Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.
BACKGROUND
Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers<or=10% improvement in relapse-free survival and overall survival with significant toxicity.


OBJECTIVE
The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy.


METHODS
Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a >/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN.


RESULTS
Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05).


CONCLUSIONS
Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.
Bramlette
Tracy B
TB
Department of Dermatology, Winship Cancer Institue, Emory University School of Medicine, Atlanta, Georgia 30322, USA. tbialy@emory.edu
Lawson
David H
DH
Washington
Carl V
CV
Veledar
Emir
E
Johns
Barry R
BR
Brisman
Stacey F
SF
Abramova
Liana
L
Chen
Suephy C
SC
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008545:Melanoma / Q000523:psychology* / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011994:Recombinant Proteins; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*
D000970:Antineoplastic Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins