Clinical Research Papers:
The outweigh of toxicity versus risk of recurrence for adjuvant interferon therapy: a survey in German melanoma patients and their treating physicians
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Katharina C. Kähler1, Christine Blome2, Andrea Forschner3, Ralf Gutzmer4, Axel Hauschild1, Lucie Heinzerling5, Elisabeth Livingstone6, Carmen Loquai7, Tina Müller-Brenne7, Dirk Schadendorf6, Jochen Utikal8, Tobias Wagner2 and Matthias Augustin2
1Department of Dermatology, Skin Cancer Center, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
2Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg, Hamburg, Germany
3Department of Dermatology, Eberhard-Karls University of Tübingen, Tübingen, Germany
4Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
5Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
6Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
7Department of Dermatology, University of Mainz, Mainz, Germany
8Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
Katharina C. Kähler, email: [email protected]
Keywords: melanoma; patient preferences; interferon
Received: March 27, 2018 Accepted: April 28, 2018 Published: May 25, 2018
After more than two decades with interferon alfa-2a and 2b (IFN) as the only approved drugs in the adjuvant setting for melanoma, new treatment approaches like immune checkpoint inhibitors and BRAF-MEK inhibitors improve the progression free survival (PFS) and also the overall survival (OS).
We compared physicians’ preferences (“utilities”) for health states associated with IFN therapy to their patients’ preferences. Utilities describe a preference for a specific health state on a scale of 0 (as bad as death) to 1.0 (perfect health).
Setting: We assessed utilities for health states associated with adjuvant IFN using the standard gamble technique in 108 physicians and 130 melanoma patients. Four IFN toxicity scenarios and three outcome scenarios were given to the participants. Both groups were asked for the 5-year disease free survival (DFS) they would need to accept the described IFN-related side effects.
Results: In both groups, utilities for melanoma relapse were significantly lower than for IFN side effects, showing that toxicity was more acceptable than relapse. Physicians indicated higher utilities for each scenario and needed lower 5-year DFS both in case of mild-to-moderate and severe side effects. Patients were willing to tolerate mild-to-moderate and severe toxicity for a 50% and 75% chance of 5-year DFS, while physicians only required a chance of 40% and 50%, respectively.
Conclusion: Both physicians and patients rated melanoma recurrence much lower than even severe IFN side effects. In direct comparison, physicians rated cancer-related scenarios more positively and accepted IFN toxicity for an even lower treatment benefit.
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