BRAF/MEK-inhibition for patients with metastatic melanoma: Towards patient-centered care

Abstract

Background: The incidence of melanoma - the deadliest form of skin cancer - is steadily increasing. Over the last few years, treatment options for inoperable or metastatic melanoma have increased. Treatment with BRAF/MEK-inhibitors (BMi) induces fast responses in the large majority of patients with BRAF-mutant melanoma. As a result, BMi are often used as a palliative treatment for patients with aggressive metastatic melanoma. A successful palliative treatment - a treatment in which life is prolonged and the patient experiences an acceptable quality of life - requires intensive support. Nursing interventions are aimed at empowering people and helping them to achieve, maintain or (re)acquire their independence. This Dutch study was set up to collect building blocks in order to develop an evidence-based nursing intervention that supports patients during palliative treatment with BMi. Methods: Using the van Meijel model, a problem analysis, a literature review, a patient needs analysis and a current practice analysis, were performed. A literature search was performed to collect available, appropriate interventions. Nationwide questionnaires - in patients as well as in nurses - were used to gain insight into patient needs and the current practice. Results: The problem analysis and results of the literature review showed that patient education, disease and/or treatment related symptoms and support with self-management are key components during treatment with BMi in adult patients with metastatic melanoma. When considering nursing care, the available literature focusses on promoting adherence in particular. Conclusions: Treatment with BMi is a life-prolonging treatment. As a result, medication adherence seems more important in relation to symptom burden and quality of life than to the effectiveness of the treatment alone. In conclusion, future nursing interventions should not only focus on treatment adherence, but also on quality of life and quality of dying, with respect to the patient's needs and wishes.