Integrated follow-up for melanoma: results of an exploratory randomised trial in primary care

Introduction Traditionally routine follow-up for people treated for cutaneous melanoma is delivered in secondary care. Such services will becoming increasingly burdensome for the NHS as the incidence of melanoma rises and it is detected earlier. It may be that a system of routine follow-up for people with cutaneous melanoma delivered in primary care by trained general practitioners could offer advantages to patients, professionals and the NHS. The authors addressed this question in a randomised trial in northeast Scotland. Methods An integrated programme of GP led routine melanoma follow-up was developed over 18 months. Methods employed included an expert steering group, semi-structured interviews with potential recipients and deliverers, and a piloting exercise carried out at two general practices. The final intervention that proceeded to trial comprised a GP training package, a tailored programme of patient education, a centralised recall system, protocol driven reviews by GPs and a rapid access pathway to secondary care. 35 general practices and 142 eligible patients from northeast Scotland were recruited to the study. 17 practices were cluster randomised to intervention and 18 to control. From each intervention practice a GP received training in the delivery of integrated melanoma follow-up. Following baseline data collection by GP case note review and participant questionnaire, patients in the intervention group (n=53) received structured follow-up from a GP at their own practice (three or six monthly according to local guidelines) for one year. Those in the control group (n=89) continued to attend the hospital melanoma clinic. Outcome data were collected after one year from general practice casenotes and a postal questionnaire to participants. Results During the study year there were two recurrences of melanoma, (one intervention, one control). Both were detected by GPs. One new primary was detected at GP follow-up in the intervention group. Satisfaction improved between baseline and outcome in the intervention group in 11 out of 15 domains of a patient satisfaction questionnaire. Depression and anxiety did not appear to increase in the intervention group. Conclusions GP led routine follow-up for cutaneous melanoma appears to be preferred by patients, and at least in the short term does not result in adverse outcomes.