Treatment of malignant melanoma in certified cancer centres and its relationship to survival

BackgroundHospital certification programs in Germany aim to improve the quality of cancer care. Previous research indicates that treatment in certified cancer centres leads to better overall and disease-free survival compared to non-certified hospitals for various cancers. Skin cancer, however, has not been investigated in this regard. ObjectivesTo test the hypothesis that treatment of melanoma in a certified cancer centre is related to survival benefits. MethodsData from clinical cancer registries in Germany were analysed. The analytical sample included n = 47,924 patients diagnosed with malignant melanoma between 2000 and 2022. Mixed-effects Cox regression models, adjusted for demographic and clinical confounders, were used to assess overall and disease-free survival. Hazard ratios (HR) with 95% confidence intervals (CI) are reported. ResultsThe proportion of patients treated in certified cancer centres increased over time to > 60 % from 2016 onward. Treatment in certified centres was associated with significant better overall survival (HR = 0.85, 95% CI = 0.82-0.88, p < 0.001). Results were statistically significant for stages I to III. For stage IV, the overall survival difference was not statistically significant, but subgroup analyses revealed a significant effect for cases diagnosed since 2011 (HR = 0.75, 95% CI = 0.61-0.91, p < 0.010). With regard to disease-free survival, multivariable analyses revealed better survival in certified centres (HR = 0.88, 95% CI = 0.85-0.92, p < 0.001). Similar results were observed across all subgroups stratified by stage of disease, except for stage IV. ConclusionsTreatment in certified cancer centres was associated with significant survival benefits for malignant melanoma patients, suggesting that the adherence to evidence-based quality standards improves patient outcomes. The fact that one in three patients has not been treated in certified cancer centres in recent years underscores the importance of expanding access to high-quality care. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=133 SRC="FIGDIR/small/26347792v1_ufig1.gif" ALT="Figure 1"> View larger version (27K): org.highwire.dtl.DTLVardef@7caac5org.highwire.dtl.DTLVardef@af7a1forg.highwire.dtl.DTLVardef@7aa859org.highwire.dtl.DTLVardef@c27dc4_HPS_FORMAT_FIGEXP M_FIG C_FIG Plain Language SummaryO_ST_ABSHow specialized cancer centres improve survival for melanoma patientsC_ST_ABSThis study examined whether treatment in certified cancer centres in Germany improves survival outcomes for patients with malignant melanoma, a type of skin cancer. Using data from nearly 50,000 patients diagnosed between 2000 and 2022, we compared survival rates between those treated in certified cancer centres and non-certified hospitals. Certified centres adhere to strict quality standards designed to enhance cancer care. The proportion of patients treated in certified centres increased significantly over time, from 22% in 2000 to over 60% after 2016. Patients treated in certified centres had better overall survival, with a 16% lower risk of death compared to those treated in non-certified hospitals. This survival benefit was consistent across early stages of melanoma (stages I-III) and cases with unknown stages. For patients with advanced stage IV melanoma, a positive effect of treatment in certified centres was only visible for diagnoses made since 2011. Disease-free survival, which measures the time patients remain cancer-free, was also better in certified centres, showing an 12% lower risk of recurrence or progression. The findings emphasize the critical role of certified cancer centres in improving outcomes for melanoma patients. Expanding access to these centres and ensuring adherence to high-quality treatment protocols could further enhance survival rates and reduce disease recurrence, particularly for patients diagnosed at earlier stages. Key pointsO_ST_ABSWhy was the study undertaken?C_ST_ABSExisting evidence suggests that treatment in certified centres leads to better survival compared to non-certified hospitals. Using data from clinical cancer registries in Germany, this study aims to evaluate whether these benefits extend to malignant melanoma. What does this study add?Treatment in certified cancer centres is associated with significant survival benefits for malignant melanoma patients, with effects particularly pronounced for patients diagnosed at earlier stages. What are the implications of this study for disease understanding and/or clinical care?The findings underscore the importance of expanding access to certified care and ensuring adherence to high-quality treatment protocols in order to ensure equitable care for all patients.