Bastiaannet, Esther

Garioch, Jennifer

Heaton, Martin

Hoekstra, Harald

Hoekstra-Weebers, Josette

Moncrieff, Marc

Patel, Nakul

Underwood, Beverly

NARCIS 

ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years

University of Groningen

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

English

ASO Author Reflections:The MelFo-Study, UK: Effects of a Reduced Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years

ARTS repository - University of Groningen

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

Dissertations of the University of Groningen

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: 12-10-2022ASO AUTHOR REFLECTIONSASO Author Reflections: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

University of East Anglia digital repository

ASO AUTHOR REFLECTIONSASO Author Reflections: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

ASO author reflections: The MelFo-Study, UK: Effects of a reduced frequency, stage-adjusted follow-up schedule for cutaneous melanoma IB–IIC patients after 3 years

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: 26-12-2020ASO AUTHOR REFLECTIONSASO Author Reflections: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: 10-09-2023ASO AUTHOR REFLECTIONSASO Author Reflections: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

   University of GroningenASO Author ReflectionsMoncrieff, Marc; Underwood, Beverly; Garioch, Jennifer; Heaton, Martin; Patel, Nakul;Bastiaannet, Esther; Hoekstra-Weebers, Josette; Hoekstra, HaraldPublished in:Annals of Surgical OncologyDOI:10.1245/s10434-020-08763-5IMPORTANT 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):Moncrieff, M., Underwood, B., Garioch, J., Heaton, M., Patel, N., Bastiaannet, E., Hoekstra-Weebers, J., &Hoekstra, H. (2020). ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency,Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB-IIC Patients After 3 Years. Annals ofSurgical Oncology, 27(11), 4120–4121. https://doi.org/10.1245/s10434-020-08763-5CopyrightOther 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: The MelFo-Study, UK: Effectsof a Reduced Frequency, Stage-Adjusted Follow-Up Schedulefor Cutaneous Melanoma IB–IIC Patients After 3 YearsMarc Moncrieff, MD, FRCS(Plast)1,2 , Beverly Underwood, RGN1, Jennifer Garioch, MD, FRCP3,Martin Heaton, MD, FRCS(Plast.)4, Nakul Patel, FRCS(Plast.)1, Esther Bastiaannet, PhD5,Josette Hoekstra-Weebers, PhD6,7, and Harald Hoekstra, MD, PhD81Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2NorwichMedical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK; 3Department ofDermatology, Norfolk and Norwich University Hospital, Norwich, UK; 4Department of Plastic Surgery, Norfolk andNorwich University Hospital NHS Foundation Trust, Norwich, UK; 5Department of Surgery, Leiden University MedicalCenter, Leiden, The Netherlands; 6Wenckebach Institute, Universitair Medisch Centrum Groningen, Groningen, TheNetherlands; 7Integraal Kankercentrum Nederland Locatie Groningen, Groningen, The Netherlands; 8Department ofSurgical Oncology, University Medical Center Groningen, Groningen, The NetherlandsPASTThe routine use of sentinel lymph node biopsy (SLNB) toaccurately stage melanoma patients has been incorporatedinto most international melanoma guidelines. On average,over 80% of patients are sentinel node negative.1 However,these patients still require follow-up, since the risk oflocoregional or distant spread, although comparatively low,remains a possibility. Approximately 90% of recurrencesoccur within 3 years of diagnosis for American Joint Com-mittee on Cancer (AJCC) stage II melanomas, but for AJCCstage I melanomas; a significant proportion of recurrencesoccur after a substantial delay.2 Accordingly, it is chal-lenging for national guidelines committees to devise simplefollow-up schedules for melanoma patients.PRESENTThe melanoma follow-up (MelFO) study is an interna-tional phase III randomized controlled trial whereparticipants are randomized into two groups—onefollowing the conventional schedule recommended in theUK National Institutes for Health and Care Excellence(NICE) melanoma guidelines,3 and one whose follow-upwas an AJCC stage-adjusted reduced schedule. Impor-tantly, the primary endpoint for this study is patients’quality of life (QoL), although secondary endpoints includethe usual standard outcomes data such as disease-specificand overall survival. We found that both cohorts expressedhigh satisfaction with their regimens ([ 93%).4 Overallcompliance with the follow-up schedules was high at the 1-and 3-year timepoints (68.5% and 66.5%, respectively). At3 years, no significant group effect was found on anypatient-reported outcomes measure scores, indicating noQoL difference between the follow-up protocols. Therecurrence rate was identical (approximately 16%) andself-examination was the main method of detection forboth groups (approximately 70%). Melanoma-specificsurvival was also identical.FUTUREThese reflections were written at a time when mostmodern healthcare services have been disrupted beyondrecognition during the COVID-19 pandemic. It is likelythat many services will be rationalized in the future, oncethe pandemic subsides. Accordingly, evidenced-based fol-low-up regimens will be needed to ensure that the The Author(s) 2020First Received: 25 April 2020;Published Online: 10 July 2020M. Moncrieff, MD, FRCS(Plast)e-mail: marc.moncrieff@nnuh.nhs.ukAnn Surg Oncol (2020) 27:4120–4121https://doi.org/10.1245/s10434-020-08763-5appropriate balance is struck between diagnosing early thefew recurrences in low-risk groups such as these and notoverburdening both patients and society alike.The UK MelFO study has shown that 3 years afterstaging with a negative SLNB, AJCC stage IB–IIC cuta-neous melanoma patients assigned to the prescribedreduced stage-adjusted follow-up schedule reported nodifference in levels of anxiety, cancer worry, and mentalhealth-related QoL when compared with those of patientsassigned to the follow-up schedule as currently advised inthe UK NICE melanoma guideline. These results mirror thefindings of the Dutch group who recently reported verysimilar results using the same protocol in 2019.5 Weanticipate reporting the combined data for the final out-come of the study at the end of 2020, with adequate powerto detect any difference in recurrence rates. It is our hopethat the results will assist future national guideline com-mittees designing protocols for the follow-up of cutaneousmelanoma patients.DISCLOSURE The authors declare that they have no conflict ofinterest.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report ofsentinel-node biopsy versus nodal observation in melanoma. NEngl J Med. 2014;370(7):599–609.2. Francken AB, Shaw HM, Accortt NA, Soong S-J, Hoekstra HJ,Thompson JF. Detection of first relapse in cutaneous melanomapatients: implications for the formulation of evidence-basedfollow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.3. Melanoma: assessment and management. Guidance and guide-lines. NICE. https://www.nice.org.uk/guidance/ng14. Accessed 22Nov 2018.4. Moncrieff MD, Underwood B, Garioch JJ, et al. The MelFo-studyUK: effects of a reduced frequency, stage-adjusted follow-upschedule for cutaneous melanoma IB-IIC patients after 3-years.Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08758-2.5. Deckers EA, Hoekstra-Weebers JEHM, Damude S, et al. TheMELFO study: a multicenter, prospective, randomized clinicaltrial on the effects of a reduced stage-adjusted follow-up scheduleon cutaneous melanoma IB-IIC patients-results after 3 years. AnnSurg Oncol. 2020;27(5):1407–17. https://doi.org/10.1245/s10434-019-07825-7.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency 4121

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DL Morton

AB Francken

MD Moncrieff

EA Deckers

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ASO Author Reflections: The MelFo-Study, UK: Effects of a Reduced Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma IB–IIC Patients After 3 Years

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ASO author reflections: The MelFo-Study, UK: Effects of a reduced frequency, stage-adjusted follow-up schedule for cutaneous melanoma IB–IIC patients after 3 years

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