Background: The New Zealand Ministry of Health “Faster Cancer Treatment” programme aims for timely care for patients with cancer, including melanoma. Melanoma care guidelines detail investigation and treatment timeliness standards.1 This audit assesses compliance with these and evaluates contributing factors.
Methods: Patients admitted to Waikato Hospital for melanoma surgery during the year ending February 2016 were retrospectively identified. Time intervals between care events were calculated, and demographic, lesion, surgical and histopathological characteristics examined.
Results: See Table for compliance rates. The distribution of age, site, horizontal and deep specimen margins, criteria for consideration of sentinel node biopsy, Breslow thickness, Clark’s level of invasion and satellite and in-transit lesion characteristics across patients managed within and outside guideline times was such that no characteristic was likely to have influenced management.
Conclusions: Compliance with guidelines was low. There are recommendation inconsistences within and between suspicious-lesion and confirmed-diagnosis referral pathways. This suggests the investigation and treatment events selected and intervals mandated by the guidelines could usefully be reconsidered. This may facilitate greater compliance, as could attention to current logistical constraints in the department.
|
Interval
|
Standards1 Applied |
Recommended Time Calculated from Standards1 [days] |
Observed Time [median(range): days] |
Compliance [%] |
|
Referred with skin lesion suspicious for melanoma: |
||||
|
Referral to first treatment |
2.1 |
62 |
114(63-320) |
0 |
|
Referral to first treatment |
2.2, 2.3, 2.4, 4.4 |
73 |
114(63-320) |
9.3 |
|
Referral to diagnostic skin biopsy |
2.2, 2.3 |
28 |
51(0-287) |
17.6 |
|
Histology report to first treatment |
2.4 |
31 |
43(8-223) |
21.7 |
|
Diagnostic skin biopsy to first treatment |
2.4, 4.4 |
45 |
61(27-238) |
21.7 |
|
Referred with biopsy-confirmed melanoma: |
||||
|
Referral to first treatment |
2.2, 2.4 |
45 |
54(16-282) |
42.2 |
|
Diagnostic skin biopsy to first treatment |
2.2, 2.4, 4.4 |
59 |
63(5-241) |
42.9 |