Psychological Changes in Melanoma Patients During Ipilimumab Treatment Compared to Low-Dose Interferon Alpha Therapy—A Follow-Up Study of First Experiences

Abstract

Immuntherapies are frequently accompanied by psychological side effects. Our goals were to detect the changes of psychological factors (depression, anxiety) among melanoma patients during ipilimumab treatment. Ten ipilimumab treated melanoma patients (Group 1.) and 18 low-dose interferon-alpha treated patients (Group 2.) were compared. In our longitudinal study we measured depression (Zung Self-Rating Depression Scale) and anxiety (State-Trait Anxiety Inventory, STAI). Psychological status was tested four times: in every 3 week during ipilimumab treatment according to the relevant treatment protocol and at baseline, 1st, 3rd and 6th month of interferon therapy. No significant differences were detected at different timepoints in the level of depression or in the anxiety scale in Group 1. However significant increase of depression was found in Group 2 during the 6 months of the study. Increased levels of anxiety were found in the second timepoint in both treatment groups. This increase was only temporary and the level of anxiety returned to the baseline. In our sample no measurable psychological differences were detectable during the 12 weeks treatment period of ipilimumab. Ipilimumab seems to have fewer psychological side-effects compared to other immune therapies.

Systematic review of psychosocial outcomes for patients with advanced melanoma

“…Depression increased significantly over time in 1 study of stage III patients, although there was no significant change in other studies . No studies reported a change in anxiety over time . In 1 study with a sub‐group of stages III and IV patients receiving IFN‐alpha, 14 of 31 patients were diagnosed with adjustment disorder (3 stage III, 11 stage IV) .…”

“…Patients participating in an RCT or clinical trial most commonly received chemotherapy (eg, dacarbazine and temozolomide) ( n = 12) or interferon‐α 2a or 2b (including pegylated) ( n = 8) in 1 or both intervention arms. Patients receiving new therapies were examined in 6 studies (5 RCTs and 1 prospective quantitative study), and these included ipilimumab, dabrafenib, trametinib, a combination of dabrafenib and trametinib, or vemurafenib, in 1 or both intervention arms. Of these, only the prospective study of patients receiving ipilimumab included a measure designed specifically to assess psychosocial outcomes, as opposed to the RCTs that assessed emotional and social function using a broader QoL measure (EORTC‐QLQ‐C30).…”

“…Four quantitative descriptive studies prospectively assessed the psychosocial outcomes (excluding supportive care needs and melanoma‐specific concerns or behaviours) of patients receiving a medical intervention. In all studies, this intervention was IFN‐alpha alone, and 1 study included patients receiving ipilimumab . Depression increased significantly over time in 1 study of stage III patients, although there was no significant change in other studies .…”

“…In all studies, this intervention was IFN‐alpha alone, and 1 study included patients receiving ipilimumab . Depression increased significantly over time in 1 study of stage III patients, although there was no significant change in other studies . No studies reported a change in anxiety over time .…”

Social support decreases depressogenic effect of low-dose interferon alpha treatment in melanoma patients

“…Demographic data, such as sex, age, home, family and financial status, and level of education were measured by a standardised background questionnaire regularly used in our institute [15]. Financial status was categorized with a single question "How well do you feel you are managing financially these days?"…”