JAMA Dermatology

<jats:sec id="ab-doi240056-4"><jats:title>Importance</jats:title><jats:p>Most patients who present with primary cutaneous melanomas have thin tumors (≤1.0 mm in Breslow thickness, ie, pT1a and pT1b). Although their prognosis is generally considered to be excellent, there is limited precise information on the association of risk of death with specific Breslow measurements in thin lesions.</jats:p></jats:sec><jats:sec id="ab-doi240056-5"><jats:title>Objective</jats:title><jats:p>To assess the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death.</jats:p></jats:sec><jats:sec id="ab-doi240056-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>Registry data for all Australians diagnosed with thin invasive primary melanomas between 1982 and 2014 were analyzed. Data were extracted from all 8 Australian state and territory population-based cancer registries. Dates and causes of death were obtained from the Australian National Death Index. Adults diagnosed with a first invasive primary melanoma of 1.0 mm or smaller in thickness were included.</jats:p></jats:sec><jats:sec id="ab-doi240056-7"><jats:title>Exposure</jats:title><jats:p>First invasive primary melanoma between 1982 and 2014.</jats:p></jats:sec><jats:sec id="ab-doi240056-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The primary outcomes were melanoma-related deaths and nonmelanoma-related deaths. Competing-risk regression analyses and cause-specific analyses were performed to investigate the relationships between Breslow thickness subcategory (&amp;amp;lt;0.8 mm versus ≥0.8 mm by 0.1-mm increments) and the primary outcomes.</jats:p></jats:sec><jats:sec id="ab-doi240056-9"><jats:title>Results</jats:title><jats:p>Overall, a cohort of 144 447 participants was included. The median (range) age was 56 (18-101) years and 78 014 (54.0%) were men. Median (IQR) follow-up was 15.0 (9.5-23.3) years. Crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3% (95% CI, 6.1%-6.5%) for the whole cohort, 6.0% (95% CI, 5.7%-6.2%) for tumors smaller than 0.8 mm, and 12.0% (95% CI, 11.4%-12.6%) for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9% (95% CI, 91.6%-92.1%), 94.2% (95% CI, 94.0%-94.4%), and 87.8% (95% CI, 87.3%-88.3%), respectively. On multivariable analysis, tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92; 95% CI, 2.74-3.12) and a greater rate of melanoma-related death (hazard ratio, 2.98; 95% CI, 2.79-3.18) than thinner tumors (&amp;amp;lt;0.8 mm). Risk of death from nonmelanoma-related causes was not associated with Breslow thickness.</jats:p></jats:sec><jats:sec id="ab-doi240056-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas.</jats:p></jats:sec>

Update on thin melanoma: outcome of an international workshop.

Adv Anat Pathol

Long-term deaths from melanoma according to tumor thickness at diagnosis.

Int J Cancer

Global burden of cutaneous melanoma in 2020 and projections to 2040.

JAMA Dermatol

Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual.

CA Cancer J Clin

Melanoma survival is superior in females across all tumour stages but is influenced by age.

Arch Dermatol Res

Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register.

Br J Dermatol

Survival in 31?670 patients with thin melanomas–a Swedish population-based study.

British Journal of Dermatology

Mortality burden and prognosis of thin melanomas overall and by subcategory of thickness, SEER registry data, 1992-2013.

J Am Acad Dermatol

Population-based 20-year survival among people diagnosed with thin melanomas in Queensland, Australia.

J Clin Oncol

Prognosis for patients with thin cutaneous melanoma: long-term survival data from New South Wales Central Cancer Registry and the Sydney Melanoma Unit.

Cancer

An analysis of risk factors for cutaneous melanoma by anatomical site (Australia).

Cancer Causes Control

Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma.

Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma.

Ann Surg

Long-term survival of patients with thin (T1) cutaneous melanomas: a Breslow thickness cut point of 0.8 mm separates higher-risk and lower-risk tumors.

Ann Surg Oncol

Choice and interpretation of statistical tests used when competing risks are present.

Introduction to the analysis of survival data in the presence of competing risks.

Circulation

Testing for causality and prognosis: etiological and prognostic models.

Kidney Int

A competing risks analysis should report results on all cause-specific hazards and cumulative incidence functions.

J Clin Epidemiol

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Lancet

Survival analysis part I: basic concepts and first analyses.

Br J Cancer

Competing risk regression models for epidemiologic data.

Am J Epidemiol

A proportional hazards model for the subdistribution of a competing risk.

