Department of Psychiatry & Behavior Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Oncologist. 2023 Apr 6;28(4):351-357. doi: 10.1093/oncolo/oyac266.
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 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.
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.
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.
辅助抗 PD1 治疗可提高无复发生存率（RFS），但并未显示可改善黑色素瘤的总生存期（OS），并且与免疫相关不良事件（irAE）的风险相关，其中一些是永久性的。我们确定了患者在决定是否接受辅助抗 PD1 治疗时考虑的因素，并评估了前瞻性健康相关生活质量（HRQoL）、治疗满意度和决策后悔。
患有 IIIB-IV 期皮肤黑色素瘤且无疾病的患者，有资格接受辅助抗 PD1 免疫治疗，且尚未与肿瘤学家讨论过辅助治疗选择。参与者观看了一段 4 分钟的信息视频，该视频根据疾病阶段量身定制，传达了关于有无辅助治疗复发风险的全面定量信息，以及每种 irAE 的风险，然后决定是否选择辅助治疗。我们在 1 年内收集了有关人口统计学，HRQoL 和对辅助治疗态度的数据。
14/34 例患者（41％）选择了辅助抗 PD1 免疫治疗，20/34 例（59％）选择了观察。选择辅助免疫治疗的患者在治疗前的 HRQoL 社交幸福感得分较高，更倾向于对辅助免疫治疗发表积极意见，并且认为他们的医生更喜欢辅助治疗。即使他们经历了毒性或复发，他们的决策后悔和满意度也较低，满意度也较高。
当提供有关辅助抗 PD1 免疫治疗的风险和收益的全面定量信息时，20/34 例患者（59％）选择了观察。即使在治疗中出现较差的结果，选择辅助免疫治疗的患者的决策后悔和满意度随着时间的推移也较低。
