Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Trade-offs of adjuvant immunotherapy in stage-III melanoma – a clinicians’ view? (#241)

Ann Livingstone 1 2 , Alexander M Menzies 3 4 , Kirsten Howard 2 , Martin R Stockler 2 5 6 , Sam D Robinson 7 , Rachael L Morton 1 3
  1. Health Economics, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
  2. School of Public Health, University of Sydney, Sydney, NSW, Australia
  3. Melanoma Institute Australia, Sydney, NSW, Australia
  4. Northern Clinical School, University of Sydney, Sydney, NSW, Australia
  5. Central Clinical School, University of Sydney, Sydney, NSW, Australia
  6. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  7. Cancer Epidemiology and Prevention Research Group, University of Sydney, Sydney, NSW, Australia

Aims

Adjuvant anti-PD-1 immunotherapy for resected stage-III melanoma patients improves disease-free survival, however is costly and incurs toxicity. Little is known about clinicians’ treatment preferences in the adjuvant setting, or the factors clinicians consider important for patients making adjuvant immunotherapy decisions for stage-III melanoma.

Methods

Purposive sampling was used to complete semi-structured interviews with clinicians from 3 metropolitan hospitals in Victoria and NSW.  Interviews focused on clinicians’ perceptions of important factors for patient choice for adjuvant immunotherapy. Interviews will be completed until data saturation is reached. Thematic analysis was used to analyse data.

Results

Four of the proposed 15 clinician interviews have been completed; in interim analysis three themes emerged as important in patient choice regarding adjuvant immunotherapy treatment. The first theme, ‘treatment harms’, included treatment toxicities, especially if life threatening or requiring life-long medication. Toxicities discussed included colitis, pneumonitis, diabetes, fatigue, and endocrinopathies. Harms also included psychological factors, such as a lack of social support, fear of cancer recurrence and anxiety. A second theme was ‘treatment benefits’, this included reducing the risk of melanoma recurrence and death. Additionally health inequity considerations such as patient age and gender were secondary to clinical indicators for treatment.

Conclusions

Results will assist healthcare professional discussions with patients and their families about adjuvant immunotherapy choices to treat stage-III melanoma. Future research will explore patient and carer preferences and inequities for adjuvant immunotherapy decisions, informing the design of a choice survey to elicit treatment preferences, and understand the trade-offs patients are willing to accept to achieve treatment benefits.