Sancy Leachman, MD, PhD, Discusses Her Early-Detection Outreach Effort for Melanoma

Sancy Leachman, MD, PhD, from Oregon Health & Science University, discusses multidisciplinary management, as well as her state-wide outreach effort in Oregon titled “War on Melanoma” and what she sees for the future of the project at the 16th International Congress of the Society for Melanoma Research (SMR), held November 20-23, in Salt Lake City.

Transcription:
Multidisciplinary management, I think, is really the gold standard. It’s state of the art for the way that the patient is going to get the best care, the highest quality care overall. And the reason for that is because each discipline plays a part, so whether you’re dermatology, or surgical oncology, or medical oncology, each of those fields have specialized knowledge that can really help the patient and if you don’t work together as a multidisciplinary team, if the oncologist is operating outside of the realm of understanding how to look at the skin lesions like the dermatologist can do, that’s a problem. If the dermatologists don’t know when to refer to a medical oncologist or a surgical oncologist, that’s a problem. And what happens is, that the patients just don’t get the best care if you don’t operate as a functional team. And it doesn’t mean that the team has to be all in one place, every day, all of the time. But there has to be really a team-based approach where they’re communicating all of the time, and especially communicating about the challenging cases. So, I think that’s the main reason is to raise the bar for patient care, that’s what multidisciplinary care does for each individual patient.

You think about melanoma as being something that’s only a portion of the care that dermatologists do, or a portion of the care that a general surgical oncologist would do, or the portion of care that a general medical oncologist would do, and when you have a melanoma patient come in and it’s only one portion, there’s no way that a generalist is going to be able to have the same level of knowledge of advanced therapeutics and advanced techniques, advanced imaging methods, all of that as a subspecialist in that area, and how do you then communicate that information that’s very sophisticated information. And so, if the people that have the knowledge of that aren’t in regular communication in a sort of formalized way, then the chances that things are just going to slip through the cracks is elevated a lot more than if you’re functioning as that team. So, I think a team-based approach is critical, but it’s not easy, it’s really hard to do and it’s hard to do really well. And what happens is, at the end of the day, when it’s really brilliant, when it’s really functioning well, what you have is people who truly trust each other. Where they trust each other to have that specialized body of knowledge that each specialty brings to the table and listens so that the patient benefits. And that’s when it really, you feel like everything is working the best it can work.

In most cases, the best place for multidisciplinary care is, like I said, it’s with the most challenging cases, the ones where there’s maybe not a right or wrong answer, maybe they’ve gotten to the end of the road in terms of standard therapeutics and still the cancer’s progressing. And at that point, it’s really important to incorporate clinical trials. And again, that’s where a multidisciplinary team can really start to put people into the right place at the right time with the right person for the right care. And that’s really important.

You know a lot of times in melanoma care dermatology is an outpatient specialty really. Most of the patients that are seen in dermatology are seen in a private clinic that’s siloed away from the operating room of the surgeon, or the infusion center of the medical oncologist, and so if you don’t have a concerted effort to bring dermatology in, then even though dermatology sees the vast majority of melanoma patients, right, compared to surgical and medical oncology, most people are in that dermatology phase, their knowledge doesn’t get incorporated unless you superimpose some structure and make sure that it happens.

The SMR, the thing that’s special about the SMR is that all of these multidisciplinary individuals are embraced. And so, there’s a spot for anybody who’s doing good science to come in and hear what state of the art really is. So if you’re a dermatologist like I am and you’re not hearing the latest greatest of what’s happening in clinical trial development, you can come to the SMR and hear unpublished data and ideas and the next generation of plans for what’s going to happen in medical oncology, and in surgical oncology, and so it’s pretty spectacular to have a conference where all of these different disciplines are represented and the expectation is that you don’t just come with the best science you’ve got, you come with the stuff that’s not yet published. The stuff that you can’t get outside of a meeting or you have interaction one on one with the speakers and the other participants. And so, it really is, it’s an opportunity to add that human element to that cutting-edge science that hasn’t yet been published. That makes it easier to learn in a lot of ways. Don’t we all learn better by experiencing it rather than just reading it on a piece of paper or computer screen? So I think there’s a lot of levels of how a conference is very vital to bringing the community together, to bringing the interactions of the people together, building better multidisciplinary teams, presenting the state of the art, cutting edge data in each of those disciplines so that you get a chance to hear it, and then learning it in a way that really sticks so that you can take it back with you to your home department, your home institution, and transmit the knowledge in a way, again, that is so important for patient care. Because that, again, is the only way that patients are really going to get the best that we’ve got to give is that we know what the best we have is. And that’s what the conference really does bring.

