Interferon Therapy After Radical Surgery in Melanoma Patients
Interferon Therapy After Radical Surgery in Melanoma Patients
Melanoma is the fastest growing solid tumor in men and women, and despite accounting for only 4% of skin cancer cases, it accounts for more than 79% of skin cancer-related deaths. The present study was designed to evaluate the impact of interferon (IFN) treatment on patients' quality of life (QOL) after radical surgery of cutaneous melanoma. The tests were carried out in a group of patients treated in the Department of Soft Tissue and Bone Cancer, Institute of Oncology, in Warsaw. The present study included 2 groups of the patients, 110 persons each. One group consisted of patients who had been subjected to radical surgery of cutaneous melanoma, and the other one consisted of 110 patients treated with a supplementary interferon alfa-2b (IFN-α-2b) therapy. Data were collected by means of an anonymous QLQ-C30 (version 2.0.) questionnaire elaborated and provided by the European Organisation for Research and Treatment of Cancer. The QLQ-C30 questionnaire consisted of 43 questions. The IFN-α-2b treatment significantly affected patients' physical condition, mental health, and social life. The emotional state of the patients was more affected during IFN-α-2b treatment. Somatic symptoms were also increased in those patients. The IFN-α-2b therapy also significantly affected family and social life. In spite of several adverse effects, the patients assessed their QOL as good. The IFN-α-2b treatment is troublesome for the melanoma patients. It is important that the treating physician and nurse should be aware of the 4 major categories of IFN-α-2b toxicity: constitutional, neuropsychiatric, hepatic, and hematologic. A number of steps can be taken to minimize the morbidity associated with IFN-α-2b therapy, resulting in an improvement in both QOL and patient compliance.
Melanoma is the fastest growing solid tumor in men and women, and despite accounting for only 4% of skin cancer cases, it accounts for more than 79% of skin cancer-related deaths. The increasing incidence for melanoma is of some concern, given that it is a particularly deadly form of cancer if allowed to advance; the 5-year survival rate, although encouraging when melanoma is diagnosed early, decreases significantly with disease stage. In particular, although 5-year survival is more than 96% for stage 0 and 92.5% for stage I, it drops to 74.8% for stage II, 49% for stage III, and to 17.9% by stage IV. Because of the rapidly increasing incidence and potential for lethality of melanoma, patients with this diagnosis may be considered an appropriate group with whom to apply new methods aimed at evaluating and treating distress. It is known that high levels of distress have been found to slow recovery, increase morbidity, and hasten mortality through faster disease course and even suicide. Specific illnesses have been linked to alterations in mood, and alterations in mood have been found to be correlated with immune system functioning, with negative mood related to lower immune response. With regard to the cost of medical service utilization, emotional distress has been associated with increased costs of up to 4 times those of nondistressed patients. Quality of life (QOL) has been studied in cancer patients for the past years. One important component of QOL is the amount of emotional distress an individual is currently experiencing. However, a process of formal evaluation and treatment of distress to improve QOL has not been a major consideration associated with the treatment of cancer patients. It has been demonstrated that approximately 30% of all cancer patients have distress that reaches clinically significant levels. In addition, although distress is occasionally of sufficient severity to meet criteria for a psychiatric diagnosis, it is often missed by nonpsychiatric physicians, who comprise the vast majority of healthcare providers for most cancer patients. It is important for clinicians to have an effective means of identifying and treating distress in their patients to ensure optimal outcomes, including QOL. Patients with primary melanomas (T4) and those with pathologic or clinical evidence of regional nodal metastasis (N1) have a high risk of tumor recurrence after definitive surgical treatment. The rate of recurrence ranges from 40% to 90% and usually results in death as a result of melanoma. In 1996, the pivotal Eastern Cooperative Oncology Group trial E1684 demonstrated that adjuvant high-dose interferon alfa-2b (IFN-α-2b) administered intravenously and subcutaneously for 1 year to melanoma high-risk patients significantly prolonged their relapse-free survival and overall survival. In the trial, patients received intravenous induction 5 times a week for 4 weeks, then subcutaneous maintenance therapy 3 times a week for 11 months.