J Am Stat Assoc

Checking Fine and Gray subdistribution hazards model with cumulative sums of residuals.

Lifetime Data Anal

Accuracy of cause of death data routinely recorded in a population-based cancer registry: impact on cause-specific survival and validation using the Geneva Cancer Registry.

BMC Cancer

Variability in cancer death certificate accuracy by characteristics of death certifiers.

Am J Forensic Med Pathol

Prognosis for people with multiple primary melanomas compared with a single primary melanoma.

Most patients who present with primary cutaneous melanomas have thin tumors (≤1.0 mm in Breslow thickness, ie, pT1a and pT1b). Although their prognosis is generally considered to be excellent, there is limited precise information on the association of risk of death with specific Breslow measurements in thin lesions.
To assess the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death.
Registry data for all Australians diagnosed with thin invasive primary melanomas between 1982 and 2014 were analyzed. Data were extracted from all 8 Australian state and territory population-based cancer registries. Dates and causes of death were obtained from the Australian National Death Index. Adults diagnosed with a first invasive primary melanoma of 1.0 mm or smaller in thickness were included.
First invasive primary melanoma between 1982 and 2014.
The primary outcomes were melanoma-related deaths and nonmelanoma-related deaths. Competing-risk regression analyses and cause-specific analyses were performed to investigate the relationships between Breslow thickness subcategory (<0.8 mm versus ≥0.8 mm by 0.1-mm increments) and the primary outcomes.
Overall, a cohort of 144 447 participants was included. The median (range) age was 56 (18-101) years and 78 014 (54.0%) were men. Median (IQR) follow-up was 15.0 (9.5-23.3) years. Crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3% (95% CI, 6.1%-6.5%) for the whole cohort, 6.0% (95% CI, 5.7%-6.2%) for tumors smaller than 0.8 mm, and 12.0% (95% CI, 11.4%-12.6%) for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9% (95% CI, 91.6%-92.1%), 94.2% (95% CI, 94.0%-94.4%), and 87.8% (95% CI, 87.3%-88.3%), respectively. On multivariable analysis, tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92; 95% CI, 2.74-3.12) and a greater rate of melanoma-related death (hazard ratio, 2.98; 95% CI, 2.79-3.18) than thinner tumors (<0.8 mm). Risk of death from nonmelanoma-related causes was not associated with Breslow thickness.
In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas.

Risk of Death Due to Melanoma and Other Causes in Patients With Thin Cutaneous Melanomas.

Risk of Death Due to Melanoma and Other Causes in Patients With Thin Cutaneous Melanomas

<jats:sec id="ab-doi240040-4"><jats:title>Importance</jats:title><jats:p>Over the past decades, many global regions have experienced a steady increase in the incidence of cutaneous melanoma. However, more recently, a downward trend has been observed in the younger age groups in Australia and the US. Yet, in Europe, none of the countries have reported any significant decline in melanoma incidence for any age group.</jats:p></jats:sec><jats:sec id="ab-doi240040-5"><jats:title>Objective</jats:title><jats:p>To assess melanoma incidence and mortality trends in Sweden, with a focus on individuals younger than the average age of melanoma onset.</jats:p></jats:sec><jats:sec id="ab-doi240040-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cohort study used data on the national population from the Swedish Melanoma Registry and the Swedish Cancer Registry, which cover more than 99% of all primary invasive cutaneous melanomas diagnosed in the country. All patients diagnosed from 1990 to 2022 were included.</jats:p></jats:sec><jats:sec id="ab-doi240040-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Incidence and mortality rates per 100 000 inhabitants were calculated for each year and shown as average annual rates for every 5-year period from 1990 to 2022. Joinpoint regression models were used to evaluate statistical significance of temporal trends and points of change.</jats:p></jats:sec><jats:sec id="ab-doi240040-8"><jats:title>Results</jats:title><jats:p>There were 34 800 primary invasive cutaneous melanomas (19 582 [56.3%] in females and 15 218 [43.7%] in males) reported in 33 324 individuals younger than 60 years (median [IQR] age, 48 [36-58] years) from 1990 to 2022. A consistent rise in melanoma incidence was observed among those 50 to 59 years old. The age groups from 20 to 29 years, 30 to 39 years, and 40 to 49 years showed an incidence peak in 2013 to 2015 followed by stable or significantly declining rates until 2022. In patients younger than 20 years, melanoma incidence remained low with no significant trends. There was also a significant decline in melanoma mortality among 30- to 59-year-old individuals, but not in those 60 years and older.</jats:p></jats:sec><jats:sec id="ab-doi240040-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>The findings of this cohort study showed a significant recent downward trend in both melanoma incidence and melanoma mortality in the age group 30 to 49 years in Sweden. The reasons for these declines are unclear but may include UV protection, public health campaigns, changing population demographics, and the introduction of effective melanoma treatment. None of these possibilities were evaluated; further study is needed.</jats:p></jats:sec>

International trends in the incidence of malignant melanoma 1953-2008–are recent generations at higher or lower risk?

