Neurocognitive Function, Psychosocial Outcome, and Health-Related Quality of Life of the First-Generation Metastatic Melanoma Survivors Treated with Ipilimumab

Abstract

Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI). Methods. Melanoma survivors were identified within two study populations (N=104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up. Results. Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence (N=8), existential problems (N=2), survivor guilt (N=2), and posttraumatic stress disorder (N=6). The mean EORTC QLQ-C30 Global Score was not significantly different from the European mean of the healthy population. Nine survivors reported anxiety and/or depression (Hospitalization Depression Scale) during the survey. Seven survivors (41%) reported fatigue (Fatigue Severity Scale). Seven patients (41%) had impairment in NCF; only three out of seven survivors had impairment in subjective cognition (Cognitive Failure Questionnaire). Anxiety, depression, fatigue, and neurocognitive symptoms remained stable at the 1-year follow-up. All cases of skin toxicity (N=8), hepatitis (N=1), colitis (N=3), and sarcoidosis (N=1) resolved without impact on HRQoL. Three survivors experienced hypophysitis; all suffered from persistent fatigue and cognitive complaints 5 years after onset. One survivor who experienced a Guillain-Barré-like syndrome suffered from persisting depression, fatigue, and impairment in NCF. Conclusion. A majority of melanoma survivors treated with IPI continue to suffer from emotional distress and impairment in NCF. Timely detection in order to offer tailored care is imperative, with special attention for survivors with a history of neuroendocrine or neurological irAE. The trial is registered with B.U.N. 143201421920.

Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review

“…A useful comparison among cancer types is therefore difficult. In contrast to the two studies on breast and testicular cancer survivors that reported a prevalence of 1.5% and 6.8%, respectively, the prevalences in two studies with melanoma survivors were higher (up to 40%)[ 14 , 27 ]. For all three of the previously mentioned psychiatric comorbidities, melanoma survivors seemed to show relatively high prevalences, which might indicate a distinctive demand for psychological support for this survivor group.…”

“…For each site, the number of articles included were as follows: Breast (5), gynecological/cervical (2), hematological (4), testicular (5), prostate (1), head and neck (3), stomach (1), melanoma (3), brain (1) and lung (1). The number of participants ranged between 17[ 13 ] and 1260[ 14 ]. The studies were published between 2002 and 2020.…”

“…Comparing the prevalences among tumor types, a high variability, between 7.9% and 48%, can be seen. Whereas most tumor sites showed a range between 8% and 22% for clinical levels of depression, four cancer subtypes showed a much higher prevalence (above 40%): Head and neck[ 21 ], stomach[ 22 ], melanoma[ 14 ] and brain[ 23 ] cancer.…”

“…The included tumor types were breast, testicular and melanoma (2 studies). The two studies assessing the prevalence in melanoma patients showed a prevalence of comorbid anxiety-depression in up to 40%[ 14 ] of survivors. The smallest prevalence was found in breast cancer survivors, with a study indicating a prevalence of comorbid anxiety-depression of 1.5%[ 26 ].…”

Living with Metastatic Cancer: A Roadmap for Future Research

“…PTSS such as intrusive thoughts about aversive cancer-related events, avoiding reminders of cancer, negative cognitive appraisals (e.g., fatalistic or hopeless beliefs), and hyperarousal (i.e., heightened psychophysiological reactivity) are experienced to some extent by most people who have had cancer [ 121 ], although the prevalence of cancer-related PTSD generally falls around 10% [ 67 , 101 ]. In metavivors, cancer-related PTSD may be more common, with small sample sizes of metastatic breast cancer and melanoma showing prevalence rates between 35 and 52% [ 122 , 123 , 124 ]. In general, cancer-related distress appears to peak at diagnosis and during active treatment, and decline over time.…”