Well I was very excited to present this year because we have started a thing called “War on Melanoma” in Oregon. It’s a state-wide outreach effort to try to enhance early detection of melanoma, and it’s built, the foundation of it was built on a replication of an experiment like this, a public health experiment that they did in Schleswig-Holstein in Germany. And what we’ve done is sort of extend it, modify it, make it hopefully a little bit more rigorous, and we’re doing, it’s very exciting because what we’re doing is, we’re hitting, we did some baseline surveys so that we knew where everybody stands. We did it throughout the entire state of Oregon, and then we used control states of Washington state and Utah. And so we have a baseline of everybody in terms of what their knowledge about melanoma is, about what their, if they are doing self-skin exams or have the intention to ever do self-exams, and if they saw something on a self-exam, what would they do about it, would they go and seek care, and that sort of gives us an idea into where we stand at baseline. Now, on May 18th, this year, we launched this massive outreach program to try to encourage early detection and it’s got four elements. The first is a general marketing campaign and it’s called, “Start Seeing Melanoma.” You can go to startseeingmelanoma.com. It’s got billboards and all kinds of you know, radio, and television, and social media, and all of that, and that’s for the general public, right? But it also has a branch for patients and lay-people who have had friends or family members that want to be more focused on really trying to get the message. And it’s like a network, we have about 4,000 people in Oregon that have signed up for this that are out there helping be ambassadors, hometown heroes, people that are helping us to get the word out and amplify it to the general public, right? We’re trying to get it to the people who don’t care, because that’s the way you’re going to actually improve things, right? Then, so that was the first and the second, the third focus of the campaign is on massage therapists, hairdressers, and tattoo artists, and people who see more skin than all of the doctors combined. There’s 40,000 licensed skin-care professionals and we have a thing that we’re working with “Impact Melanoma” that’s out in Boston that’s a foundation, and they’ve put together a program called “Skinny on Skin.” And we’ve worked with them to make it, to adapt it for this purpose. We’re training people, and it’s important right, because they see tons of skin, but how do you not exceed your scope of practice, how do you talk about this with a client in a way that doesn’t, isn’t verging on diagnosis and doesn’t offend that person, that does it in a really positive way, so it helps to take them through that process, as well as, you know, teach them about what a melanoma looks like. And so that’s the first three, and then the last is to educate providers. So primary care providers don’t get very much dermatology experience in medical school at all, and once they graduate there’s no more education of skin, right? And melanoma’s only a small part of skin. And so, there’s just not a lot, there’s not a lot of education, so we’ve created all these free CME courses both online and in person with workshops that the PCPs and other providers who are interested in really learning about that can do it. So, the idea is that we’ve crossed the entire spectrum. All the way from people who really don’t even care about skin or skin cancer, all the way to people who have the opportunity to really identify things. Now, we’ve had that going since May, and so what I did in our presentation today was to present the data, the unpublished data of what came for each of those categories. And then of course, the long range goal is that after about five years, we believe that we’ll be able to have proven that this campaign was good, that it reached enough people, that if the message of early detection was successfully distributed across the entire state, and that we would be able to tell by whether people changed that survey from baseline, right? Whether or not we caught more melanoma’s early and saved lives? So, we’ll be able to see, did we reduce the mortality due to melanoma because we were able to catch it earlier? And we’ll see if we decreased the cost, because the cost of care of melanoma at the in-stage is really really high. And if you catch it early, it’s not that much. So, you don’t have to move many people from that really life threatening stage into the stage where you can cure it for it to make a huge difference in terms of quality of life, quantity of life, and cost to society. So, I’m excited about it, I think it’s great, and I think, you know, we got great response from people. Got a lot of questions after the session from all types of people from all over the world and I’m hoping to engage with as many people who want to take advantage of this, because we’re very open to sharing and to letting people brand our materials for themselves or whatever they need to do to make it happen in their community as well.

