Quality of life and mental health in real-world patients with resected stage III/IV melanoma receiving adjuvant immunotherapy

Pedersen, Sidsel; Holmstroem, Rikke Boedker; Heymann, Annika von; Tolstrup, Lærke Kjær; Madsen, Kasper; Petersen, Morten Aagaard; Haslund, Charlotte Aaquist; Ruhlmann, Christina H; Johansen, Christoffer; Svane, Inge Marie; Ellebæk, Eva

doi:10.1080/0284186x.2023.2165449

Cited by 12 publications

(5 citation statements)

References 43 publications

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“…It is important to note that there has been improvements in treatment of advanced melanoma over the last decade, leading to a positive impact on quality of life and overall patient survival [46,47,58,61]. Obviously, the bigger the improvements in treatment and overall survival, the more the duration in the ill state is underestimated and the more the number of years of life lost is overestimated.…”

Section: Discussionmentioning

confidence: 99%

Health indices for disease incidence risk and duration in the Semi-Markov setting

Soetewey,

Legrand,

Denuit

et al. 2024

Preprint

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Over the last decade, the number of years of life lost (YLL) became a popular tool in biostatistics and epidemiology to measure discrepancies in life expectancy or mortality between a cohort of patients and the general population. Its prominence in the literature is primarily due to its ease of interpretation and because information on the cause of death is not required. Moreover, multi-state models are a powerful statistical approach to study the evolution of individuals between several "states". Derived from data collected by the Belgian Cancer Registry, encompassing 161,007 cases of melanoma, thyroid, and female breast cancer, a three-state (healthy-cancer-death) illness-death model is used to illustrate how it can be applied to cancer registry data to estimate the incidence risk, and the number of years of life lost due to cancer at different ages at diagnosis and given that the patient survived some years after diagnosis. Results suggest that the probabilities of being diagnosed with cancer over the next 20 years for a healthy individual remain rather low for melanoma and thyroid cancers for both sexes, but considerably increases with age for female breast cancer. Results also suggest that, for female breast cancer, the number of years of life lost before the age of 70 years due to cancer is highest when diagnosed at young ages and then decreases with age at diagnosis, whereas for melanoma and thyroid cancers, it peaks when diagnosed at later ages (between 35 and 55 years depending on the cancer and sex). It also turns out that the number of years of life lost before the age of 70 due to cancer is larger for men than for women for both melanoma and thyroid cancers. Last, it is found that, for melanoma and thyroid cancer patients diagnosed between the age of 20 and 70 years, once they have survived their cancer for 10 years, the number of years of life lost before the age of 70 due to cancer remains below one year. This indicates that, up to the age of 70 years, these patients lose a limited number of years of life due to cancer compared to the general population.

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Section: Discussionmentioning

confidence: 99%

Health indices for disease incidence risk and duration in the Semi-Markov setting

Soetewey,

Legrand,

Denuit

et al. 2024

Preprint

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“…The toxicity of targeted therapy, dabrafenib and trametinib, is characterized by symptoms such as fever, gastrointestinal symptoms, joint pain, a decrease in the left ventricular function, and eye disorders (Lazaroff and Bolotin 2023 ) that can also impair quality of life (Scarpato et al 2022 ; Lai-Kwon et al 2023 ) In contrast, immune checkpoint inhibitors (c(ICI)) can induce autoimmune toxicity in nearly every organ system and a small subset of patients with a fatal course (Wang et al 2018 ). Despite the frequency of side effects, in the majority of patients, health-related quality of life (HrQoL) is not or only temporarily impaired (Bottomley et al 2021 ; Khattak et al 2022 ; Pedersen et al 2023 ; Lai-Kwon et al 2023 ). However, in case of severe side effects, HRQoL may be persistently impaired, which can eventually lead to treatment stop (Pedersen et al 2023 ; Wang et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the frequency of side effects, in the majority of patients, health-related quality of life (HrQoL) is not or only temporarily impaired (Bottomley et al 2021 ; Khattak et al 2022 ; Pedersen et al 2023 ; Lai-Kwon et al 2023 ). However, in case of severe side effects, HRQoL may be persistently impaired, which can eventually lead to treatment stop (Pedersen et al 2023 ; Wang et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Preferences of physicians for treatment-related toxicity vs. recurrence in melanoma (GERMELATOX-A): the doctors’ perspective

