Burden of illness associated with metastatic melanoma - An audit of 100 consecutive referral center cases

BACKGROUND, Although long-term survival in patients with metastatic melanom a (MM) is infrequent, response to a variety of cytotoxic and immunotherapie s occurs and survival varies based on the site of metastases. Because diffe rent patterns of care of MM are likely to vary substantially in their inten sity and resource use, the authors audited care at a regional referral cent er. METHODS. The records of 100 consecutive new patients with MM who presented at the University of Pittsburgh Cancer Institute (UPCI) after January 1997 were audited. Demographics, disease sites, and treatment prior to presentat ion at UPCI as well as the diagnostic and therapeutic methods undertaken at UPCI were tracked monthly with regard to inpatient and outpatient activity . RESULTS. The median age of the patient cohort was 51 years was a median 2.2 years after the time of initial diagnosis. Eighty-two percent of the patie nts had died and only 8% had been lost to long-term follow-up. Eighty-seven percent of patients had been referred to UPCI and 28% had received some tr eatment prior to presenting at UPCI. The median survival was 9.0 months. Th e lung was the most common symptomatic site and 38% of patients developed c entral nervous system (CNS) metastases. Eighty-four percent of patients ini tially were treated on a research protocol 30% of whom were part of a Phase III study. Twenty-nine percent of the patients were never hospitalized. Th e most common reason for hospitalization was elective treatment with high-d ose interleukin-2. Lifetime hospital days averaged only 7.3 days. Therapeut ic actions (if ever given) by category type were surgery in 23% of patients , radiation therapy in 44%, immunotherapy in 75%, and chemotherapy in 51%. Using assigned values for the identified resources used, the approximate co st per patient averaged $59,400. CONCLUSIONS. The current audit of MM patients demonstrated that lung and CN S metastases dominate a broad variety of complications, that clinical trial participation was the norm, that hospitalizations occurred relatively infr equently, and that the direct health care costs of current treatment patter ns are among the highest for all malignancies. Medical auditing of contempo rary American cancer care provides meaningful insights into its patterns of care. (C) 2001 American Cancer Society.