Fast-track Cancer Patient Pathways and their impact on melanoma stage distribution and prognosis: A nationwide Danish cohort study.

IMPORTANCE: In 2008, the Danish national health care reform introduced fast-track Cancer Patient Pathways (CPPs) to structure the diagnosis and treatment of various cancers, including melanoma. However, the impact of CPP implementation on melanoma stage distribution and outcomes has not been assessed. OBJECTIVE: Evaluate the impact of CPP implementation on melanoma stage distribution, melanoma recurrence, melanoma-specific and overall mortality. METHODS: This population-based observational cohort study includes Danish patients diagnosed with cutaneous melanoma from 2004 to 2017, identified through the Danish Cancer Registry, with follow-up through December 2022. Exposure was defined as a diagnosis of melanoma between 2013 and 2017 (post-CPP), compared with diagnoses between 2008 and 2012 (early-CPP) and 2004-2007 (pre-CPP). The primary outcome was melanoma stage at diagnosis. Secondary outcomes were melanoma-specific recurrence, melanoma-specific- and overall mortality. RESULTS: A total of 20,815 patients with cutaneous melanoma were included, with a mean age of 56 years, and 54% females. From the pre-CPP to the post-CPP period, the proportion of stage I melanoma increased (difference, 5%; 95% CI, 1.0% to 9.0%; P = 0.02), while stage II remained stable, and stage III (difference -2.8%; 95% CI, -5.3% to -0.1%; P = 0.04) and stage IV (difference, -1.6%; 95% CI, -3.3% to 0.0% P = 0.05) declined. The mean annual numbers of stage I melanoma (748 to 1229, p < 0.001) and stage II melanoma (160 to 228, p < 0.001) increased, while the mean annual number of advanced stages III and IV remained unchanged. The melanoma-specific recurrence, melanoma-specific mortality, and overall mortality decreased across the study periods. CONCLUSION: Implementation of the fast-track melanoma-specific CPP was associated with earlier-stage detection, reflected primarily in increased numbers and proportions of stage I melanomas, while the absolute burden of advanced-stage disease remained unchanged. Mortality decreased across the periods, likely reflecting broader changes in melanoma diagnosis and treatment.