Impact of Adopting a Multidisciplinary Care Delivery Model on Treatment Effectiveness and Outcomes in Stage III...

Purpose Stage III melanoma represents a high-risk patient population, highlighting the need to implement strategies to prevent the onset of metastatic disease. This study evaluates the impact of systems of care, incorporating multidisciplinary care (MDC), nurse navigation, clinical trials, and early anti-PD1 immunotherapy use, on outcomes for this patient population. Patients and methods We conducted a retrospective chart review to evaluate the impact of an updated melanoma MDC program implemented at our institution in late 2016. This program facilitated access to nurse navigation, along with early PD-1 immunotherapy use and clinical trial enrollment, with the expectation of improved outcomes for our melanoma patients. Data were collected from 121 stage III melanoma patients treated at our institution between 2014 and 2019, divided into two cohorts: 2014-2016 (n = 66) and 2017-2019 (n = 55). Primary outcomes included three-year disease-free survival (DFS) and overall survival (OS). Secondary outcomes included disease recurrence rates and melanoma-related mortality. Results Implementation of an MDC model led to a significant increase in immunotherapy use, multidisciplinary visits, and nurse navigation. These combined factors resulted in a 30% increase in three-year DFS (from 48% to 78%, p = 0.001) and a 17% increase in three-year OS (from 63% to 80%, p = 0.04). There was a 30% decrease in stage III melanoma mortality (39% vs. 9%, p < 0.001). Conclusion Systematic sub-specialized care, nurse navigation, access to clinical trials, MDC care, and rapid adoption of advancements in the standard of care led to improved patient outcomes at our institution.