Poster Presentation NSW State Cancer Conference 2023

Impact of an Online Risk Prediction Tool for Sentinel Node Positivity on Clinical Decision Making in Melanoma Care: A Mixed Methods Study (#276)

Rehana A Salam 1 , Anne Cust 1 2 3 , Andrea Smith 1 4 , Richard Scolyer 3 , Georgina Long 3 , Caroline Watts 1
  1. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia, Sydney
  2. University of Sydney, Camperdown, NSW, Australia
  3. Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia, Sydney
  4. Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia, Sydney

INTRODUCTION: Sentinel lymph node biopsy (SLNB) plays an important role in staging and prognostic assessment of patients with melanoma and with the evolving landscape of systemic adjuvant therapy, SLNB has become crucial in guiding patient management. The Melanoma Institute Australia (MIA) has recently developed an externally validated risk prediction tool using an updated and refined set of clinico-pathological parameters that estimates the probability of sentinel node positivity.

METHODS: The aim of the study is to understand how clinicians and patients in Australia are using the tool and to assess its influence on clinical decision making with regards to referrals for SLNB in patients with early (stage I or II) melanoma using a mixed method approach. 61 participants (clinicians=52 and patients/carers=9) completed an online questionnaire, and a subgroup (n=14) took part in interviews from April 2022 to April 2023. Online questionnaire data were analysed descriptively and thematic analysis of the qualitative data was conducted.

RESULTS: Participants included general practitioners in skin care clinics (51%), surgeons (23%), general practitioners (6%), dermatologists (2%) and others (3%); patients/carers constituted 15% of the total participants. From the questionnaire, 40% of the clinicians suggested that the online tool has led to increased referrals or performance of SLNB while 33% suggested that there has been no change in their practice regarding SLNB. SLNB recommendation differed by risk level: 79% clinicians suggested that they would not recommend SLNB for <5% risk; 90% suggested that they would discuss it in a neutral way with their patients for risks between 5 to 10%; while 84% and 96% suggested that would recommend SLNB for risks between 10-20% and >20% respectively. Qualitative analysis showed the risk prediction tool assisted clinicians in communication and guide the discussion regarding SLNB with patients. However, clinicians also expressed confusion and uncertainty in interpreting the risk scores in cases with wide confidence intervals. Majority of the clinicians mentioned their clinical decision making regarding SLNB is still highly influenced by previous guidelines, histological characteristics of the tumour, age and co-morbidities of the patient, and whether or not the procedure would be acceptable to the patient.

CONCLUSION: An online risk prediction tool for SLNB might have led to increased discussions about biopsies. However, the clinicians are still highly influenced by the guidelines and clinical characteristics when making clinical decisions regarding referrals and performance of sentinel lymph node biopsies.

  1. Lo SN, Ma J, Scolyer RA, Haydu LE, Stretch JR, Saw RP, Nieweg OE, Shannon KF, Spillane AJ, Ch’ng S, Mann GJ. Improved risk prediction calculator for sentinel node positivity in patients with melanoma: the melanoma institute Australia nomogram. Journal of Clinical Oncology. 2020 Aug 8;38(24):2719.