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

Ann Livingstone; Kathy Dempsey; Martin R Stockler; Kirsten Howard; Georgina V Long; Matteo S Carlino; Alexander M Menzies; Rachael L Morton

doi:10.1186/s12885-021-08752-1

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

BMC Cancer. 2021 Sep 10;21(1):1014. doi: 10.1186/s12885-021-08752-1.

Authors

Ann Livingstone^{1

2}, Kathy Dempsey³, Martin R Stockler^{3

4

5}, Kirsten Howard⁴, Georgina V Long^{6

7

8}, Matteo S Carlino^{5

6

9}, Alexander M Menzies^{5

6

8}, Rachael L Morton^{3

6}

Affiliations

¹ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. ann.livingstone@sydney.edu.au.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. ann.livingstone@sydney.edu.au.
³ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
⁴ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁵ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁶ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
⁷ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁸ Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
⁹ Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia.

Abstract

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.

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

Publication types

Multicenter Study

MeSH terms

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