Adjuvant immunotherapy recommendations for stage III melanoma: physician and nurse interviews.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967800 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2407 (Electronic) Linking ISSN: 14712407 NLM ISO Abbreviation: BMC Cancer Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Immunotherapy*; Melanoma/*therapy ; Skin Neoplasms/*pathology ; Skin Neoplasms/*therapy; Adult ; Age Factors ; Attitude of Health Personnel ; Australia ; Cancer Care Facilities ; Clinical Decision-Making ; Consultants ; Dermatologists ; Female ; Humans ; Male ; Melanoma/pathology ; Middle Aged ; Nurses ; Oncologists ; Risk Assessment ; Surgeons ; Melanoma, Cutaneous Malignant

Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
(© 2021. The Author(s).)

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Keywords: Decision making; Immunotherapy; Interviews; Melanoma; Nurse clinicians; Physicians; Professional role; Surgeons

Date Created: 20210911 Date Completed: 20211014 Latest Revision: 20231213

20240105

PMC8434723

10.1186/s12885-021-08752-1

34507552