S J Slack

BACKGROUND: Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. METHODS: Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. RESULTS: Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. CONCLUSIONS: One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.

Background MSM community outreach using oral home sampling kits posted to virology for testing previously demonstrated success in attracting non-healthcare seeking individuals at risk of HIV. The outcome of targeting other specific at-risk groups to offer home sampling has not previously been described. Objective To determine the acceptability of home sampling kits for HIV using oral swabs in two at-risk groups Black Africans (BA) and partners of HIV positive patients (PPP). Methods Self-taken oral fluid home sampling kits were returned to virology for testing using two HIV assays: Roche COBAS and Genscreen Ultra (previously validated for oral fluid testing). Total IgG was also measured to assess sample adequacy. Participant recruitment was two-pronged: community based (BA) or via an HIV clinic (PPP). For BA recruitment, home sampling kits were actively promoted at relevant social events and venues by trained African volunteers from July to December 2010. 19 free condom distribution points were also utilised to provide information about HIV and the testing kits. From September to December 2011, PPPs of unknown current HIV status were contacted and offered the option of attending clinic or receiving an oral fluid home sampling kit by post. Results Despite intense promotional activity, only 12 kits from 11 individuals in the BA community project were returned: 5 male; 6 female. Two of these participants were not African. In the PPP clinic based study, of 46 partners offered a kit, 38 (83%) accepted, and 34 (89%) returned a sample. BA partners were less likely to accept a home sampling kit (9/13; 69%) than white partners (29/33; 88%) in the PPP group. Participant feedback was favourable in both studies. Discussion Further evaluation is needed to understand the difference in acceptability of this method of HIV testing in specific at-risk groups (MSM, BA and PPP) in community and clinic settings.