Poster Presentation FCIC Survivorship Conference 2013

How good is the guidance for cutaneous melanoma follow- up? A systematic review of clinical practice guidelines (#77)

Jackie Street 1 , Nino Marciano 1 , Tracy Merlin 2 , Taryn Bessen 1
  1. School of Population Health, University of Adelaide, Adelaide, SA, Australia
  2. Adelaide Health Technology Assessment, University of Adelaide, Adelaide, SA, Australia

Background: Clinical practice guidelines are produced to assist clinicians in making evidence-based choices for patient care. We were interested in determining the extent of evidence-based support for recommended patterns of follow-up for melanoma survivors with a history of melanoma and whether this differs according to guideline quality.

Materials and Methods: Guidelines that provide recommendations regarding patient follow-up or surveillance were identified through electronic database searches and appraised using the AGREE II instrument. Evidence relating to melanoma follow-up recommendations in each of the guidelines was reviewed.
 Guidelines from the USA, Canada, UK, Europe and Australia/New Zealand were included in the study. 

Results: Most guidelines performed well in ‘clarity of presentation’ and poorly in terms of ‘applicability’. ‘Rigour of development’ scores were highly variable. Despite the availability of clear frameworks for guideline development, methodological quality of recently published guidelines is similar to older guidelines. Most guideline recommendations concerning the follow-up of melanoma patients were based on low-level evidence or consensus expert opinion. There was considerable variability between guidelines as to what constituted ‘best care’ in melanoma follow-up.

Conclusions: The variable methodological quality of guidelines for melanoma follow-up could be improved by attention to the criteria ascribed in AGREE II. Clinicians should be aware of how scant the evidence base is for many of the recommended courses of action and that this can lead to considerable variability in the guidance that is provided and potentially in the quality of care provided to melanoma survivors.