After being treated with immune checkpoint inhibitors, survivors of metastatic melanoma face several challenges in resuming their lives. They have several unmet aftercare needs. This has emerged from a qualitative study by Erasmus MC.
Every year, nearly 300,000 people worldwide are newly diagnosed with skin melanoma. Thanks to multiple improvements in treatment, including the advent of immune checkpoint inhibitors, patients with metastatic melanoma today have better chances of survival than in the past. This has transformed the melanoma from an incurable cancer with a very poor prognosis into a potentially curable disease.
Picking up life again and usefulness of aftercare
Due to the improved prognosis, more and more patients with metastatic melanoma are faced with the challenge of returning to their lives after successful treatment. Research in patients with other cancers has shown that this can be difficult. They may experience not only persistent or recurrent physical complaints, but also emotional, psychosocial and work-related problems. In addition, the often unexpected turnaround in prognosis – from impending death to expected recovery – can be difficult.
To address these challenges and long-term consequences, the American Institute of Medicine recommends providing follow-up care to all patients who have completed primary treatment. This aftercare is aimed at informing and supporting patients, guaranteeing access to effective interventions and improving quality of life.
Previous research into aftercare
Until now, no research had been done on the aftercare for survivors of a melanoma. Studies in patients with other forms of metastatic and non-metastatic cancer have shown that patients often have many unmet needs in terms of follow-up care.
Previous quantitative studies have shown that patients with melanoma can also be confronted with physical and emotional problems after treatment. An initial qualitative exploratory analysis of the experiences of patients recovering from stage I/IV melanoma revealed several challenges. However, in-depth research on this topic has been lacking.
Qualitative study from Rotterdam
The current qualitative study was conducted in 20 patients with metastatic melanoma whose immune checkpoint inhibitors were discontinued after a sustained tumor response was achieved. In addition to a focus group with 9 patients, 11 individual interviews took place. The changed prognosis often caused mixed feelings among patients, mainly because of the uncertainty about the future. Many found it difficult to continue with their lives as they were before the metastatic cancer was diagnosed. There are several reasons for this, including demands and expectations of oneself and of others, persistent complaints and new problems in different areas of life.
Furthermore, the patients indicated that they needed to find a new balance, such as learning to deal with uncertainty and a changed outlook on life and close relationships. With regard to aftercare, patients mainly needed more customized patient information, available in one location. They also wanted to know who they could turn to with questions. Finally, they needed psychosocial support, including for their close relatives.
Clinical implications of this study
When guiding survivors of a metastatic melanoma, a single point of contact and a personalized aftercare plan can be of added value. The latter is especially important in melanoma care, given its multidisciplinary character.
Bron:
Kamminga NCW, van der Veldt AAM, Joosen MCW, et al. Experiences of resuming life after immunotherapy and associated survivorship care needs: a qualitative study among patients with metastatic melanoma. Br J Dermatol. 2022 May 21.
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