Effective surveillance strategies for melanoma patients

黑色素瘤患者的有效监测策略

• 批准号: 7738904
• 负责人: Janice N Cormier
• 金额: $ 31.91万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-07 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7738904
• 关键词: Adoption; Cancer Survivor; Caring; Cessation of life; Characteristics; Clinical; Clinical Trials; Communities; Data; Data Quality; Data Reporting; Development; Diagnosis; Diagnostic Imaging; Diagnostic tests; Disease; Distant Metastasis; Early Diagnosis; Effectiveness; Excision; Goals; Guidelines; Health Technology; Healthcare; Incidence; Individual; Life; Literature; Measures; Medical Surveillance; Medicare; Meta-Analysis; Methodology; Methods; Modeling; Natural History; Nodal; Operative Surgical Procedures; Outcome; Pathologic; Patient Care; Patients; Pattern; Persons; Population; Positron-Emission Tomography; Practice Guidelines; Primary Neoplasm; Probability; Protocols documentation; Proxy; Publishing; Quality-Adjusted Life Years; Recurrence; Research; Resources; Review Literature; Risk; Science; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Simulate; Source; Staging; Staging System; Survivors; Techniques; Testing; Time; Ultrasonography; Uncertainty; base; cancer referral center; clinical decision-making; cohort; cost; cost effectiveness; disease natural history; evidence base; evidence based guidelines; experience; follow-up; imaging modality; improved; innovation; life time cost; markov model; melanoma; population based; research clinical testing; surveillance strategy; systematic review; tool; tumor

DESCRIPTION (provided by applicant): Evidence-based surveillance strategies for melanoma survivors do not exist. Given the increasing incidence of melanoma and the rapid advances in health care technology, the costs of caring for such persons are rising. More than 90% of patients with melanoma are diagnosed before the development of distant metastasis and are potentially curable. However, up to 50% of all melanoma patients may experience tumor recurrences. The early detection of recurrent melanoma, particularly locoregional disease, at a time when it is amenable to surgical resection is important to improve patient outcome. Decision-analytic models which can assimilate data from a number of sources provide an innovative approach to examining outcomes in a setting where clinical trials are difficult to perform. We propose to use a decision-analytic Markov model created to simulate the stage-specific natural history of contemporary patients with melanoma. By applying techniques of Bayesian meta-analysis we will assimilate patient-level data from the literature to determine the sensitivity of various diagnostic imaging modalities. Various surveillance strategies, including those proposed in current protocols, (e.g., clinical evaluation, nodal ultrasonography, computed and positron emission tomography) and follow-up intervals (3 months to 2 years) will be evaluated and compared in patients with stages I, II, and III melanoma. Specific effectiveness outcomes will include: the number and type of recurrences detected, number of lives saved, and quality-adjusted life years. In addition, the total lifetime costs per surveillance strategy, incremental cost-effectiveness, and net benefit will be defined for each stage-specific strategy. To evaluate model and parameter uncertainty, a probabilistic sensitivity analysis will be performed. SEER data and costs from Medicare will be used to calibrate the natural history model and to examine the outcomes of various surveillance strategies in the population. Collectively, the outcomes from this proposal will provide evidence-based guidelines for surveillance, which in turn will promote the cost-effective use of health care resources.

描述（由申请人提供）：不存在针对黑色素瘤幸存者的基于证据的监视策略。鉴于黑色素瘤发生率的增加和医疗保健技术的快速进步，照顾这些人的成本正在上升。在遥远转移发展之前，诊断出超过90％的黑色素瘤患者，并可能治愈。但是，所有黑色素瘤患者中有多达50％可能会经历肿瘤复发。在适应手术切除的时候，早期发现复发性黑色素瘤，尤其是局部疾病，对于改善患者预后很重要。可以从许多来源吸收数据的决策分析模型为检查结果提供了一种创新的方法，以检查临床试验难以执行的环境。我们建议使用创建的决策分析模型来模拟当代黑色素瘤患者的特定阶段自然史。通过应用贝叶斯荟萃分析的技术，我们将吸收文献中的患者级数据，以确定各种诊断成像方式的敏感性。各种监视策略，包括当前方案中提出的策略（例如临床评估，节点超声检查，计算和正电子发射断层扫描）和随访间隔（3个月至2年），并在I阶段I，II，II，II和III III瘤的患者中进行评估和比较。具体的有效性结果将包括：检测到的复发的数量和类型，挽救的生命数量以及质量调整后的生活年。此外，将针对每个阶段的特定策略定义每个监视策略，增量成本效益和净收益的总终身成本。为了评估模型和参数不确定性，将进行概率灵敏度分析。 SEER数据和Medicare的成本将用于校准自然历史模型，并检查人群中各种监视策略的结果。总的来说，该提案的结果将为监视提供基于证据的指南，这反过来将促进对医疗保健资源的成本效益。

项目成果

Conditional survival estimates improve over time for patients with advanced melanoma: results from a population-based analysis.

• DOI: 10.1002/cncr.24966
• 发表时间: 2010-05-01
• 期刊: CANCER
• 影响因子: 6.2
• 作者: Xing, Yan;Chang, George J.;Hu, Chung-Yuan;Askew, Robert L.;Ross, Merrick I.;Gershenwald, Jeffrey E.;Lee, Jeffrey E.;Mansfield, Paul F.;Lucci, Anthony;Cormier, Janice N.
• 通讯作者: Cormier, Janice N.