Kähler,

Gutzmer,

Angela

et al. 2024

J Cancer Res Clin Oncol

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Introduction Adjuvant treatment with immune checkpoint inhibitors, such as PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT), has shown a significant improvement in disease-free survival (DFS) for high-risk melanoma patients. However, due to specific side effects, the choice of treatment is often influenced by the risk of toxicity. Therefore, the role of physicians in treatment decisions of patients is crucial. This study investigated for the first time in a multicenter setting the attitudes and preferences of dermatooncologists in Germany and Switzerland regarding adjuvant treatment with (c)ICI and TT. Methods In the GERMELATOX-A study, 108 physicians (median age: 32 yrs, 67.6% female) from 11 skin cancer centers were surveyed to rate typical side effect scenarios of (c)ICI and TT treatments and then compared to patients’ ratings evaluated in a previous analysis from the same centers. The scenarios described mild-to-moderate or severe toxicity and included melanoma relapse leading to death. The physicians were asked about the level of side effects they would tolerate in exchange for a reduction in melanoma relapse and an increase in survival at 5 years. Results The preferences of physicians and patients revealed significant differences regarding adjuvant melanoma treatment with (c)ICI and TT (p < 0.05). Compared to patients, physicians tend to value a melanoma relapse less severe, according to a visual analog scale. They were also less threatened by all scenarios of side effects during adjuvant treatment with (c)ICI or TT, compared to patients. Physicians required lower risk reductions for disease-free survival (DFS) and overall survival (OS) for both ICI and TT and their drug-related side effects to accept these treatments. In case of severe side effects, physicians required similar 5-year DFS rates for ICI and TT (60–65%), while patients needed a 15% improvement of 5-year DFS for ICI compared to TT (80%/65%). For survival, physicians expected an OS improvement of + 10% for all three treatment modalities, whereas patients required a higher increase: + 18–22% for ICI and + 15% for TT. Conclusion Our study highlights the importance of understanding the patient’s perspective and a potential difference to the doctor’s view when making decisions about adjuvant melanoma treatment with (c)ICI and TT, especially as these treatments are increasingly being implemented in earlier stages.

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“…In contrast, c(ICI) induces autoimmune side effects in nearly every organ system that could lead in a small subset of patients to a fatal course (Wang et al 2018 ). In the majority of patients, health-related quality of life (HrQoL) is not or only temporarily impaired (Bottomley et al 2021 ; Khattak et al 2022 ; Pedersen et al 2023 ). In case of severe side effects, HRQoL may be persistently impaired, which can eventually lead to treatment cessation (Pedersen et al 2023 ; Wang et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…In the majority of patients, health-related quality of life (HrQoL) is not or only temporarily impaired (Bottomley et al 2021 ; Khattak et al 2022 ; Pedersen et al 2023 ). In case of severe side effects, HRQoL may be persistently impaired, which can eventually lead to treatment cessation (Pedersen et al 2023 ; Wang et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Preferences of German and Swiss melanoma patients for toxicities versus melanoma recurrence during adjuvant treatment (GERMELATOX-A-trial)

Kähler

Hüning

Nashan

et al. 2023

J Cancer Res Clin Oncol

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Purpose Adjuvant treatment with immune checkpoint inhibitors like PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT) in high-risk melanoma patients demonstrate a significant improvement in disease-free survival (DFS). Due to specific side effects, the choice of treatment is very often driven by the risk for toxicity. This study addressed for the first time in a multicenter setting the attitudes and preferences of melanoma patients for adjuvant treatment with (c)ICI and TT. Methods In this study (“GERMELATOX-A”), 136 low-risk melanoma patients from 11 skin cancer centers were asked to rate side effect scenarios typical for each (c)ICI and TT with mild-to-moderate or severe toxicity and melanoma recurrence leading to cancer death. We asked patients about the reduction in melanoma relapse and the survival increase at 5 years they would require to tolerate defined side-effects. Results By VAS, patients on average valued melanoma relapse worse than all scenarios of side-effects during treatment with (c)ICI or TT. In case of severe side effects, patients required a 15% higher rate of DFS at 5 years for (c)ICI (80%) compared to TT (65%). For survival, patients required an increase of 5–10% for melanoma survival during (c)ICI (85%/80%) compared to TT (75%). Conclusion Our study demonstrated a pronounced variation of patient preferences for toxicity and outcomes and a clear preference for TT. As adjuvant melanoma treatment with (c)ICI and TT will be increasingly implemented in earlier stages, precise knowledge of the patient perspective can be helpful for decision making.

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Quality of life and mental health in real-world patients with resected stage III/IV melanoma receiving adjuvant immunotherapy

Cited by 12 publications

References 43 publications

Health indices for disease incidence risk and duration in the Semi-Markov setting

Health indices for disease incidence risk and duration in the Semi-Markov setting

Preferences of physicians for treatment-related toxicity vs. recurrence in melanoma (GERMELATOX-A): the doctors’ perspective

Preferences of German and Swiss melanoma patients for toxicities versus melanoma recurrence during adjuvant treatment (GERMELATOX-A-trial)

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