Deckers, Eric

Francken, Anne Brecht

Hoekstra, Harald J

Hoekstra-Weebers, Josette E H M

English

Proceedings - University of Groningen

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 04-06-2022ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

ASO Author Reflections:Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, Until Biomarkers to Predict Prognosis Have Been Identified

University of Groningen

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 29-04-2023ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

Dissertations of the University of Groningen

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.Advance online publication. https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 01-11-2023ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 19-05-2020ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 05-06-2022ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

ARTS repository - University of Groningen

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.Advance online publication. https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 11-09-2023ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

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ASO Author Reflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, Until Biomarkers to Predict Prognosis Have Been Identified

   University of GroningenASO Author ReflectionsFrancken, Anne Brecht; Hoekstra-Weebers, Josette E H M; Deckers, Eric; Hoekstra, Harald JPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-019-07611-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Francken, A. B., Hoekstra-Weebers, J. E. H. M., Deckers, E., & Hoekstra, H. J. (2020). ASO AuthorReflections: Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been Identified. Annals of Surgical Oncology, 27(5), 1418-1419.https://doi.org/10.1245/s10434-019-07611-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 07-06-2022ASO AUTHOR REFLECTIONSASO Author Reflections: Stage-Adjusted Reduced Follow-Upof Melanoma Patients is Justified and Cost Effective, UntilBiomarkers to Predict Prognosis Have Been IdentifiedAnne Brecht Francken, MD, PhD1, Josette E. H. M. Hoekstra-Weebers, PhD2, Eric Deckers, MD3, andHarald J. Hoekstra, MD, PhD31Department of Surgical Oncology, Isala Clinics, Zwolle, The Netherlands; 2Wenckebach Institute, University ofGroningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Surgical Oncology,University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsPASTThe incredible rise in melanoma health care costsurgently demands a reduction in these costs where appro-priate.1 Nevertheless, cancer patients demand frequent andclose follow-up out of fear of recurrence. Historically,melanoma patients have been followed regularly, withlimited therapeutic options in case of disease progression.2In addition, survival benefit as a result of follow-up hasnever been demonstrated.3 There is a lack of internationalconsensus regarding the follow-up frequency of melanomapatients,4 and evidence regarding the optimal follow-upfrequency of these patients with respect to disease-free andoverall survival, patients’ quality of life (QoL), and costs ishighly needed.PRESENTThe current randomized controlled MELFO studycompared two groups of stage Ib–IIc melanoma patients,3 years after diagnosis.5 The first group received follow-upas advised in the guideline, while the second groupreceived a stage-adjusted, less frequent follow-up schedule.Patients’ QoL, anxiety, satisfaction regarding follow-up,and disease-free and overall survival were comparable, buta 39% cost reduction was found in those who were lessfrequently followed-up. A reduced and stage-adjusted fol-low-up schedule could be a step forward in betterdistribution of resources, such as finances, time, andmanpower.FUTURESeveral questions need to be answered in the future todetermine the optimal, safe, (cost)-effective follow-up thatwill benefit all melanoma patients.3 Apart from recurrencedetection, mental support and patient education areimportant after-care goals for melanoma patients with anystage of disease.6,7 Now that several effective therapeuticadjuvant systemic treatment options with drug targetingand/or immunotherapy have become available, follow-uphas become even more complex.8 What is the best strategyto improve OS in stage IB–II melanoma? Adjuvant therapyof high-risk stage II patients or treatment at the time ofrecurrence? How to select patients who will benefit fromadjuvant treatment while sparing those who are unlikely tobenefit from toxic effects? If melanoma biomarkers couldbe identified that can better predict the potential tometastasize than the current prognostic factors do, aASO Author Reflections is a brief invited commentary on the article‘‘The MELFO-Study: a Multi-Center Prospective RandomizedClinical Trial on the Effects of a Reduced Stage-Adjusted Follow-upSchedule on Cutaneous Melanoma IB-IIC patients: Results After3-Years’’, Ann Surg Oncol. In press The Author(s) 2019First Received: 19 June 2019;Published Online: 3 September 2019H. J. Hoekstra, MD, PhDe-mail: h.j.hoekstra@umcg.nlAnn Surg Oncol (2020) 27:1418–1419https://doi.org/10.1245/s10434-019-07611-5personalized follow-up, including emotional support andpatient education, could be delivered even more (cost)effectively. Currently, stage-adjusted follow-up is the bestpersonalized follow-up approach for stage IB–IImelanoma.DISCLOSURES Anne Brecht Francken, Josette E.H.M. Hoekstra-Weebers, Eric Deckers, and Harald J. Hoekstra have no conflicts ofinterest to disclose.OPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.REFERENCES1. Guy GP Jr, Ekwueme DU, Tangka FK, Richardson LC. Melanomatreatment costs: a systematic review of the literature, 1990–2011.Am J Prev Med. 2012;43:537–45.2. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patientswith localised primary cutaneous melanoma. Lancet Oncol.2005;6:608–21.3. Fields RC, Coit DG. Evidence-based follow-up for the patient withmelanoma. Surg Oncol Clin North Am. 2011;20:181–200.4. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE,Lucci A, et al. Variability in melanoma post-treatment surveillancepractices by country and physician specialty: a systematic review.Melanoma Res. 2012;22:376–85.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB,ter Meulen S, Bastiaannet E, et al. The MELFO-study: a multi-center prospective randomized clinical trial on the effects of areduced stage-adjusted follow-up schedule on cutaneous mela-noma IB-IIC patients: results after 3-years. Ann Surg Oncol. (inpress).6. Morton RL Rychetnik L, Mccaffery K, Thompson JF, Irwig L.Patients’ perspectives of long-term follow-up for localised cuta-neous melanoma. Eur J Surg Oncol. 2013;39:297–303.7. Lim WY, Morton RL, Turner RM, Jenkins MC, Guitera P, Irwig L,et al. Patient preferences for follow-up after recent excision of alocalized melanoma. JAMA Dermatol. 2018;154:420–7.8. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG,Gutzmer R, Hauschild A, et al. Melanoma Lancet.2018;392:971–84.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: Stage-Adjusted Reduced Follow-Up 1419

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ASO Author Reflections:Stage-Adjusted Reduced Follow-Up of Melanoma Patients is Justified and Cost Effective, Until Biomarkers to Predict Prognosis Have Been Identified

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