(Press-News.org) In a study that included more than 32,000 cases of melanoma among Medicare patients, approximately 1 in 5 experienced a delay of surgery that was longer than 1.5 months, and about 8 percent of patients waited longer than 3 months for surgery, according to an article published online by JAMA Dermatology.
Melanoma is a leading cause of new cancer diagnoses in the United States, accounting for most skin cancer¬related deaths. Surgical excision is the primary therapy for melanoma. Surgical delay may result in the potential for increased illness and death from other malignant neoplasms, and may cause anxiety and stress. No guidelines exist regarding timely surgery for melanoma, although informal recommendations suggest that melanomas should be excised within 4 to 6 weeks of diagnostic biopsy. Population-based studies characterizing the delay of surgery for melanoma in the United States have not been performed, according to background information in the article.
Jason P. Lott, M.D., M.H.S., M.S.H.P., of the Yale University School of Medicine, New Haven, Conn., and colleagues examined surgical delay among Medicare beneficiaries diagnosed as having melanoma between January 2000 and December 2009, using the Surveillance, Epidemiology, and End Results-Medicare database. The researchers included all patients undergoing surgical excision of melanoma diagnosed by means of results of skin biopsy.
The study included 32,501 cases of melanoma; patients were more likely to be 75 years or older (61 percent) and to have no prior melanoma (94 percent). Of the total study population, 78 percent of melanoma cases underwent excision within 1.5 months, 22.3 percent underwent excision after 1.5 months, and 8.1 percent underwent excision after 3 months. Surgical delay longer than 1.5 months was significantly increased among patients 85 years or older compared with those younger than 65 years, those with a prior melanoma, and those with more co-existing medical conditions.
Melanomas that underwent biopsy and excision by dermatologists had the lowest likelihood of delay; the highest likelihood of delay occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician.
"Our results show that a delay of surgery for melanoma may be relatively common among Medicare beneficiaries. Although no gold standard exists to judge appropriate vs inappropriate surgical delay, minimization of delay is an important patient¬centered objective of high-quality dermatologic care, especially given the potential harms of psychological stress associated with untreated malignant neoplasms. Our study highlights opportunities for quality improvement in dermatologic care and suggests that efforts to minimize the delay of surgery for melanoma might focus on increased access to dermatologic expertise and enhanced coordination of care among different specialists," the authors write.
(JAMA Dermatology. Published online April 8, 2015. doi:10.1001/jamadermatol.2015.119. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Timely Surgical Follow-up for Melanoma Among Medicare Beneficiaries
"Further research aimed at substantiating the consequences of surgical delay in the setting of melanoma may also improve a movement toward a standard of care and possible guidelines among all medical subspecialties," write Elaine Lin, B.S., a medical student at the School of Medicine, Loma Linda University, Loma Linda, Calif., and Jerry D. Brewer, M.D., of the Mayo Clinic, Rochester, Minn., in an accompanying commentary.
"In addition, medical training should emphasize heightened communication skills and the importance of multidisciplinary teamwork as an essential element to establishing solid surgical follow-up. Another interesting, technologically savvy option could include a 'Time to Treat' program integrated into the electronic medical records system to aid in prompt intervention."
(JAMA Dermatology. Published online April 8, 2015. doi:10.1001/jamadermatol.2015.0559. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Conflict of Interest Disclosures - None reported.
INFORMATION:
Media Advisory: To contact corresponding author Jason P. Lott, M.D., M.H.S., M.S.H.P., call Ziba Kashef at 203-436-9317 or email ziba.kashef@yale.edu. To contact commentary co-author Jerry D. Brewer, M.D., call Joe Dangor at 507-284-5005 or email newsbureau@mayo.edu.
To place an electronic embedded link to this study in your story Links will be live at the embargo time: http://archderm.jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2015.119 and http://archderm.jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2015.0559
African-American women who live in rural areas have lower rates of major depressive disorder (MDD) and mood disorder compared with their urban counterparts, while rural non-Hispanic white women have higher rates for both than their urban counterparts, according to an article published online by JAMA Psychiatry.
MDD is a common and debilitating mental illness and the prevalence of depression among both African Americans and rural residents is understudied, according to background in the study.
Addie Weaver, Ph.D., of the University of Michigan, Ann Arbor, and coauthors ...