Trends in the survival of patients diagnosed with malignant melanoma of the skin in the Nordic countries 1964-2003 followed up to the end of 2006.

Acta Oncol

Emerging trends in the epidemiology of melanoma.

Multiple primary melanoma incidence trends over five decades: a nationwide population-based study.

J Natl Cancer Inst

Trends in incidence of thick, thin and in situ melanoma in Europe.

Eur J Cancer

Incidence of in situ and invasive melanoma in Denmark from 1985 through 2012: a national database study of 24,059 melanoma cases.

Increased incidence of melanoma in children and adolescents in Finland in 1990-2014: nationwide re-evaluation of histopathological characteristics.

Ann Med

Age-specific incidence of melanoma in the United States.

Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995-2014.

Changing epidemiology and age-specific incidence of cutaneous malignant melanoma in England: an analysis of the national cancer registration data by age, gender and anatomical site, 1981-2018.

Lancet Reg Health Eur

Trend shifts in age-specific incidence for in situ and invasive cutaneous melanoma in Sweden.

Cancers (Basel)

Melanoma incidence increases in the elderly of Catalonia but not in the younger population: effect of prevention or consequence of immigration?

Acta Derm Venereol

The forthcoming inexorable decline of cutaneous melanoma mortality in light-skinned populations.

Global trends in cutaneous malignant melanoma incidence and mortality.

Melanoma Res

Äldre med melanom söker sent och har högre dödlighet - Med ökande kunskap kan trenden brytas – några kliniska särdrag är viktiga att uppmärksamma [Older people with melanoma seek care late and have a higher mortality].

Lakartidningen

The completeness of the Swedish Cancer Register: a sample survey for year 1998.

Prognostic instrument for survival outcome in melanoma patients: based on data from the population-based Swedish Melanoma Register.

The Swedish cause of death register.

Eur J Epidemiol

Evaluation of sex-specific incidence of melanoma.

In response to: immigration is the most likely reason for the generational change in melanoma incidence in Queensland, Australia.

Immigration is the most likely reason for the generational change in melanoma incidence in Queensland, Australia.

Prognostic factors and disease-specific survival among immigrants diagnosed with cutaneous malignant melanoma in Sweden.

Skin cancer control in the 1990’s, from slip! slop! slap! to sun smart.

Australas J Dermatol

Improved survival with ipilimumab in patients with metastatic melanoma.

N Engl J Med

Pembrolizumab versus ipilimumab in advanced melanoma.

Nivolumab in previously untreated melanoma without BRAF mutation.

Improved survival with vemurafenib in melanoma with BRAF V600E mutation.

Combined BRAF and MEK inhibition versus BRAF inhibition alone in melanoma.

Increasing melanoma incidence and survival trend shifts with improved melanoma-specific survival between 1990 and 2020 in Sweden.

Over the past decades, many global regions have experienced a steady increase in the incidence of cutaneous melanoma. However, more recently, a downward trend has been observed in the younger age groups in Australia and the US. Yet, in Europe, none of the countries have reported any significant decline in melanoma incidence for any age group.
To assess melanoma incidence and mortality trends in Sweden, with a focus on individuals younger than the average age of melanoma onset.
This cohort study used data on the national population from the Swedish Melanoma Registry and the Swedish Cancer Registry, which cover more than 99% of all primary invasive cutaneous melanomas diagnosed in the country. All patients diagnosed from 1990 to 2022 were included.
Incidence and mortality rates per 100 000 inhabitants were calculated for each year and shown as average annual rates for every 5-year period from 1990 to 2022. Joinpoint regression models were used to evaluate statistical significance of temporal trends and points of change.
There were 34 800 primary invasive cutaneous melanomas (19 582 [56.3%] in females and 15 218 [43.7%] in males) reported in 33 324 individuals younger than 60 years (median [IQR] age, 48 [36-58] years) from 1990 to 2022. A consistent rise in melanoma incidence was observed among those 50 to 59 years old. The age groups from 20 to 29 years, 30 to 39 years, and 40 to 49 years showed an incidence peak in 2013 to 2015 followed by stable or significantly declining rates until 2022. In patients younger than 20 years, melanoma incidence remained low with no significant trends. There was also a significant decline in melanoma mortality among 30- to 59-year-old individuals, but not in those 60 years and older.
The findings of this cohort study showed a significant recent downward trend in both melanoma incidence and melanoma mortality in the age group 30 to 49 years in Sweden. The reasons for these declines are unclear but may include UV protection, public health campaigns, changing population demographics, and the introduction of effective melanoma treatment. None of these possibilities were evaluated; further study is needed.

