PMID- 29228470
OWN - NLM
STAT- MEDLINE
DCOM- 20180409
LR  - 20180409
IS  - 1096-9098 (Electronic)
IS  - 0022-4790 (Linking)
VI  - 117
IP  - 4
DP  - 2018 Mar
TI  - Melanoma patterns of care in Ontario: A call for a strategic alignment of
      multidisciplinary care.
PG  - 597-617
LID - 10.1002/jso.24936 [doi]
AB  - 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.
CI  - (c) 2017 Wiley Periodicals, Inc.
FAU - Look Hong, Nicole J
AU  - Look Hong NJ
AUID- ORCID: http://orcid.org/0000-0002-2106-341X
AD  - Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto,
      Ontorio, Canada.
FAU - Cheng, Stephanie Y
AU  - Cheng SY
AD  - Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada.
FAU - Baxter, Nancy N
AU  - Baxter NN
AD  - Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada.
AD  - St. Michael's Hospital, Department of Surgery and Keenan Research Centre,
      Toronto, Ontorio, Canada.
FAU - Wright, Frances C
AU  - Wright FC
AD  - Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto,
      Ontorio, Canada.
LA  - eng
PT  - Journal Article
DEP - 20171211
PL  - United States
TA  - J Surg Oncol
JT  - Journal of surgical oncology
JID - 0222643
RN  - Melanoma, Cutaneous Malignant
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Combined Modality Therapy
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Melanoma/*diagnosis/epidemiology/surgery/*therapy
MH  - Middle Aged
MH  - Ontario/epidemiology
MH  - Patient Care Team
MH  - Practice Patterns, Physicians'/statistics & numerical data
MH  - Registries
MH  - Retrospective Studies
MH  - Skin Neoplasms/*diagnosis/epidemiology/surgery/*therapy
MH  - Young Adult
OTO - NOTNLM
OT  - dermatology
OT  - surgery
OT  - variation
EDAT- 2017/12/12 06:00
MHDA- 2018/04/10 06:00
CRDT- 2017/12/12 06:00
PHST- 2017/07/01 00:00 [received]
PHST- 2017/11/02 00:00 [accepted]
PHST- 2017/12/12 06:00 [pubmed]
PHST- 2018/04/10 06:00 [medline]
PHST- 2017/12/12 06:00 [entrez]
AID - 10.1002/jso.24936 [doi]
PST - ppublish
SO  - J Surg Oncol. 2018 Mar;117(4):597-617. doi: 10.1002/jso.24936. Epub 2017 Dec 11.