NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
BMC Cancer. 2021 Sep 10;21(1):1014. doi: 10.1186/s12885-021-08752-1.
Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma.
In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma at three Australian tertiary melanoma centres between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken.
Twenty-five physicians and nurses, aged 28-68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) nurses, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: [1] clinical and patient factors, [2] treatment information provision, and [3] individual physician/nurse factors. Melanoma sub-stage and an individual patient's therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy's effectiveness and their views about treatment burden patients might consider acceptable.
Patients' disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals' adjuvant immunotherapy endorsement. Findings clarify clinician preferences and values, aiding clinical communication with patients and facilitating clinical decision-making about management options for resected stage III melanoma.
辅助免疫疗法正在彻底改变 III 期和 IV 期黑色素瘤患者的治疗方法。然而，免疫疗法可能与毒性有关，这使得治疗决策变得复杂。本研究旨在确定医生和护士在考虑黑色素瘤辅助免疫疗法时所考虑的因素。
2019 年 7 月至 2020 年 3 月，在澳大利亚的三个三级黑色素瘤中心对管理 III 期黑色素瘤切除后患者的医生（肿瘤内科医生、外科医生和皮肤科医生）和护士进行了深入访谈。探讨了辅助免疫治疗中考虑的因素。继续招募，直到数据饱和并进行主题分析。
25 名医生和护士，年龄 28-68 岁，女性占 60%，包括 11 名（44%）肿瘤内科医生、8 名（32%）外科医生、5 名（20%）护士和 1 名（4%）皮肤科医生接受了采访。超过一半的样本管理着每月有五名或五名以上新的 III 期黑色素瘤切除患者，他们可能有资格接受辅助免疫治疗。关于辅助免疫治疗建议出现了三个主题：[1]临床和患者因素，[2]治疗信息提供，[3]个体医生/护士因素。黑色素瘤亚分期和个体患者的治疗风险/获益情况是主要考虑因素。次要因素包括对辅助免疫治疗效果的不确定性以及他们对患者可能认为可接受的治疗负担的看法。
患者的疾病亚分期和治疗风险与获益是黑色素瘤医疗保健专业人员支持辅助免疫治疗的驱动因素。研究结果阐明了临床医生的偏好和价值观，有助于与患者进行临床沟通，并促进对 III 期黑色素瘤切除后管理选择的临床决策。
