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Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses
OBJECTIVE: Assess current clinical practices for uveal melanoma (UM) and the impact of molecular prognostic testing on treatment decisions. DESIGN: Cross-sectional survey and sequential medical records review. PARTICIPANTS: Ophthalmologists who treat UM. METHODS: (A) Medical records review of all Me...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262218/ https://www.ncbi.nlm.nih.gov/pubmed/25587217 http://dx.doi.org/10.2147/OPTH.S70839 |
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author | Aaberg, Thomas M Cook, Robert W Oelschlager, Kristen Maetzold, Derek Rao, P Kumar Mason, John O |
author_facet | Aaberg, Thomas M Cook, Robert W Oelschlager, Kristen Maetzold, Derek Rao, P Kumar Mason, John O |
author_sort | Aaberg, Thomas M |
collection | PubMed |
description | OBJECTIVE: Assess current clinical practices for uveal melanoma (UM) and the impact of molecular prognostic testing on treatment decisions. DESIGN: Cross-sectional survey and sequential medical records review. PARTICIPANTS: Ophthalmologists who treat UM. METHODS: (A) Medical records review of all Medicare beneficiaries tested by UM gene expression profile in 2012, conducted under an institutional review board-approved protocol. (B) 109 ophthalmologists specializing in the treatment of UM were invited to participate in 24-question survey in 2012; 72 were invited to participate in a 23-question survey in 2014. MAIN OUTCOME MEASURES: Responses analyzed by descriptive statistics, frequency analyses (percentages, Tukey, histograms), and Fisher’s exact test. Descriptive presentation of essay answers. RESULTS: The review of Medicare medical records included 191 evaluable patients, 88 (46%) with documented medical treatment actions or institutional policies related to surveillance plans. Of these 88, all gene expression profiling (GEP) Class 1 UM patients were treated with low-intensity surveillance. All GEP Class 2 UM patients were treated with high-intensity surveillance (P<0.0001 versus Class 1). There were 36 (19%) with information concerning referrals after initial diagnosis. Of these 36, all 23 Class 2 patients were referred to medical oncology; however, none of the 13 Class 1 patients were referred (P<0.0001 versus Class 1). Only Class 2 patients were recommended for adjunctive treatment regimens. 2012 survey: 50 respondents with an annual median of 35 new UM patients. The majority of respondents (82%) performed molecular analysis of UM tumors after fine needle biopsy (FNAB); median: 15 FNAB per year; 2014 survey: 35 respondents with an annual median of 30 new UM patients. The majority offered molecular analyses of UM tumor samples to most patients. Patients with low metastatic risk (disomy 3 or GEP Class 1) were generally assigned to less frequent (every 6 or 12 months) and less intensive clinical visits. Patients with high metastatic risk (monosomy 3 or GEP Class 2) were assigned to more frequent surveillance with hepatic imaging and liver function testing every 3–6 months. High-risk patients were considered more suitable for adjuvant treatment protocols. CONCLUSION: The majority of ophthalmologists treating UM have adopted molecular diagnostic tests for the purpose of designing risk-appropriate treatment strategies. |
format | Online Article Text |
id | pubmed-4262218 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-42622182015-01-13 Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses Aaberg, Thomas M Cook, Robert W Oelschlager, Kristen Maetzold, Derek Rao, P Kumar Mason, John O Clin Ophthalmol Original Research OBJECTIVE: Assess current clinical practices for uveal melanoma (UM) and the impact of molecular prognostic testing on treatment decisions. DESIGN: Cross-sectional survey and sequential medical records review. PARTICIPANTS: Ophthalmologists who treat UM. METHODS: (A) Medical records review of all Medicare beneficiaries tested by UM gene expression profile in 2012, conducted under an institutional review board-approved protocol. (B) 109 ophthalmologists specializing in the treatment of UM were invited to participate in 24-question survey in 2012; 72 were invited to participate in a 23-question survey in 2014. MAIN OUTCOME MEASURES: Responses analyzed by descriptive statistics, frequency analyses (percentages, Tukey, histograms), and Fisher’s exact test. Descriptive presentation of essay answers. RESULTS: The review of Medicare medical records included 191 evaluable patients, 88 (46%) with documented medical treatment actions or institutional policies related to surveillance plans. Of these 88, all gene expression profiling (GEP) Class 1 UM patients were treated with low-intensity surveillance. All GEP Class 2 UM patients were treated with high-intensity surveillance (P<0.0001 versus Class 1). There were 36 (19%) with information concerning referrals after initial diagnosis. Of these 36, all 23 Class 2 patients were referred to medical oncology; however, none of the 13 Class 1 patients were referred (P<0.0001 versus Class 1). Only Class 2 patients were recommended for adjunctive treatment regimens. 2012 survey: 50 respondents with an annual median of 35 new UM patients. The majority of respondents (82%) performed molecular analysis of UM tumors after fine needle biopsy (FNAB); median: 15 FNAB per year; 2014 survey: 35 respondents with an annual median of 30 new UM patients. The majority offered molecular analyses of UM tumor samples to most patients. Patients with low metastatic risk (disomy 3 or GEP Class 1) were generally assigned to less frequent (every 6 or 12 months) and less intensive clinical visits. Patients with high metastatic risk (monosomy 3 or GEP Class 2) were assigned to more frequent surveillance with hepatic imaging and liver function testing every 3–6 months. High-risk patients were considered more suitable for adjuvant treatment protocols. CONCLUSION: The majority of ophthalmologists treating UM have adopted molecular diagnostic tests for the purpose of designing risk-appropriate treatment strategies. Dove Medical Press 2014-12-03 /pmc/articles/PMC4262218/ /pubmed/25587217 http://dx.doi.org/10.2147/OPTH.S70839 Text en © 2014 Aaberg Jr et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Aaberg, Thomas M Cook, Robert W Oelschlager, Kristen Maetzold, Derek Rao, P Kumar Mason, John O Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title | Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title_full | Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title_fullStr | Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title_full_unstemmed | Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title_short | Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
title_sort | current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262218/ https://www.ncbi.nlm.nih.gov/pubmed/25587217 http://dx.doi.org/10.2147/OPTH.S70839 |
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