A magnetic resonance imaging (MRI)-based screening program for individuals at high risk of pancreatic cancer identified pancreatic lesions in 16 of 40 (40 percent) of patients, of whom 5 five underwent surgery, according to a report published online by JAMA Surgery.
Pancreatic cancer is a leading cause of cancer death and can be considered a global lethal disease because incidence and mortality rates are nearly identical. Although treatment has improved, the surgery rate in patients with ductal adenocarcinoma is around 30 percent and the five-year survival rate is less ...
New Haven, Conn. -- One in five Medicare patients with melanoma experience delays in getting surgery, a Yale study found.
The research was published April 8 in JAMA Dermatology.
Melanoma, a type of skin cancer, is a leading cause of new cancer diagnoses in the United States. A delay between diagnosis and surgery to remove melanomas may cause patients psychological harm and affect health-care quality. Using the national Surveillance, Epidemiology, and End Result-Medicare database, the Yale team conducted the first population-based analysis of delay of surgery among Medicare ...
DENVER - The Women's Health Initiative Studies, a large prospective study of lung cancer, found no strong associations between lung cancer risk and a wide range of reproductive history variables and only revealed weak support for a role of hormone use in the incidence of lung cancer.
In the United States 40% of the 160,000 deaths from lung cancer are women. In men 90% of lung cancer deaths are associated with tobacco usage; however in women this number is around 75-80%. Female never-smokers are more likely to develop lung cancer than male never-smokers and the histological ...
The discovery of antibiotics produced by soil fungi and bacteria gave the world life-saving medicine. But new antimicrobials from this resource have become scarce as the threat of drug resistance grows. Now, scientists have started mining lakes and rivers for potential pathogen-fighters, and they've found one from Lake Michigan that is effective against drug-resistant tuberculosis. Their report on the new compound appears in the journal ACS Infectious Diseases.
Brian T. Murphy and colleagues point out that the emergence of drug-resistant strains of Mycobacterium tuberculosis ...
COLLEGE PARK, Md. - Companies work fairly hard to place one woman -- but only one -- in a top management position, according to research by Cristian Desz?, an associate professor at the Robert H. Smith School of Business, and two co-authors. The article found evidence of a "quota" effect: Once a company had appointed one woman to a top-tier job, the chances of a second woman landing an elite position at the same firm drop substantially -- by about 50 percent, in fact.
The study's design did not allow a conclusion about whether the quota was the result of conscious discrimination ...
Now that most consumers download and stream their movies and music, more and more CDs and DVDs will end up in landfills or be recycled. But soon these discarded discs could take on a different role: curbing the release of greenhouse gases. In the journal ACS Sustainable Chemistry & Engineering, scientists report a way to turn the discs into a material that can capture carbon dioxide, a key greenhouse gas, and other compounds.
Mietek Jaroniec and colleagues from Poland and the U.S. note that manufacturers typically use natural sources, such as coal and wood, to make activated ...
Figuring out why the French have low cardiovascular disease rates despite a diet high in saturated fats has spurred research and many theories to account for this phenomenon known as the "French paradox." Most explanations focus on wine and lifestyle, but a key role could belong to another French staple: cheese. The evidence, say scientists in ACS' Journal of Agricultural and Food Chemistry, is in cheese metabolism.
Hanne Bertram and colleagues note that recent research on some dairy products' positive effects on health has cast doubt on the once-firm rule that saturated ...
Researchers of the Nanobiology Unit from the UAB Institute of Biotechnology and Biomedicine, led by Antonio Villaverde, managed to create artificial viruses, protein complexes with the ability of self-assembling and forming nanoparticles which are capable of surrounding DNA fragments, penetrating the cells and reaching the nucleus in a very efficient manner, where they then release the therapeutic DNA fragments. The achievement represents an alternative with no biological risk to the use of viruses in gene therapy.
Gene therapy, which is the insertion of genes into the ...
COLUMBUS, Ohio - When children are unmotivated at school, new research suggests their genes may be part of the equation.
A study of more than 13,000 twins from six countries found that 40 to 50 percent of the differences in children's motivation to learn could be explained by their genetic inheritance from their parents.
The results surprised study co-author Stephen Petrill, who thought before the study that the twins' shared environment - such as the family and teachers that they had in common - would be a larger factor than genetics.
Instead, genetics and nonshared ...
