OBJECTIVES: Electronic health records (EHRs) are increasingly being accepted by regulators and as real world evidence (RWE). In a recent literature review (published elsewhere in this conference), we identified that many of the commercial databases source data solely from oncology clinics. This analysis aimed to understand the extent to which melanoma skin cancer patients receive cancer care specialties other than oncology.

METHODS: Newly diagnosed melanoma patients with one or more melanoma encounters (ICD10 CM) from January-Dec 2017 were included from the Optum Electronic Health Record Data Repository. Optum EHR data repository has more than 90 million de-identified patient lives mostly sourced from integrated healthcare delivery network EHRs within the US. Optum data includes the entire care continuum across primary case, across specialties, inpatient and outpatient encounters. Index date was defined as the first date of melanoma diagnosis within the study period. EHR history was assessed for 6 months prior to index and 1 year post index. All pathology, radiology and treatment encounters were identified, and all specialties who participated in the patient’s oncology diagnosis and care were counted. All ICD codes were verified by certified medical professional.

RESULTS: A total 7351 patients had one or more melanoma related encounters in 2017. During the 6 months prior to diagnosis, histological tests were ordered mostly by dermatologists (38%), followed by pathologists (19%), while oncologists and surgeons ordered 6% and 5%, respectively. Analysis of surgical excision on or after index indicated that dermatologists performed 47% of procedures followed by plastic surgeons (10%) and oncologists (9%). Oncologists comprised 44% of chemotherapy prescribing, while general medicine accounted for 14%.

CONCLUSIONS: A large proportion of dermatological cancer care encounters occur outside the oncology setting. Therefore, to understand the factors that affect treatment outcomes, the EHR data used for outcomes research should include the entire care continuum.