Melanoma Incidence and Mortality Trends Among Patients Aged 59 Years or Younger in Sweden.

Melanoma Incidence and Mortality Trends Among Patients Aged 59 Years or Younger in Sweden

Familial risk and heritability of cancer among twins in Nordic countries.

JAMA

Genome-wide association meta-analyses combining multiple risk phenotypes provide insights into the genetic architecture of cutaneous melanoma susceptibility.

Nat Genet

Exploring the germline genetics of in situ and invasive cutaneous melanoma: a genome-wide association study meta-analysis.

Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study.

Germline variants are associated with increased primary melanoma tumor thickness at diagnosis.

Hum Mol Genet

Novel pleiotropic risk loci for melanoma and nevus density implicate multiple biological pathways.

Nat Commun

Inherited variants in the MC1R gene and survival from cutaneous melanoma: a BioGenoMEL study.

Pigment Cell Melanoma Res

Melanoma-specific survival before and after inclusion in a familial melanoma dermatologic surveillance program in CDKN2A mutation carriers and non-carriers.

J Eur Acad Dermatol Venereol

CDKN2a mutation-negative melanoma families have increased risk exclusively for skin cancers but not for other malignancies.

Cancer risks and survival in patients with multiple primary melanomas: association with family history of melanoma and germline CDKN2A mutation status.

Familial features affecting the melanoma risk in CDKN2A-negative melanoma families: a study based on the Swedish Cancer Registry.

The rapid rise in cutaneous melanoma diagnoses.

Multiplex melanoma families are enriched for polygenic risk.

Association between a 46-SNP polygenic risk score and melanoma risk in Dutch patients with familial melanoma.

J Med Genet

Does the Germline Genome Encode for the Invasiveness of a Cutaneous Melanoma?

<jats:p>This cohort study provides detailed annual rates and percentage changes of melanoma incidence before vs during the COVID-19 pandemic.</jats:p>

Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study.

Impact of COVID-19 pandemic on melanoma presentation by facility type and region in the United States.

Global association of COVID-19 pandemic measures with cancer screening: a systematic review and meta-analysis.

JAMA Oncol

Melanoma reporting to central cancer registries by US dermatologists: an analysis of the persistent knowledge and practice gap.

Impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors.

JCO Clin Cancer Inform

This cohort study provides detailed annual rates and percentage changes of melanoma incidence before vs during the COVID-19 pandemic.

Incidence of In Situ and Invasive Cutaneous Melanomas During the COVID-19 Pandemic in the US.

Incidence of In Situ and Invasive Cutaneous Melanomas During the COVID-19 Pandemic in the US

