Objectives

The advent of immune checkpoint inhibitor (ICI) therapy has vastly improved outcomes for patients with advanced melanoma. However, the symptom burden and intensity with their impact on quality-of-life (HRQoL) and functionality are heterogeneous and unpredictable. We used descriptive exploratory content analysis from interviews to capture the patient experience after they had completed quantitative data collection of their symptom burden and interference with the use of two patient-reported outcome (PRO) instruments.

Data Sources

Participants from a single center with advanced melanoma (n = 19) who are undergoing ICI therapy completed the Modified MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Melanoma and recorded semistructured interviews. Interpretive description informed the inductive and iterative analysis approach.

Conclusion

Participants had a heterogenous experience of ICI and melanoma-related symptoms: distress (84%), fatigue (68%), rash or skin changes (53%), pain (30%), diarrhea (30%), itching (26%), and shortness of breath (21%), with varying interference within HRQoL domains, mood (47%), relations with other people (26%), and activity (21%). Some noted a lack of physical interference (79%). Uncertainty was a pervasive theme in the interviews (68%) despite the majority having positive thoughts about ICI therapy (58%) and expectations of the success of therapy (53%). The physical and emotional burden of a melanoma diagnosis, undergoing therapy, and the uncertainty of the outcomes are pervasive for patients.

Implications for Nursing Practice

Communication surrounding the diagnosis, prognosis, treatment options, and outcomes need to be clear and acknowledge there are unknowns. Nurses may benefit from using a validated PRO instrument to help document and understand the patient's symptom experience while undergoing ICI therapy.

中文翻译：

---

晚期黑色素瘤患者接受免疫检查点抑制剂（ICI）治疗的症状经历

目标

免疫检查点抑制剂（ICI）疗法的出现极大地改善了晚期黑色素瘤患者的预后。然而，症状负担和强度及其对生活质量 (HRQoL) 和功能的影响是异质且不可预测的。我们使用访谈中的描述性探索性内容分析来捕捉患者在完成症状负担的定量数据收集以及使用两种患者报告结果 (PRO) 工具的干扰后的体验。

数据源

来自单一中心的晚期黑色素瘤 (n = 19) 接受 ICI 治疗的参与者完成了改良 MD 安德森癌症治疗黑色素瘤症状量表和功能评估，并记录了半结构化访谈。解释性描述为归纳和迭代分析方法提供了信息。

结论

参与者对 ICI 和黑色素瘤相关症状有不同的经历：痛苦 (84%)、疲劳 (68%)、皮疹或皮肤变化 (53%)、疼痛 (30%)、腹泻 (30%)、瘙痒 (26%) ）和呼吸短促（21%），在 HRQoL 领域、情绪（47%）、与他人的关系（26%）和活动（21%）内有不同的干扰。一些人指出缺乏物理干扰（79%）。尽管大多数人对 ICI 治疗持积极态度 (58%) 并期望治疗成功 (53%)，但不确定性是访谈中普遍存在的主题 (68%)。黑色素瘤诊断、接受治疗以及结果的不确定性对患者来说普遍存在身体和情感负担。

对护理实践的影响

围绕诊断、预后、治疗选择和结果的沟通需要明确，并承认存在未知因素。护士可以受益于使用经过验证的 PRO 仪器来帮助记录和了解患者在接受 ICI 治疗时的症状经历。