Metastatic Melanoma (MM) patients receiving pembrolizumab are a growing population. Its impact on their wellbeing is underexplored. Supportive care interventions for people living long-term on immunotherapy are needed.
To assess the feasibility of providing a multimodal supportive care program to MM patients being treated with pembrolizumab.
This pre-post-test feasibility cohort study recruited participants treated with pembrolizumab for MM into two cohorts: i) supportive care intervention with usual care; and, ii) usual care. The intervention, comprised comprehensive medical assessment by supportive care physician (SCP), exercise physiologist (EP), and dietitian after which a tailored supportive care program was devised. Programs included: exercise intervention, dietary advice, meditation, massage, acupuncture, reflexology, yoga, qigong and psychologist consultation. Outcome measures included: adherence to plan, patient reported outcomes (symptoms, anxiety and depression, toxicity) were collected at 3-weekly intervals. Descriptive data regarding symptoms and adherence are reported.
In total, 28 participants were recruited, 13 intervention, 15 control; 3 did not complete the study due to complications or death. The majority were male, born in Australia, all English speaking. Median age was 66 years (range 42-85). All intervention participants completed baseline and follow up assessments with SCP, EP, and dietitian. Two who missed follow-up with EP or dietitian.
Symptoms most troubling at baseline were: fatigue (n=6), sleep (n=6), general aches and pains (5), memory (4). All intervention participants were prescribed 16 exercise sessions; 8 (50%) completed all, overall exercise adherence was 85%. Use of integrative therapies varied between 2 and 18 sessions. Massage was used by 9, reflexology and exercise classes by 5. Immunotherapy related adverse event rates were low and SCP consultation identified symptoms not captured by CTCAE 4.0.
A holistic supportive care intervention tailoring a program to individual needs is feasible and warrants further investigation to determine impacts on outcomes.