Health management program: factors influencing completion of therapy with high-dose interferon alfa-2b for high-risk melanoma

Jean-François Pouliot, Nancy Levesque, K Mitchinson, Debbie Lawrie, Leslie Fedorak, D MacDonald


The goal of the 1-year observational, multicentre,
open-label study reported here was to identify factors
influencing adherence to high-dose interferon
alfa-2b adjuvant therapy in patients at high risk of
recurrence following surgical excision of malignant
melanoma. The study was carried out in 23 tertiarycare
centres across Canada.
The 225 patients enrolled in the study all had malignant
melanoma that was surgically excised and that
required adjuvant treatment with interferon alfa-2b.
Of these patients, 64% were men. Mean age was
51.7 years. All patients received interferon alfa-2b
treatment during a 4-week induction phase
(20 MU/m2 intravenously 5 days per week) followed
by a 48-week maintenance phase (10 MU/m2 subcutaneously
3 days per week).
Oncology nurses reviewed side-effect management
with the patients before the induction and maintenance
phases. Patients were provided with daily diaries, comprehensive
educational materials, and ongoing nursing
support. Data on side effects and discontinuations
were obtained from patient interviews and diaries.
The main outcome measurements were related
to treatment discontinuation: rate, timing, reason, and
prevention. Of the 225 patients, 75 (33.3%) discontinued
interferon during the induction phase, and 58
(25.8%) discontinued during the maintenance phase.
The main reasons for discontinuation were adverse
events (58%) and disease progression (26%). Patients
with a daily fluid intake greater than 1.5 L were more
likely to complete therapy than were those with an
intake less than 1.5 L (64% vs. 36%, p < 0.0001).
Of 225 patients enrolled in the interferon alfa-2b
health management program, 41% completed the
1-year treatment course. Higher fluid intake (>1.5 L
daily) was associated with increased adherence to


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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)