<jats:sec id="ab-doi230041-4"><jats:title>Importance</jats:title><jats:p>Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on health care costs and outcomes in routine practice.</jats:p></jats:sec><jats:sec id="ab-doi230041-5"><jats:title>Objective</jats:title><jats:p>To examine changes in health care costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma.</jats:p></jats:sec><jats:sec id="ab-doi230041-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cohort study assessed a longitudinal, propensity score (PS)–matched, retrospective cohort of residents of Ontario, Canada, aged 20 years or older with stages II to IV cutaneous melanoma identified from the Ontario Cancer Registry from January 1, 2018, to March 31, 2019. A historical comparison cohort was identified from a population-based sample of invasive melanoma cases diagnosed from the Ontario Cancer Registry from January 1, 2007, to December 31, 2012. Data analysis was performed from October 17, 2022, to March 13, 2023.</jats:p></jats:sec><jats:sec id="ab-doi230041-7"><jats:title>Exposures</jats:title><jats:p>Era of melanoma diagnosis (2007-2012 vs 2018-2019).</jats:p></jats:sec><jats:sec id="ab-doi230041-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The primary outcomes were mean per-capita health care and systemic therapy costs (Canadian dollars) during the first year after melanoma diagnosis, time toxicity (days with physical health care contact) within 1 year of initial treatment, and OS. Standardized differences were used to compare costs and time toxicity. Kaplan-Meier methods and Cox proportional hazards regression were used to compare OS among PS-matched cohorts.</jats:p></jats:sec><jats:sec id="ab-doi230041-9"><jats:title>Results</jats:title><jats:p>A PS-matched cohort of 731 patients (mean [SD] age, 67.9 [14.8] years; 437 [59.8%] male) with melanoma from 2018 to 2019 and 731 patients (mean [SD] age, 67.9 [14.4] years; 440 [60.2%] male) from 2007 to 2012 were evaluated. The 2018 to 2019 patients had greater mean (SD) health care (including systemic therapy) costs compared with the 2007 to 2012 patients ($47 886 [$55 176] vs $33 347 [$31 576]), specifically for stage III ($67 108 [$57 226] vs $46 511 [$30 622]) and stage IV disease ($117 450 [$79 272] vs $47 739 [$37 652]). Mean (SD) systemic therapy costs were greater among 2018 to 2019 patients: stage II ($40 823 [$40 621] vs $10 309 [$12 176]), III ($55 699 [$41 181] vs $9764 [$12 771]), and IV disease ($79 358 [$50 442] vs $9318 [$14 986]). Overall survival was greater for the 2018 to 2019 cohort compared with the 2007 to 2012 cohort (3-year OS: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%], hazard ratio, 0.72 [95% CI, 0.61-0.85]; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Time toxicity was similar between eras. Patients with stage IV disease spent more than 1 day per week (&amp;amp;gt;52 days) with physical contact with the health care system by 2018 to 2019 (mean [SD], 58.7 [43.8] vs 44.2 [26.5] days; standardized difference, 0.40; <jats:italic>P</jats:italic> = .20).</jats:p></jats:sec><jats:sec id="ab-doi230041-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>This cohort study found greater health care costs in the treatment of stages II to IV melanoma and substantial time toxicity for patients with stage IV disease, with improvements in OS associated with the adoption of immunotherapy and targeted therapies. These health system–wide data highlight the trade-off with adoption of new therapies, for which there is a greater economic burden to the health care system and time burden to patients but an associated improvement in survival.</jats:p></jats:sec>

Projections of the cost of cancer care in the United States: 2010-2020.

The economic burden of cancer care in Canada: a population-based cost study.

CMAJ Open

Cancer statistics, 2021.

Projected estimates of cancer in Canada in 2020.

CMAJ

NCCN Guidelines® Insights: melanoma: cutaneous, version 2.2021.

J Natl Compr Canc Netw

Systemic adjuvant therapy for adult patients at high risk for recurrent cutaneous or mucosal melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline.

Curr Oncol

Ipilimumab plus dacarbazine for previously untreated metastatic melanoma.

Adjuvant pembrolizumab versus placebo in resected stage III melanoma.

Prolonged survival in stage III melanoma with ipilimumab adjuvant therapy.

Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma.

Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma.

A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors.

J Immunother Cancer

Cost and economic burden of adverse events associated with metastatic melanoma treatments in five countries.

J Med Econ

Pembrolizumab versus ipilimumab for advanced melanoma: final overall survival results of a multicentre, randomised, open-label phase 3 study (KEYNOTE-006).

Systemic therapy for melanoma: ASCO guideline.

Completion dissection or observation for sentinel-node metastasis in melanoma.

Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial.

Lancet Oncol

The time toxicity of cancer treatment.

Caregiver burden #419.

J Palliat Med

What is value in health care?

Diagnostic error, uncertainty, and overdiagnosis in melanoma.

Pathology

Disparities in diagnosis of advanced melanoma: a population-based cohort study.

Identifying increased risk of readmission and in-hospital mortality using hospital administrative data.

Med Care

The generation of two specific cancer costing algorithms using Ontario administrative databases.

Health system costs for cancer medications and radiation treatment in Ontario for the 4 most common cancers: a retrospective cohort study.

Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.

Pharm Stat

Comparative healthcare costs in patients with metastatic melanoma in the USA.

Cost and utilization of immunotherapy and targeted therapy for melanoma: cross-sectional analysis in the Medicare population, 2013 and 2015.

Healthcare costs of metastatic cutaneous melanoma in the era of immunotherapeutic and targeted drugs.

Health care resource utilization and associated costs among metastatic cutaneous melanoma patients treated with ipilimumab (INTUITION study).

Oncologist

Direct costs associated with adverse events of systemic therapies for advanced melanoma: systematic literature review.

