title: The MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients-Results after 1 Year.
abstract: Guidelines for evidence-based follow-up in melanoma patients are not available. This study examined whether a reduced follow-up schedule affects: patient-reported outcome measures, detection of recurrences, and follow-up costs.
  
  
  
  This multicenter trial included 180 patients treated for AJCC stage IB-II cutaneous melanoma, who were randomized in a conventional follow-up schedule group (CSG, 4 visits first year, n = 93) or experimental follow-up schedule group (ESG, 1-3 visits first year, n = 87). Patients completed the State-Trait Anxiety Inventory, cancer worry scale, impact of events scale, and a health-related quality of life questionnaire (HRQoL, RAND-36). Physicians registered clinicopathologic features and the number of outpatient clinic visits.
  
  
  
  Sociodemographic and illness-related characteristics were equal in both groups. After 1-year follow-up, the ESG reported significantly less cancer-related stress response symptoms than the CSG (p = 0.01), and comparable anxiety, mental HRQoL, and cancer-related worry. Mean cancer-related worry and stress response symptoms decreased over time (p < 0.001), whereas mental HRQoL increased over time (p < 0.001) in all melanoma patients. Recurrence rate was 9 % in both groups, mostly patient-detected and not physician-detected (CSG 63 %, ESG 43 %, p = 0.45). Hospital costs of 1-year follow-up were reduced by 45 % in the ESG compared to the CSG.
  
  
  
  This study shows that the stage-adjusted, reduced follow-up schedule did not negatively affect melanoma patients' mental well-being and the detection of recurrences compared with conventional follow-up as dictated by the Dutch guideline, at 1 year after diagnosis. Additionally, reduced follow-up was associated with significant hospital cost reduction.
authors.affiliation: Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Samantha
authors.initials: S
authors.lastname: Damude
authors.affiliation: Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Netherlands Comprehensive Cancer Organisation, Groningen, The Netherlands.
authors.forename: Josette E H M
authors.initials: JE
authors.lastname: Hoekstra-Weebers
authors.affiliation: Department of Surgical Oncology, Isala, Zwolle, The Netherlands.
authors.forename: Anne Brecht
authors.initials: AB
authors.lastname: Francken
authors.affiliation: Department of Dermatology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ter Meulen
authors.affiliation: Department of Surgical Oncology, University of Leiden, University Medical Center Leiden, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. h.j.hoekstra@umcg.nl.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001071:Appointments and Schedules; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000523:psychology* / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics / Q000556:secondary; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult