Contemporary survivorship care patterns for melanoma patients in Ontario, Canada: variability and opportunity

Purpose — Survivorship includes surveillance for detection of cancer recurrence and addressing treatment-related side effects that may impact quality of life. Currently, melanoma survivorship is provider-driven, and little is known about survivorship care provision. We evaluated contemporary patterns of melanoma survivorship care based on physician visits and imaging study completion using population-level data from Ontario, Canada.

Methods — Patients with stage I-III invasive cutaneous melanoma diagnosed from 2007-2019 were retrospectively identified from the Ontario Cancer Registry. Linked administrative databases were used to identify patient and disease characteristics, treatments received, and implemented survivorship care. Descriptive data was analyzed based on the receipt of surgery-only or surgery + adjuvant therapy.

Results — From 2007 to 2019, 30 550 patients were identified; 26 479 underwent surgery-only, and 4 071 surgery + adjuvant therapy. The surgery-only group (median follow up 8.4 years (IQR 5.9-11.6)) was followed mainly by surgeons, dermatologists, and family physicians. The surgery + adjuvant therapy group (median follow up 8.0 years (IQR 5.5-11.6)) was followed by surgeons, dermatologists, family physicians and medical oncologists. Imaging (CT and lymph node US) was used more frequently in the surgery + adjuvant therapy group. From 2017 onwards, patients had more cross-sectional imaging completed.

Conclusion — Variability exists in the surveillance strategies for early stage (I, II) and advanced stage (III) melanoma patients, including clinical visits with various physician groups, and imaging modality and frequency. Such variability may provide a basis for development of future tailored survivorship programmatic development.