Medicine (Baltimore)

Economic burden of adverse events associated with immunotherapy and targeted therapy for metastatic melanoma in the elderly.

Am Health Drug Benefits

Economic burden of toxicities associated with treating metastatic melanoma in eight countries.

Eur J Health Econ

Economic evaluation of talimogene laherparepvec plus ipilimumab combination therapy vs ipilimumab monotherapy in patients with advanced unresectable melanoma.

Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization.

Cancer Med

Economic evaluation of nivolumab combined with ipilimumab in the first-line treatment of advanced melanoma in Japan.

Cost-effectiveness of drug treatments for advanced melanoma: a systematic literature review.

Pharmacoeconomics

Economic evaluation of systemic treatments for advanced melanoma: a systematic review.

Value Health

Determination of the impact of melanoma surgical timing on survival using the National Cancer Database.

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review.

A population-based study of survival impact of new targeted and immune-based therapies for metastatic or unresectable melanoma.

Clin Oncol (R Coll Radiol)

Current landscape of immunotherapy in breast cancer: a review.

First-line immunotherapy for non–small-cell lung cancer.

Nivolumab alone and with ipilimumab in previously treated metastatic urothelial carcinoma: CheckMate 032 nivolumab 1 mg/kg plus ipilimumab 3 mg/kg expansion cohort results.

Pembrolizumab in microsatellite-instability–high advanced colorectal cancer.

Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on health care costs and outcomes in routine practice.
To examine changes in health care costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma.
This cohort study assessed a longitudinal, propensity score (PS)-matched, retrospective cohort of residents of Ontario, Canada, aged 20 years or older with stages II to IV cutaneous melanoma identified from the Ontario Cancer Registry from January 1, 2018, to March 31, 2019. A historical comparison cohort was identified from a population-based sample of invasive melanoma cases diagnosed from the Ontario Cancer Registry from January 1, 2007, to December 31, 2012. Data analysis was performed from October 17, 2022, to March 13, 2023.
Era of melanoma diagnosis (2007-2012 vs 2018-2019).
The primary outcomes were mean per-capita health care and systemic therapy costs (Canadian dollars) during the first year after melanoma diagnosis, time toxicity (days with physical health care contact) within 1 year of initial treatment, and OS. Standardized differences were used to compare costs and time toxicity. Kaplan-Meier methods and Cox proportional hazards regression were used to compare OS among PS-matched cohorts.
A PS-matched cohort of 731 patients (mean [SD] age, 67.9 [14.8] years; 437 [59.8%] male) with melanoma from 2018 to 2019 and 731 patients (mean [SD] age, 67.9 [14.4] years; 440 [60.2%] male) from 2007 to 2012 were evaluated. The 2018 to 2019 patients had greater mean (SD) health care (including systemic therapy) costs compared with the 2007 to 2012 patients ($47 886 [$55 176] vs $33 347 [$31 576]), specifically for stage III ($67 108 [$57 226] vs $46 511 [$30 622]) and stage IV disease ($117 450 [$79 272] vs $47 739 [$37 652]). Mean (SD) systemic therapy costs were greater among 2018 to 2019 patients: stage II ($40 823 [$40 621] vs $10 309 [$12 176]), III ($55 699 [$41 181] vs $9764 [$12 771]), and IV disease ($79 358 [$50 442] vs $9318 [$14 986]). Overall survival was greater for the 2018 to 2019 cohort compared with the 2007 to 2012 cohort (3-year OS: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%], hazard ratio, 0.72 [95% CI, 0.61-0.85]; P < .001). Time toxicity was similar between eras. Patients with stage IV disease spent more than 1 day per week (>52 days) with physical contact with the health care system by 2018 to 2019 (mean [SD], 58.7 [43.8] vs 44.2 [26.5] days; standardized difference, 0.40; P = .20).
This cohort study found greater health care costs in the treatment of stages II to IV melanoma and substantial time toxicity for patients with stage IV disease, with improvements in OS associated with the adoption of immunotherapy and targeted therapies. These health system-wide data highlight the trade-off with adoption of new therapies, for which there is a greater economic burden to the health care system and time burden to patients but an associated improvement in survival.

Changes in Health Care Costs, Survival, and Time Toxicity in the Era of Immunotherapy and Targeted Systemic Therapy for Melanoma.

Changes in Health Care Costs, Survival, and Time Toxicity in the Era of Immunotherapy and Targeted Systemic Therapy for Melanoma

Papers