One of the things that we’ve seen, we’ve put out 16 million impressions in social media and billboards and all of that. 16 million is pretty good for a state that has 3 and half million people in it, right? And we’ve gotten a lot of information about where the message is being, is generating more interest. So for example, you can run all of these analytics when you do Instagram and Facebook and you do it in different age groups, you can focus it to different age groups, and what we found was, for example, Instagram was a more successful method of reaching out to young people, especially young women, whereas Facebook was surprisingly a place where we could reach older men. And older men have the highest death rate due to melanoma because they don’t pay attention to their skin, so it’s really important to hit those guys, and I wouldn’t have predicted that Facebook would be a place that a lot of older men were doing a lot of their watching, but apparently in Oregon that’s really working. So, that’s an example. Another example is we look at the analytics on the webpage, because the call to action from all of these ads is to go to the webpage and learn more. It’s a solutions page that has all of the information for any sort of question that you might have about the program. And so, you can tell by how many hits you get. Well we’ve had almost 60,000-page views since May, right? Not bad, but for 16 million impressions, come on, we’re not hitting the people that don’t care. I’ve got some work to do, right? And so what we did is we’ve time-stamped this first phase. We are analyzing, and I just presented that analysis like I said at the meeting, and now we’re revamping and pivoting to alter it, to modify it, to get a better response the next time, and we’ll go into the second phase. And what we’re planning to do is reiteratively, scientifically improve the amount of people that we get and the response that we get. We would like to go up on the number of clicks when they visit the, how far down they drill into the webpage, so there’s webpage improvement, right? So, there’s places where we’ve identified places to improve and places to hold steady and keep doing the same thing that’s already working. So, it was very fun.

I am hoping that within the next year, so the time of the meeting next year, if I’ve got data maybe they’ll invite me to present again, and what I’m hoping is that we’re going to have a synthesis of all of the baseline data, we’ll have, we can show improvement from phase I to phase II to phase III, about 3 to 4 months long for each phase, and that we’ll be able to demonstrate that we’ve actually reiteratively improved and we’ll have, I’m hoping to have a million views on my website by then. And I’m hoping that my page views, you know, the drill down, the time that people spend on average on our webpage now is only about a minute, and I’m hoping that I’ll be able to bump that up to double it, or at least, I mean if I could go to 5 minutes I would love that. I think that may be a little, you know, overly ambitious, but you don’t know, I mean that’s the whole thing. If you make it fun, if we’re able to really capture the attention of people that don’t really know that they carry it, then maybe we can get kind of a viral thing going. We’re working on figuring out how to use influencers and how to use, you know, that we’ve gone down to now all the college campuses and are working on that, so there’s a whole bunch of things that we think are going to hopefully come together to maybe, if we’re lucky, you know, over the next five years, right? Wouldn’t it be great if we got a campaign that went viral, that was replicable maybe in the next state? In five years, I don’t see why we couldn’t have gone to another one or two other states, tried the same model, see if it works there, if we’re able to prove it’s working. And then we’ll be ready and poised to make it a national program. So that, or maybe even international, you never know.

I would welcome anybody, whether they’re a physician, a scientist, a lay person who has an interest, a patient, I would welcome you to join us in our efforts. Follow along and see what we can do and maybe make a difference in Oregon and see what works and doesn’t work, and then apply it to the next state going forward. I think it’s going to be a lot of progress, and we just need to stick together and do it together. So, I’d welcome everybody to help me with that.