Strengthening multidisciplinary collaboration to enhance early-stage melanoma outcomes: A quality improvement initiative.

Abstract

e21574 Background: Guideline recommendations for adjuvant systemic treatment in stages II or III cutaneous melanoma include assessment for immunotherapy (IO) for stages IIB/C or III disease, and BRAF-targeted therapy for stage III disease. A high level of multidisciplinary collaboration can help guide appropriate treatment selection for patients with melanoma, particularly in under resourced community oncology settings. Methods: In 2024, 60 health care providers (HCPs) at 12 US community cancer clinics across a large oncology network completed baseline surveys to identify gaps in treatment decision-making and multidisciplinary care for early-stage melanoma. Chart reviews for 202 patients with early-stage disease assessed real-world practice patterns. Findings were presented at a network-wide practice summit attended by 203 HCPs, where action plans were developed to address identified gaps and align on key clinical practices. Results: Baseline surveys revealed barriers to IO integration in the community setting, including staying up to date on the latest clinical data (57%) and guidelines (43%), integrating biomarker testing results into decision making (27%), and recognizing and managing adverse events (17%). Although 90% of HCPs reported regular BRAF status assessment, only 32% of patient charts documented molecular testing. Chart reviews showed no documented first-line therapy for 49% of patients, while 37% received adjuvant IO and 3% received BRAF-targeted therapy. Only 24% of HCPs reported complete satisfaction (5 on 5-point Likert scale) with multidisciplinary coordination, with 61% reporting that improved collaboration would most improve melanoma care. Top barriers to multidisciplinary communication included a lack of interprofessional relationships, low frequency of communication, and lack of or infrequent tumor boards. Action plans included: adoption of reflex testing and reduction of turnaround times to improve molecular testing; increased use of individualized care plans and case reviews at tumor boards; and improved multidisciplinary workflows. Following action plan implementation, 100% of teams reported improved communication and collaboration across multidisciplinary teams. Additionally, 43% of providers increased biomarker testing, 29% integrated tumor boards into treatment planning, and 29% increased patient education and referrals for supportive care. Conclusions: Evidence-based integration of adjuvant therapies in early-stage melanoma is hampered by a need for HCP education on recent evidence and guidelines, suboptimal molecular testing, and poor multidisciplinary collaboration. Addressing these barriers through HCP education, reflex testing, tumor boards, and improved clinical and network-wide workflows can enhance care quality and ensure guideline adherence.