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Melanoma patterns of care in Ontario: A call for a strategic alignment of multidisciplinary care
Author(s) -
Look Hong Nicole J.,
Cheng Stephanie Y.,
Baxter Nancy N.,
Wright Frances C.
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24936
Subject(s) - medicine , multidisciplinary approach , medline , intensive care medicine , medical emergency , family medicine , nursing , social science , sociology , political science , law
Background and Objectives Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population‐level data. Methods Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003‐2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis. Melanoma treatment was categorized as inadequate or adequate based on multidisciplinary clinical algorithms. Multivariable logistic regression was used to model factors associated with treatment adequacy. Results From 2003 to 2012, 22 918 patients with invasive melanoma were identified with annual age/sex standardized incidence rates of 11.7‐14.3/100 000 for females and 13.4‐15.9/100 000 for males. Melanoma occurred at median age of 62 and primarily on extremities (43.9%). Within 1 year after diagnosis, 86.7% of patients received surgery as primary therapy. A total of 2312 (10.6%) patients received inadequate or no treatment after diagnosis. Receiving adequate treatment was associated with consultation with dermatology (OR 1.92, CI 1.71‐2.14), plastic surgery (OR 4.80, CI 4.32‐5.34), or general surgery (OR 2.15, CI 1.94‐2.38). Conclusions Significant variation exists in melanoma management and nearly one in nine patients is inadequately treated. Referral to sub‐specialized providers is critical for ensuring appropriate care.