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Research Article
Ann Livingstone
NHMRC Clinical Trials Centre, The University of Sydney
Corresponding Author
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Background
Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma.
Methods
In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken.
Results
Twenty-five physicians and nurses, aged 28-68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) clinical nurse consultants, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: (1) clinical and patient factors, (2) treatment information provision, and (3) individual physician/nurse factors. Melanoma sub-stage and an individual patient's therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy's effectiveness and their views about treatment burden patients might consider acceptable.
Conclusions
Patients' disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals' adjuvant immunotherapy endorsement. Findings will aid clinical communication with patients and facilitate clinical decision-making about management options for resected stage III melanoma.
Keywords
Melanoma, immunotherapy, interviews, physicians, surgeons, nurse clinicians, professional role, decision making
Figure 1
Competing interest reported. AL, KD, KH and RLM have no conflicts of interest to declare. MRS received institutional research support from Amgen, Astellas, AstraZeneca, Bayer, Bionomics, Bristol-Myers Squibb (BMS), Celgene, Medivation, Merck Sharpe & Dohme (MSD), Pfizer, Roche, Sanofi and Tilray, but does not sit on any advisory boards. AMM has served on advisory boards for BMS, MSD, Novartis, Pierre-Fabre, Qbiotics and Roche. GVL is a consultant advisor for Aduro Biotech, Amgen, Array Biopharma, Boehringer Ingelheim, BMS, Hexel AG, Highlight Therapeutics SL, MSD, Novartis, Pierre-Fabre, QBiotics, Regeneron Pharmaceuticals, SkylineDX B.V., and Specialised Therapeutics Australia. MSC has served on advisory boards for Amgen, BMS, Eisai, Ideaya, MSD, Nektar, Novartis, Oncosec, Pierre-Fabre, Qbiotics, Regeneron, Roche, and Sanofi, and received honoraria from BMS, MSD, and Novartis.
This is a list of supplementary files associated with this preprint. Click to download.
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CURRENT STATUS: Under Review
Version 1
Posted 24 May, 2021
No community comments so far
Editorial decision: Major revision
On 07 Jul, 2021
Reviews received
Received 04 Jun, 2021
Reviewers agreed
On 24 May, 2021
Reviewers agreed
On 21 May, 2021
Reviewers invited
Invitations sent on 20 May, 2021
Editor assigned
On 19 May, 2021
Editor invited
On 19 May, 2021
Submission checks complete
On 19 May, 2021
First submitted
On 11 May, 2021
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A new preprint design is coming!
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This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Ann Livingstone
NHMRC Clinical Trials Centre, The University of Sydney
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 24 May, 2021
No community comments so far
Editorial decision: Major revision
On 07 Jul, 2021
Reviews received
Received 04 Jun, 2021
Reviewers agreed
On 24 May, 2021
Reviewers agreed
On 21 May, 2021
Reviewers invited
Invitations sent on 20 May, 2021
Editor assigned
On 19 May, 2021
Editor invited
On 19 May, 2021
Submission checks complete
On 19 May, 2021
First submitted
On 11 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma.
Methods
In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken.
Results
Twenty-five physicians and nurses, aged 28-68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) clinical nurse consultants, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: (1) clinical and patient factors, (2) treatment information provision, and (3) individual physician/nurse factors. Melanoma sub-stage and an individual patient's therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy's effectiveness and their views about treatment burden patients might consider acceptable.
Conclusions
Patients' disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals' adjuvant immunotherapy endorsement. Findings will aid clinical communication with patients and facilitate clinical decision-making about management options for resected stage III melanoma.
Figure 1
Competing interest reported. AL, KD, KH and RLM have no conflicts of interest to declare. MRS received institutional research support from Amgen, Astellas, AstraZeneca, Bayer, Bionomics, Bristol-Myers Squibb (BMS), Celgene, Medivation, Merck Sharpe & Dohme (MSD), Pfizer, Roche, Sanofi and Tilray, but does not sit on any advisory boards. AMM has served on advisory boards for BMS, MSD, Novartis, Pierre-Fabre, Qbiotics and Roche. GVL is a consultant advisor for Aduro Biotech, Amgen, Array Biopharma, Boehringer Ingelheim, BMS, Hexel AG, Highlight Therapeutics SL, MSD, Novartis, Pierre-Fabre, QBiotics, Regeneron Pharmaceuticals, SkylineDX B.V., and Specialised Therapeutics Australia. MSC has served on advisory boards for Amgen, BMS, Eisai, Ideaya, MSD, Nektar, Novartis, Oncosec, Pierre-Fabre, Qbiotics, Regeneron, Roche, and Sanofi, and received honoraria from BMS, MSD, and Novartis.
This is a list of supplementary files associated with this preprint. Click to download.
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