With the rising cost of healthcare, there is growing prioritisation of patient outcomes per healthcare dollar. De-escalation is the rationalisation of routine treatment without compromising patient outcomes. It has the potential to optimise value for the healthcare system and patients by reducing physical, time, and financial toxicities. This scoping review will establish the role of systemic therapies in current and emerging opportunities to de-escalate cutaneous melanoma treatment. It will also seek to comment on the proportion of relevant studies that include patient-reported outcomes and quality of life measurements.
This scoping review will follow guidance provided by the JBI Manual for Evidence Synthesis. In consultation with a health sciences librarian, a systematic search strategy has been developed for MEDLINE and PubMed from 1 January 2013 to 30 June 2023. Additional sources will be included from grey literature, Google Scholar, and reference scanning.
Abstract and full text screening, facilitated by the Covidence software, will be conducted by two reviewers with any disagreements resolved by consensus or a third reviewer. A data extraction tool will be implemented by one author, whilst a second will review a random selection of papers to ensure consistent interpretation. De-escalation strategies will be categorised by concept, potential impact on resource utilisation and patient outcomes, strength of evidence, and estimated ease of implementation. Data will be synthesised qualitatively and quantitatively. Results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
Preliminary results will be available for presentation at COSA ASM in November 2023. The final results of this scoping review will directly inform a melanoma consumer and clinician survey exploring their perspectives on de-escalation therapies. This survey will use a novel platform, Pol.is, that integrates machine learning to provide real-time feedback to participants.