Thursday, November 2, 2017

I've repeated it endlessly. If you have melanoma - you need an EXPERT!!!!

I have long ranted about the need for a melanoma expert if you are dealing with melanoma.  And holy crappy wizard balls!  Was I ever right!!! ~

Variance between experts and community practitioners in the use of immune checkpoint inhibitors for advanced melanoma.  Quill, Agarwala, Atkins, Daud, Flaherty, Weber, Obholz.  Society for Melanoma Research 2016 Congress.  Published 29 January 2017. 

Immune checkpoint blockade has revolutionized the care of patients (pts) with melanoma; however, treatment guidelines lack specific recommendations on the use of these agents for individual pt cases. We developed an interactive, online treatment (Tx) decision tool to assess whether expert Tx recommendations based on specific disease and pt characteristics would affect the planned Tx decisions of community practitioners. In January 2016, 5 experts provided Tx recommendations for 90 case variations based on key factors they considered important to guide Tx choice and then an online tool was developed to provide this guidance to clinicians. To use the tool, specific pt and disease characteristics along with the intended Tx for that pt were entered. Then Tx recommendations from 5 experts for that scenario were provided and users were prompted to indicate whether this online consultation would change their Tx plan. An analysis of 432 cases entered into the tool found variation between the intended use of immunotherapy among tool users versus Tx recommendations from the experts. For example, compared with the experts who all chose immune checkpoint blockade as frontline Tx for BRAF wild-type disease, 44% of tool users planned to use a different Tx or were unsure. For BRAFV600-mutant disease with a good PS and normal LDH, all of the experts recommended frontline immunotherapy whereas 55% of users selected combination BRAF/MEK therapy for this scenario. In total, 59% of tool users whose planned Tx differed from the experts indicated that the expert recommendations from the tool would subsequently change their Tx plan. An analysis of specific first- and second-line agent and combination choice along with Tx variance in other case scenarios will be presented. 

What the hell is wrong with these community oncologists????  I have been providing care to children for over 30 years.  Not only does maintenance of my license REQUIRE continuing education training on an annual basis, but I REQUIRE keeping up with changes in standards of care for my little patients of MYSELF!!!!  How in the world these providers could insert the particulars of their patient's melanoma data into a program designed by melanoma experts and PURPOSELY CHOOSE to provide a "treatment" NOT recommended is beyond me!!!  But...they did.

This report highlights a sad state of medicine and a seriously scary situation for folks with melanoma.  All I can tell you is:  learn from more than half of these 432 ratties (and these are just the ones we know about in this particular study) who were given treatment that was NOT recommended by melanoma experts by their local oncologist.  RUN, don't walk...even if it takes more effort than a trip to a local a melanoma expert if you are dealing with melanoma.  Your life may depend on it!  - c

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