Wiens Lisa, Schäffeler Norbert, Eigentler Thomas, Garbe Claus, Forschner Andrea
Department of Dermatology, University Hospital Tübingen, 72076 Tübingen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany.
Cancers (Basel). 2021 May 27;13(11):2642. doi: 10.3390/cancers13112642.
Immune checkpoint inhibitors (ICI) provide effective treatment options for advanced melanoma patients. However, they are associated with high rates of immune-related side effects. There are no data on the distress of melanoma patients during their ICI treatment. We, therefore, conducted a prospective longitudinal study to assess distress and the need for psycho-oncological support in these patients.
Questionnaires were completed before initiation of ICI (T0), after 6-8 weeks (T1), and after 12-14 weeks (T2). We furthermore included the Hornheide Screening Instrument (HSI), distress thermometer (DT), and patients' self-assessment. Binary logistic regression was performed to identify factors indicating a need for psychooncological support.
36.3%/55.8% (HSI / DT) of the patients were above the threshold, indicating a need for psychooncological support at T0, and 7.8% of the patients reported practical problems. In contrast, at T2, the distress values had decreased to 29.0%/40.2% (HSI/DT), respectively. Female gender and occurrence of side effects significantly correlated to values above the threshold. The strongest factor was the patient's self-assessment.
With the beginning of ICI, psychooncological support should be offered. Furthermore, practical problems should be considered, e.g., transport to therapy. Female patients and patients with side effects should be given special attention, as well as the patient self-assessment.
免疫检查点抑制剂（ICI）为晚期黑色素瘤患者提供了有效的治疗选择。然而，它们与高发生率的免疫相关副作用有关。目前尚无关于黑色素瘤患者在ICI治疗期间痛苦程度的数据。因此，我们进行了一项前瞻性纵向研究，以评估这些患者的痛苦程度以及对心理肿瘤学支持的需求。
在ICI治疗开始前（T0）、6 - 8周后（T1）和12 - 14周后（T2）完成问卷调查。我们还纳入了霍恩海德筛查工具（HSI）、痛苦温度计（DT）以及患者的自我评估。进行二元逻辑回归以确定表明需要心理肿瘤学支持的因素。
在T0时，36.3%/55.8%（HSI / DT）的患者高于阈值，表明需要心理肿瘤学支持，7.8%的患者报告存在实际问题。相比之下，在T2时，痛苦值分别降至29.0%/40.2%（HSI/DT）。女性性别和副作用的发生与高于阈值的值显著相关。最强的因素是患者的自我评估。
随着ICI治疗的开始，应提供心理肿瘤学支持。此外，应考虑实际问题，例如前往治疗的交通问题。女性患者和有副作用的患者应给予特别关注，以及患者的自我评估。