The present study was designed to evaluate the impact of IFN-α-2b treatment on patients' QOL after radical surgery of cutaneous melanoma.
Melanoma is the fastest growing solid tumor in men and women, and despite accounting for only 4% of skin cancer cases, it accounts for more than 79% of skin cancer-related deaths. The present study was designed to evaluate the impact of interferon (IFN) treatment on patients' quality of life (QOL) after radical surgery of cutaneous melanoma. The tests were carried out in a group of patients treated in the Department of Soft Tissue and Bone Cancer, Institute of Oncology, in Warsaw. The present study included 2 groups of the patients, 110 persons each. One group consisted of patients who had been subjected to radical surgery of cutaneous melanoma, and the other one consisted of 110 patients treated with a supplementary interferon alfa-2b (IFN-α-2b) therapy. Data were collected by means of an anonymous QLQ-C30 (version 2.0.) questionnaire elaborated and provided by the European Organisation for Research and Treatment of Cancer. The QLQ-C30 questionnaire consisted of 43 questions. The IFN-α-2b treatment significantly affected patients' physical condition, mental health, and social life. The emotional state of the patients was more affected during IFN-α-2b treatment. Somatic symptoms were also increased in those patients. The IFN-α-2b therapy also significantly affected family and social life. In spite of several adverse effects, the patients assessed their QOL as good. The IFN-α-2b treatment is troublesome for the melanoma patients. It is important that the treating physician and nurse should be aware of the 4 major categories of IFN-α-2b toxicity: constitutional, neuropsychiatric, hepatic, and hematologic. A number of steps can be taken to minimize the morbidity associated with IFN-α-2b therapy, resulting in an improvement in both QOL and patient compliance.
Melanoma is the fastest growing solid tumor in men and women, and despite accounting for only 4% of skin cancer cases, it accounts for more than 79% of skin cancer-related deaths. The increasing incidence for melanoma is of some concern, given that it is a particularly deadly form of cancer if allowed to advance; the 5-year survival rate, although encouraging when melanoma is diagnosed early, decreases significantly with disease stage. In particular, although 5-year survival is more than 96% for stage 0 and 92.5% for stage I, it drops to 74.8% for stage II, 49% for stage III, and to 17.9% by stage IV. Because of the rapidly increasing incidence and potential for lethality of melanoma, patients with this diagnosis may be considered an appropriate group with whom to apply new methods aimed at evaluating and treating distress. It is known that high levels of distress have been found to slow recovery, increase morbidity, and hasten mortality through faster disease course and even suicide. Specific illnesses have been linked to alterations in mood, and alterations in mood have been found to be correlated with immune system functioning, with negative mood related to lower immune response. With regard to the cost of medical service utilization, emotional distress has been associated with increased costs of up to 4 times those of nondistressed patients. Quality of life (QOL) has been studied in cancer patients for the past years. One important component of QOL is the amount of emotional distress an individual is currently experiencing. However, a process of formal evaluation and treatment of distress to improve QOL has not been a major consideration associated with the treatment of cancer patients. It has been demonstrated that approximately 30% of all cancer patients have distress that reaches clinically significant levels. In addition, although distress is occasionally of sufficient severity to meet criteria for a psychiatric diagnosis, it is often missed by nonpsychiatric physicians, who comprise the vast majority of healthcare providers for most cancer patients. It is important for clinicians to have an effective means of identifying and treating distress in their patients to ensure optimal outcomes, including QOL. Patients with primary melanomas (T4) and those with pathologic or clinical evidence of regional nodal metastasis (N1) have a high risk of tumor recurrence after definitive surgical treatment. The rate of recurrence ranges from 40% to 90% and usually results in death as a result of melanoma. In 1996, the pivotal Eastern Cooperative Oncology Group trial E1684 demonstrated that adjuvant high-dose interferon alfa-2b (IFN-α-2b) administered intravenously and subcutaneously for 1 year to melanoma high-risk patients significantly prolonged their relapse-free survival and overall survival. In the trial, patients received intravenous induction 5 times a week for 4 weeks, then subcutaneous maintenance therapy 3 times a week for 11 months.
The present study was designed to evaluate the impact of IFN-α-2b treatment on patients' QOL after radical surgery of cutaneous melanoma.
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