Decision-Making and Health-Related Quality of Life in Patients with Melanoma Considering Adjuvant Immunotherapy

Abstract Background Adjuvant anti-PD1 treatment improves relapse-free survival (RFS) but has not been shown to improve overall survival (OS) in melanoma and is associated with risks of immune-related adverse events (irAEs), some permanent. We identified factors patients consider in deciding whether...

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Published in:The oncologist (Dayton, Ohio) Vol. 28; no. 4; pp. 351 - 357
Main Authors: Atkinson, Thomas M, Hay, Jennifer L, Young Kim, Soo, Schofield, Elizabeth, Postow, Michael A, Momtaz, Parisa, Warner, Allison Betof, Shoushtari, Alexander N, Callahan, Margaret K, Wolchok, Jedd D, Li, Yuelin, Chapman, Paul B
Format: Journal Article
Language:English
Published: US Oxford University Press 01.04.2023
Subjects:
Adjuvants
Care and treatment
Decision-making
Demographic aspects
Diagnosis
Evaluation
Health aspects
Humans
Immunotherapy
Melanoma
Melanoma - therapy
Melanoma and Cutaneous Malignancies
Melanoma, Cutaneous Malignant
Neoplasm Recurrence, Local
Patient outcomes
Quality of Life
Skin Neoplasms - therapy
United States
ISSN:1083-7159, 1549-490X, 1549-490X
Online Access:Get full text
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Summary:Abstract Background Adjuvant anti-PD1 treatment improves relapse-free survival (RFS) but has not been shown to improve overall survival (OS) in melanoma and is associated with risks of immune-related adverse events (irAEs), some permanent. We identified factors patients consider in deciding whether to undergo adjuvant anti-PD1 treatment and assessed prospective health-related quality of life (HRQoL), treatment satisfaction, and decisional regret. Patients and Methods Patients with stage IIIB-IV cutaneous melanoma and free of disease, were candidates for adjuvant anti-PD1 immunotherapy, and had not yet discussed adjuvant treatment options with their oncologist were eligible. Participants viewed a 4-minute informational video tailored to their disease stage which communicated comprehensive, quantitative information about the risk of relapse both with and without adjuvant treatment, and risks of each irAE before deciding whether or not to opt for adjuvant therapy. We collected data on demographics, HRQoL, and attitudes toward adjuvant treatment over 1 year. Results 14/34 patients (41%) opted for adjuvant anti-PD1 immunotherapy, 20/34 (59%) opted for observation. Patients choosing adjuvant immunotherapy scored higher on HRQoL social well-being at pre-treatment, were more likely to endorse positive statements about adjuvant immunotherapy, and to perceive that their physician preferred adjuvant therapy. They had lower decisional regret and higher satisfaction, even if they experienced toxicity or recurrence. Conclusions When provided with comprehensive quantitative information about risks and benefits of adjuvant anti-PD1 immunotherapy, 20/34 (59%) of patients opted for observation. Patients choosing adjuvant immunotherapy had lower decisional regret and higher satisfaction over time even if they had poorer outcomes in treatment. This pilot study examined how patients make the decision of whether or not to undergo adjuvant anti-PD1 immunotherapy when made aware of quantitative risks and benefits. This article examines the factors that influenced patient decisions, satisfaction with their decision prospectively, and health-related quality of life.
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ISSN:1083-7159
1549-490X
1549-490X
DOI:10.1093/oncolo/oyac266