Livingstone E, Krajewski C, Eigentler T K, Windemuth-Kieselbach C, Benson S, Elsenbruch S, Hauschild A, Rompel R, Meiss F, Mauerer A, Kähler K C, Dippel E, Möllenhoff K, Kilian K, Mohr P, Utikal J, Schadendorf D
Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany.
Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
Eur J Cancer. 2015 Mar;51(5):653-67. doi: 10.1016/j.ejca.2015.01.007. Epub 2015 Jan 28.
Patient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance is costly and guideline recommendations vary substantially.
In this German nationwide study, information on surveillance and treatment of patients diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was prospectively collected over four years. Additionally, patient self-report questionnaires were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic information and use of disease specific health information sources at year 4 after primary diagnosis.
Complete data was available for 668 patients from 67 centres, of whom 96.0% were in regular melanoma surveillance. In year 3-4 of surveillance, only 55.6% of locoregionary metastases were detected during surveillance visits. Only 33.3% were self-detected by the patient even though 69.4% were documented as being clinically visible or palpable. Costs of 4year surveillance of 550 patients without tumour recurrence (stage I-IIC and MMis) accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately 60% in year 3-4 of surveillance. Multivariate regression analysis showed that certain patient/tumour characteristics and regional differences were significantly associated with guideline deviations. The percentage of patients who exceeded published cut-off scores indicating clinically relevant symptoms of anxiety and depression were significantly increased. Patients frequently reported lack of psychosocial support and education but ascribed great importance to these.
We recommend further reduction of melanoma follow-up in low-risk melanoma patients and improvement of psycho-social support and patient education for all melanoma patients.
需要长期进行黑色素瘤监测的患者数量持续上升。监测成本高昂，且指南建议差异很大。
在这项德国全国性研究中，前瞻性收集了2008年4月至6月期间诊断为黑色素瘤和原位黑色素瘤（MMis）的患者的监测和治疗信息，为期四年。此外，还对患者自我报告问卷进行了评估，以评估初次诊断后第4年的焦虑、抑郁、健康相关生活质量、社会人口统计学信息以及疾病特定健康信息来源的使用情况。
来自67个中心的668例患者有完整数据，其中96.0%处于黑色素瘤常规监测中。在监测的第3 - 4年，仅55.6%的局部区域转移在监测访视期间被发现。即使69.4%的转移灶被记录为临床上可见或可触及，但只有33.3%是患者自我发现的。550例无肿瘤复发患者（I - IIC期和MMis）的4年监测成本累计达228,155.75欧元。在监测的第3 - 4年，随访频率、淋巴结超声、S100血清水平检测和诊断成像建议的指南依从性约为60%。多变量回归分析表明，某些患者/肿瘤特征和区域差异与指南偏差显著相关。超过已公布的表明焦虑和抑郁临床相关症状临界值的患者百分比显著增加。患者经常报告缺乏心理社会支持和教育，但认为这些非常重要。
我们建议进一步减少低风险黑色素瘤患者的黑色素瘤随访，并改善所有黑色素瘤患者的心理社会支持和患者教育。
