Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study

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Abstract

Purpose: The aim of this study was to assess the evolution of health-related quality of Life (HRQoL), emotional burden, and neurocognitive function in the first-generation metastatic melanoma survivors treated with pembrolizumab. Methods: Survivors were defined as patients who achieved a durable remission for at least 6 months after initiating pembrolizumab in a single-center observational study (N = 141). A semi-structured interview was performed at baseline. Neurocognitive computerized testing and patient-reported outcomes were collected at 4 time points to assess HRQoL using the EORTC QLQ-C30 and the HADS to assess anxiety and depression. Results: Out of 35 eligible patients, 25 were recruited and completed baseline assessment (18 female; median age 58 years [range 28–86]; 24 completed the 1-year follow-up phase. Median time since diagnosis was 30 months (range 12–84); median time since initiation of pembrolizumab was 19 months (range 6–42). At all visits, survivors reported a significantly lower global HRQoL, lower physical, emotional, cognitive, role, and social functioning compared with the European Mean of the healthy population. Fifteen patients (64%) had clinical levels of anxiety/depression at one time point during follow-up. The clinical interview revealed that 12 patients (48%) suffered from Cancer-Related-Post-Traumatic-Stress disorder, of whom 7 (28%) developed transient suicidal ideation, 1 patient made a suicide attempt. Neurocognitive testing revealed cognitive impairment in 8 patients (32%). Conclusions: Metastatic melanoma survivors, treated successfully with pembrolizumab, are at risk for suffering from emotional distress and neurocognitive impairment with a persistent impact on their HRQOL. Timely detection in order to offer tailored care is indicated.

Original languageEnglish
Pages (from-to)3267-3278
Number of pages12
JournalSupportive Care in Cancer
Volume28
Issue number7
DOIs
Publication statusPublished - Jul 2020

Bibliographical note

Funding Information:
AR has consulting and advisory role in the Bristol-Myers Squibb and Merck Sharp & Dome. GA received travel accommodations from the Merck Sharp & Dome and Pfizer, research grant from the Pfizer and Novartis. AS is a full-time employee of the Cogstate Ltd., the company that provided the computerized cognitive tests in this study. MD received research agreement from the Brainlab AG, and has consulting or advisory role in the Novalis Certification Expert. BN received honoraria from the Bristol-Myers Squibb, Merck Sharp & Dome, Novartis, and Roche, has consulting or advisory role in the Bristol-Myers Squibb, Merck Sharp & Dome, Novartis, Roche, Speakers’ Bureau-Novartis, and received travel, accommodations, and expenses from the Amgen, Bristol-Myers Squibb, Merck Sharp & Dome, Novartis, and Roche.The other authors have no conflict of interest to declare.

Funding Information:
We would like to thank the patients and their family for participating in this study, and Yanina Jansen, Julia K. Schwarze, and Laila Ben Salama for helping with the data collection. We thank Prof Paul Maruff, Chief Science Officer of Cogstate Ltd and Associate Professor at the Florey Institute for Neuroscience and Mental Health, for the critical reading and his constructive input that helped us to improve the manuscript.

Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Cancer survivorship . Quality of life . Psychosocial outcome . Melanoma . Pembrolizumab . Immunotherapy

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