title: Burden of illness associated with metastatic melanoma: an audit of 100 consecutive referral center cases.
abstract: BACKGROUND
  Although long-term survival in patients with metastatic melanoma (MM) is infrequent, response to a variety of cytotoxic and immunotherapies occurs and survival varies based on the site of metastases. Because different patterns of care of MM are likely to vary substantially in their intensity and resource use, the authors audited care at a regional referral center.
  
  
  METHODS
  The records of 100 consecutive new patients with MM who presented at the University of Pittsburgh Cancer Institute (UPCI) after January 1997 were audited. Demographics, disease sites, and treatment prior to presentation at UPCI as well as the diagnostic and therapeutic methods undertaken at UPCI were tracked monthly with regard to inpatient and outpatient activity.
  
  
  RESULTS
  The median age of the patient cohort was 51 years was a median 2.2 years after the time of initial diagnosis. Eighty-two percent of the patients had died and only 8% had been lost to long-term follow-up. Eighty-seven percent of patients had been referred to UPCI and 28% had received some treatment prior to presenting at UPCI. The median survival was 9.0 months. The lung was the most common symptomatic site and 38% of patients developed central nervous system (CNS) metastases. Eighty-four percent of patients initially were treated on a research protocol 30% of whom were part of a Phase III study. Twenty-nine percent of the patients were never hospitalized. The most common reason for hospitalization was elective treatment with high-dose interleukin-2. Lifetime hospital days averaged only 7.3 days. Therapeutic actions (if ever given) by category type were surgery in 23% of patients, radiation therapy in 44%, immunotherapy in 75%, and chemotherapy in 51%. Using assigned values for the identified resources used, the approximate cost per patient averaged $59,400.
  
  
  CONCLUSIONS
  The current audit of MM patients demonstrated that lung and CNS metastases dominate a broad variety of complications, that clinical trial participation was the norm, that hospitalizations occurred relatively infrequently, and that the direct health care costs of current treatment patterns are among the highest for all malignancies. Medical auditing of contemporary American cancer care provides meaningful insights into its patterns of care.
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Medical College of Virginia Campus at Virginia Commonwealth University, Richmond, Virginia 23298-0170, USA. hillner@hsc.vcu.edu
authors.forename: B E
authors.initials: BE
authors.lastname: Hillner
authors.forename: J M
authors.initials: JM
authors.lastname: Kirkwood
authors.forename: S S
authors.initials: SS
authors.lastname: Agarwala
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002493:Central Nervous System Diseases / Q000209:etiology; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008545:Melanoma / Q000191:economics* / Q000401:mortality; D008875:Middle Aged; D015996:Survival Rate