of T1b, 74% of T2, 63% of T3, and 47% of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95% and 92% of cases versus other practitioners in 38% and 67%, respectively (P < .0001). Documented compliance with margin guidelines improved from 46% to 73% for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74% to 84% (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05). Conclusions: Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.

AB - Background: Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines. Methods: We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports. Results: Documented margins of excision conformed to NCCN guidelines in 87% of Tis-T1 tumors and 60% of T2-T4 tumors. Lymph node staging was performed in 11% of T1a, 64% of T1b, 74% of T2, 63% of T3, and 47% of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95% and 92% of cases versus other practitioners in 38% and 67%, respectively (P < .0001). Documented compliance with margin guidelines improved from 46% to 73% for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74% to 84% (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05). Conclusions: Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.

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