Quality of Life Following Sentinel Node Biopsy for Primary Cutaneous Melanoma: Health Economic Implications.
BACKGROUND
Sentinel node biopsy (SNB) is commonly performed in contemporary melanoma management, however there is a paucity of long-term quality of life (QoL) estimates required for economic evaluation of this treatment.


METHODS
A single-center, prospective, cross-sectional study of adults with American Joint Committee on Cancer stage I/II/IIIA melanoma of the limbs, trunk, or neck who had undergone wide excision and SNB, but not complete regional node dissection, was undertaken. Limb volume was measured using perometry, with lymphedema defined as a ≥10% volume increase in the ipsilateral limb compared with the contralateral limb. The Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire measured QoL. Associations between patient and treatment characteristics were assessed using linear regression.


RESULTS
Among 694 patients (median time from SNB of 37 months), 14 (2%) had objectively measured lymphedema (i.e. an increase in limb volume of ≥10%). Of 687 stage I/II patients with complete QoL data, the mean weighted QoL was 0.745 (standard deviation 0.04) on a 0-1 scale (i.e. death to full health). In multivariable analysis, weighted QoL was 0.0004 higher for each year of increasing age (p = 0.001); 0.011 lower for females (p = 0.001), 0.018 lower following post-SNB limb trauma (p = 0.002); 0.252 lower for patients who perceived a large increase in limb size (p = 0.015); and 0.027 lower with self-reported difficulty in walking, running, or climbing stairs (p = 0.043).


CONCLUSIONS
Our data suggest that very few patients treated at our institution had lymphedema in the long-term following SNB, with weighted QoL strongly associated with perceived rather than actual changes in limb size.
NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia. rachael.morton@sydney.edu.au.
Rachael L
RL
Morton
NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
Anh
A
Tran
Graduate Program, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Johan Yusof
JY
Vessey
NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
Nick
N
Rowbotham
Patricia Ritchie Centre, The Mater Hospital, University of Sydney, Sydney, NSW, Australia.
Julie
J
Winstanley
Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Kerwin
K
Shannon
Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Andrew J
AJ
Spillane
Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Jonathan
J
Stretch
Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
John F
JF
Thompson
Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Robyn P-M
RP
Saw
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D012878:Skin Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma