Multidisciplinary programs increase patient access to comprehensive melanoma care

Dermatology Nursing, Feb, 2008

Providers for any given melanoma patient may include dermatologists, nurses, medical oncologists, radiation oncologists, primary care doctors, and a variety of surgeons. Providers affiliated with multidisciplinary melanoma programs seem better positioned to facilitate patient access to comprehensive melanoma care than providers who do not have such affiliations, concludes a new study.

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Researchers found, for example, that solo practitioners were less likely to perform lymph node biopsy and excision and were less likely to have access to clinical trials than other providers. However, coordination of care varied, noted Karyn B. Stitzenberg, MD, MPH, and University of North Carolina co-investigators.

The researchers surveyed North Carolina dermatologists and surgeons. Of the survey respondents, dermatologists were significantly less likely to be affiliated with a hospital-based cancer center or community clinical oncology program than surgeons (14% vs. 57% and 4% vs. 16%). Dermatologists varied from seeing 0 to 150 patients with melanoma per year (median of 12), and surgeons saw from 0 to 1,200 patients per year. High-volume dermatologists and surgeons saw 20 or more patients with melanoma per year.

Although 75% of dermatologists said they or a partner performed the definitive primary tumor excision, 48% frequently referred patients to surgeons, depending on depth and location of the tumor. Seventy percent of surgeons performed lymphatic mapping and sentinel lymphadenectomy (LM/SL) and 32% referred patients to other surgeons for the procedure.

Dermatologists ranged in their referral of patients with thick tumors for nodal staging, with 86% referring 90% to 100% of these patients and 1% referring less than 10% of these patients. Dermatologists and surgeons usually referred patients to a medical oncologist for interferon alpha 2 b, if necessary. Most providers had access to consultants within 1 hour of their own practice for LM/SL and for medical oncology services.

The study was supported by the Agency for Healthcare Research and Quality (HS00032). For more information, see Stitzenberg, K.B., et al. (2007). Influence of provider and practice characteristics on melanoma care. American Journal of Surgery, 193, 206-212.