RESUMO
Background: The COVID-19 pandemic imposes major challenges for care of cancer patients. Objectives: Our aim was to assess the effects of the pandemic on treatment and appointments of patients with malignant melanoma based on a large skin cancer centre in Berlin, Germany, and identify reasons for, and impact factors associated with these changes. Materials & Methods: Patients with melanoma treated from January 1st 2019 received a postal survey with questions on impairment due to the pandemic, fear of COVID-19, fear of melanoma, changes in therapy and/or appointments, including reasons for the changes. Impact factors on postponed/missed appointments were examined using descriptive analyses and multivariate logistic regression. Results: The response rate was 41.3% (n = 324; 57.4% males; mean age: 67.9 years). Among 104 participants currently receiving therapy, four (3.8%) reported treatment changes due to the pandemic. Postponements or cancellations of appointments occurred in 48 participants (14.8%), most frequently, at their own request (81.3%) due to fear of SARS-CoV-2 infection (68.8%). Current treatment was associated with a reduced chance of post-poning/missing appointments (OR = 0.208, p = 0.003), whereas a high or very high level of concern for COVID-19 (OR = 6.806, p = 0.034; OR= 10.097, p = 0.038), SARS-CoV-2 infection among close acquaintances (OR = 4.251, p = 0.026), anxiety disorder (OR = 5.465, p = 0.016) and AJCC stage IV (OR = 3.108, p = 0.048) were associated with a higher likelihood of postponing/missing appointments. Conclusion: Among our participants, treatment changes were rare and the proportion of missed/delayed appointments was rather small. The main reasons for delays/cancellations of appointments were anxiety and concern for COVID-19.
Assuntos
COVID-19 , Melanoma , Idoso , Berlim , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Melanoma/epidemiologia , Melanoma/terapia , Pandemias , SARS-CoV-2RESUMO
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic poses a great challenge for cancer patients. Our aim was to assess its influence on treatment and appointments of melanoma patients after one year of pandemic. METHODS: Melanoma patients treated in the Vivantes Skin Cancer Centre in Berlin, Germany completed a postal survey on pandemic-related alterations in melanoma care. Impact factors on changes of appointments were examined with descriptive analyses and multivariate logistic regression. Data after one year of pandemic were compared to those after its first wave. RESULTS: Among 366 participants (57.7 % males; mean age 69.2 years, response rate: 36.1 %), 38 (10.1 %) reported postponed or missed appointments, mostly on their own demand (71.1 %) due to fear of COVID-19 (52.6 %). Current treatment was associated with a lower risk of changing appointments (Odds Ratio [OR]: 0.194, p = 0.002), higher age (OR: 1.037, p = 0.039), longer disease duration (OR: 1.007, p = 0.028), and higher school degree (OR: 2.263, p = 0.043) with higher probability. Among 177 patients currently receiving therapy, only 1.7 % experienced pandemic-related treatment alterations. Concern about COVID-19 was significantly higher after one year of pandemic than after its first wave, but the number of missed appointments was lower. CONCLUSIONS: Pandemic-related changes were rare in our cohort and decreased over time despite increasing concern.
Assuntos
COVID-19 , Melanoma , Idoso , Agendamento de Consultas , Berlim/epidemiologia , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Melanoma/epidemiologia , Melanoma/terapia , PandemiasAssuntos
Carcinoma Basocelular , Infecções por HIV , Neoplasias Cutâneas , Compostos de Bifenilo , Carcinoma Basocelular/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Síndrome do Hamartoma Múltiplo , Humanos , Piridinas/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
BACKGROUND AND OBJECTIVES: Choice of treatment for advanced melanoma is crucially influenced by comorbidities and patient preferences. Our study aimed to investigate the impact of comorbidities on preferences. PATIENTS AND METHODS: 150 patients with melanoma stage IIC-IV completed a discrete choice experiment to determine preferences for outcome (overall response rate [ORR], 2-year survival, progression-free survival [PFS], time to response [TTR], kind of adverse events [AE], AE-related treatment discontinuation) and process attributes (frequency and route of administration [RoA], frequency of consultations) of systemic melanoma treatments. The impact of comorbidities was assessed by analysis of variance and multivariate regression. RESULTS: Participants with hypertension and other cardiovascular diseases attached significantly greater importance to TTR and RoA than others. Respondents with arthropathy cared more about TTR (ß = 0.179, P = 0.047) and RoA, but less about ORR (ß = -0.209, P = 0.021). Individuals with diabetes considered AE (ß = 0.185, P = 0.039) and frequency of consultations more essential, but ORR less relevant. Those with other malignancies were particularly worried about treatment discontinuation (ß = 0.219, P = 0.008), but less about ORR (ß = -0.202, P = 0.015). Participants with depression focused more on PFS (ß = 0.201, P = 0.025) and less on TTR (ß = -0.201, P = 0.023) and RoA (ß = -0.167, P = 0.050). CONCLUSIONS: Treatment preferences of melanoma patients vary significantly dependent on comorbidities.
Assuntos
Melanoma , Preferência do Paciente , Doenças Cardiovasculares , Comorbidade , Humanos , Melanoma/terapiaRESUMO
Treatment paradigms for advanced melanoma have changed fundamentally over recent years. A discrete choice experiment was performed to explore patient preferences regarding outcome (overall response rate, 2-year survival rate, progression-free survival, time to response, type of adverse events, probability of adverse event-related treatment discontinuation) and process attributes (frequency and route of administration, frequency of consultations) of modern treatments for melanoma. Mean preferences of 150 patients with melanoma stage IIC-IV were highest for overall response rate (relative importance score (RIS) 26.8) and 2-year survival (RIS 21.6), followed by type of adverse events (RIS 11.7) and probability of adverse event-related treatment discontinuation (RIS 9.2). Interest in overall response rate and 2-year survival declined with increasing age, whereas process attributes gained importance. Participants who had experienced treatment with immune checkpoint inhibitors valued overall response rate more highly and worried less about the type of adverse events. In conclusion, patients with advanced melanoma consider efficacy of treatment options most important, followed by safety, but preferences vary with individual and disease-related characteristics.