Access to Care

Multidisciplinary programs increase patient access to comprehensive melanoma care

Providers for any given melanoma patient may include dermatologists, 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.

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, note Karyn B. Stitzenberg, M.D., M.P.H., and University of North Carolina coinvestigators.

They 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 percent and 4 vs. 16 percent). Dermatologists varied from seeing 0 to 150 melanoma patients per year (median of 12), and surgeons saw from 0 to 1200 patients per year. High-volume dermatologists and surgeons saw 20 or more melanoma patients per year.

Although 75 percent of dermatologists said they or a partner performed the definitive primary tumor excision, 48 percent 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 percent referred patients to other surgeons for the procedure.

Dermatologists ranged in their referral of patients with thick tumors for nodal staging, with 86 percent referring 90 to 100 percent of these patients and 1 percent referring less than 10 percent 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).

See "Influence of provider and practice characteristics on melanoma care," by Dr. Stitzenberg, Nancy E. Thomas, M.D., Ph.D., and David W. Ollila, M.D., in the American Journal of Surgery 193, pp. 206-212, 2007.

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