Health-related Quality of Life and hospital costs of Finnish melanoma patients participating in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II)
DOI:
https://doi.org/10.2340/1651-226X.2025.42314Keywords:
Malignant melanoma, sentinel lymph node biopsy, lymph node excision, lymph node dissection, lymphedema quality of life inventory, cost analysis, health care costs, cost of care, Secondary lymphedemaAbstract
Background and purpose: After reports that complete lymph node dissection (CLND) did not improve melanoma-specific survival of sentinel lymph node (SLN)-positive patients, the use of CLND has diminished but it is still carried out for selected patients. We sought to assess differences in Health-Related Quality of Life (HRQoL) and tertiary care costs among the Finnish Multicenter Selective Lymphadenectomy Trial (MSLT)-II-patients.
Patients/materials and methods: A total of 52 patients randomized to CLND and 55 to nodal observation completed a modified version of the standardized and validated, RAND-36 questionnaire at baseline, 4 months and annually up to 5 years. Tertiary care costs between the groups were also compared.
Results: At 60 months, the mean HRQoL score for the CLND and observation groups for General Health were 77.3 versus 65.0 (p = 0.007, adjusted p = 0.065), for role limitations due to physical health 89.5 versus 72.3 (p = 0.029, adjusted p = 0.203) and for role limitations due to emotional problems 91.4 versus 71.9 (p = 0.006, adjusted p = 0.065) and at 48 months, 92.8 versus 71.3 (p = 0.002, adjusted p = 0.056). Median costs per patient were higher in the CLND group at 4 months but the difference disappeared during follow-up.
Interpretation: This study suggests that undergoing CLND after a positive SLN biopsy is not a predictor of worse HRQoL. CLND generates greater costs initially, but there seem to be no major differences in total cost per patient between the two groups.
Downloads
References
Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–222.
https://doi.org/10.1056/NEJMoa1613210 DOI: https://doi.org/10.1056/NEJMoa1613210
Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757–67.
https://doi.org/10.1016/S1470-2045(16)00141-8 DOI: https://doi.org/10.1016/S1470-2045(16)00141-8
Leonard LD, Beaty L, Thomas M, Quinn C, Colborn KL, de Araujo TB, et al. Unmeasured factors are associated with the use of completion lymph node dissection (CLND) in melanoma. J Surg Oncol. 2023;127(4):716–26.
https://doi.org/10.1002/jso.27153 DOI: https://doi.org/10.1002/jso.27153
Bredbeck BC, Mubarak E, Zubieta DG, Tesorero R, Holmes AR, Dossett LA, et al. Management of the positive sentinel lymph node in the post-MSLT-II era. J Surg Oncol. 2020;122(8):1778–84.
https://doi.org/10.1002/jso.26200 DOI: https://doi.org/10.1002/jso.26200
Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10(6):676–80.
https://doi.org/10.1245/ASO.2003.10.001 DOI: https://doi.org/10.1245/ASO.2003.10.001
Faries MB, Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol. 2010;17(12):3324–9.
https://doi.org/10.1245/s10434-010-1203-0 DOI: https://doi.org/10.1245/s10434-010-1203-0
Bello DM, Faries MB. The landmark series: MSLT-1, MSLT-2 and DeCOG (management of lymph nodes). Ann Surg Oncol. 2020;27(1):15–21.
https://doi.org/10.1245/s10434-019-07830-w DOI: https://doi.org/10.1245/s10434-019-07830-w
de Vries M, Hoekstra HJ, Hoekstra-Weebers, JE Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma. Ann Surg Oncol. 2009;16:2840–7.
https://doi.org/10.1245/s10434-009-0602-6 DOI: https://doi.org/10.1245/s10434-009-0602-6
Burke EE, Portschy PR, Tuttle TM, Kuntz KM. Completion lymph node dissection or observation for melanoma sentinel lymph node metastases: a decision analysis. Ann Surg Oncol. 2016;23(9):2772–8.
https://doi.org/10.1245/s10434-016-5273-5 DOI: https://doi.org/10.1245/s10434-016-5273-5
Hays, RD, Sherbourne CD, Mazel RM. User’s manual for the medical outcomes study (MOS) core measures of health-related quality of life. Santa Monica (CA): RAND Corporation; 1995.
Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Econ. 1993;2(3):217–27.
https://doi.org/10.1002/hec.4730020305 DOI: https://doi.org/10.1002/hec.4730020305
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.
https://doi.org/10.1097/00005650-199206000-00002 DOI: https://doi.org/10.1097/00005650-199206000-00002
RAND Health Care. 36-Item Short Form Survey (SF-36) scoring instructions [Internet]. Available from:
https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html [Cited: December 2, 2024]
de Vries M, Vonkeman WG, van Ginkel RJ, Hoekstra HJ. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006;32(7):785–9.
https://doi.org/10.1016/j.ejso.2006.05.003 DOI: https://doi.org/10.1016/j.ejso.2006.05.003
Theodore JE, Frankel AJ, Thomas JM, Barbour P, Bayley GJ, Allan CP, et al. Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma. ANZ J Surg. 2017;87(1–2):44–8.
https://doi.org/10.1111/ans.13526 DOI: https://doi.org/10.1111/ans.13526
Guggenheim MM, Hug U, Jung FJ, Rousson V, Aust MC, Calcagni M, et al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008;247(4):687–93.
https://doi.org/10.1097/SLA.0b013e318161312a DOI: https://doi.org/10.1097/SLA.0b013e318161312a
Gjorup CA, Groenvold M, Hendel HW, Dahlstroem K, Drzewiecki KT, Klausen TW, et al. Health-related quality of life in melanoma patients: impact of melanoma-related limb lymphoedema. Eur J Cancer. 2017;85:122–32.
https://doi.org/10.1016/j.ejca.2017.07.052 DOI: https://doi.org/10.1016/j.ejca.2017.07.052
Heino P, Mylläri P, Jahkola T, Luoma ML, Räsänen P, Roine RP. Surgery, limb edema and health-related quality of life: a prospective follow-up study on patients with cutaneous malignant melanoma. Anticancer Res. 2022;42(11):5507–19.
https://doi.org/10.21873/anticanres.16056 DOI: https://doi.org/10.21873/anticanres.16056
Rautalin M, Jahkola T, Roine RP. Breast reconstruction-prospective follow up on breast cancer patients’ health-related quality of life. World J Surg. 2022;46(4):836–44.
https://doi.org/10.1007/s00268-021-06426-4 DOI: https://doi.org/10.1007/s00268-021-06426-4
Cornish D, Holterhues C, van de Poll-Franse LV, Coebergh JW, Nijsten T. A systematic review of health-related quality of life in cutaneous melanoma. Ann Oncol. 2009;20(Suppl 6):vi51–8.
https://doi.org/10.1093/annonc/mdp255 DOI: https://doi.org/10.1093/annonc/mdp255
Heino PJ, Mylläri PH, Jahkola TA, Sintonen H, Luoma ML, Räsänen P, et al. Long-term quality of life of melanoma survivors is comparable to that of the general population. Anticancer Res. 2019;39(5):2633–40.
https://doi.org/10.21873/anticanres.13387 DOI: https://doi.org/10.21873/anticanres.13387
Naeser Y, Helgadottir H, Hansson J, Ingvar C, Elander NO, Flygare P. Quality of life in the first year of follow-up in a randomized multicenter trial assessing the role of imaging after radical surgery of stage IIB-C and III cutaneous melanoma (TRIM Study). Cancers (Basel). 2022;14(4):1040.
https://doi.org/10.3390/cancers14041040 DOI: https://doi.org/10.3390/cancers14041040
Rowsell A, Sodergren SC, Vassiliou V, Darlington AS, Guren MG, Alkhaffaf B, et al. Systematic review of health-related quality of life (HRQoL) issues associated with gastric cancer: capturing cross-cultural differences. Gastric Cancer. 2022;25(4):665–677. Epub 2022 Jun 11. Erratum in: Gastric Cancer. 2023;26(1):167. DOI: https://doi.org/10.1007/s10120-022-01309-6
https://doi.org/10.1007/s10120-022-01346-1 DOI: https://doi.org/10.1007/s10120-022-01346-1
Revicki DA, Kaplan RM. The relationship between health-related quality of life and economic outcomes: the case of cost-utility analysis. Health Econ. 1993;2(1):95–9.
https://doi.org/10.1007/BF00422222 DOI: https://doi.org/10.1007/BF00422222
Downloads
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Pia J. Heino, Jukka Pappinen, John F. Thompson, Micaela Hernberg, Tiina A. Jahkola, Mark B. Faries
This work is licensed under a Creative Commons Attribution 4.0 International License.
