Preferences of German melanoma patients for interferon (IFN) α-2b toxicities (the DeCOG "GERMELATOX survey") versus melanoma recurrence to quantify patients' relative values for adjuvant therapy.

Currently interferon alfa-2b (IFNα-2b) is an approved adjuvant drug for high-risk melanoma patients that leads to an improvement in disease-free survival (DFS). However, it is unclear whether it also impacts overall survival. Widespread use of adjuvant high-dose IFNα has been tempered by its significant toxicity and its limited efficacy. Current therapeutic strategies like immune checkpoint blockade or targeted therapy may also be useful in the adjuvant setting. Therefore, it is important to weigh the trade-offs between possible side effects and therapeutic benefit.We assessed patient utilities for health states associated with IFN therapy. Utilities are measures of preference for a specific health state on a scale of 0 (death) to 1 (perfect health).Utilities were determined for health states associated with adjuvant IFN among 130 German low-risk melanoma patients using the standard gamble technique. Four IFNα-2b toxicity scenarios and the following 3 posttreatment outcomes were assessed: disease-free health and melanoma recurrence (with or without previous use of IFNα-2b) resulting in cancer death. Patients were asked to trade-off the improvement in 5-year DFS and the IFN-related side effects.Utilities for melanoma recurrence (mean 0.60) were significantly lower than for all IFNα-2b toxicity scenarios (mean 0.81-0.90). Patients were willing to tolerate mild-to-moderate and severe toxicity for a 50% and 75% chance of 5-year DFS, respectively. Both utilities and threshold benefits were mostly independent from patient characteristics like gender, income, and social situation. Significant impact was only observed by age and previous personal experience with cancer.On average, German patients were willing to trade even severe IFNα-2b toxicity for reducing the rate of melanoma recurrence. This result points out the importance of a relapse-free survival for melanoma patients. The utilities measured in our study can be applied to decision-making processes in clinical trials of new adjuvant drugs.

Skin cancer prevention.

Prevention signifies the avoidance of diseases. It also includes the early detection of diseases and taking measures to avoid worsening of an existing disease. Prevention is divided into primary, secondary and tertiary prevention. The prevention of skin cancer is particularly important due to the rising incidence of skin cancer in recent years. In Germany, 195.000 new cases of skin cancer, including non melanoma skin cancer and melanoma are occurring. Therefore, skin cancer is among the most common cancer diseases. Primary prevention comprises the reduction of skin cancer risk behavior, including education about the danger of UV exposure and the right way of dealing with natural and artificial UV radiation. The implementation of a systematic skin cancer screening in Germany contributes to secondary prevention. First data from the initial project in Schleswig-Holstein, Germany's most northern state, indicate for the first time that the incidence and mortality of melanoma can be reduced by secondary prevention. For tertiary prevention, the national associations recommend a risk-adapted, evidence-based follow-up for all types of skin cancer. From the perspectives of the payers and from the patients, prevention is assessed positively. Prevention can contribute to a reduction of disease burden.

Skin cancer screening in Germany - perception by the public.

BACKGROUND: In 2008, community skin cancer screening (cSCS) was introduced into routine care of the German statutory health insurances (SHI). In the meantime, more than 13 million individuals have been screened. To date, no data are available on the perception of cSCS by the general public. AIM: Evaluation of public perception of cSCS in Germany. PATIENTS AND METHODS: From 10 to 17th March 2011, a phone survey on a population-based sample of n = 1 014 German adults with SHI status was conducted by the Forsa Institute, including 12 questions on the use, knowledge and attitude regarding cSCS. RESULTS: Of the interviewees 48 % were concerned about skin cancer, 29 % of all persons and 31 % of those eligible had already undergone cSCS. Of these, a major proportion (80 %) had been screened by dermatologists. Of the interviewees 75 % would (again) consult a dermatologist for the next cSCS, and less than 10 % would consult the general practitioner. Although about 93 % considered health screenings useful, only 44 % were informed about the legal right to undergo free cSCS after the age of 35. CONCLUSIONS: In Germany cSCS is highly accepted in the community. Leading care providers are the dermatologists. Knowledge about the right to free cSCS needs better public propagation.

Routine skin cancer screening in Germany: four years of experience from the dermatologists' perspective.

BACKGROUND: In 2008, routine skin cancer screening (rSCS) was introduced into routine care for persons ≥35 years in Germany. To date, about 95% of approximately 3,500 office-based dermatologists participate in this program paid by the statutory health insurances. OBJECTIVE: To evaluate German rSCS from the dermatologists' perspective. METHODS: Since 2009, every year standardized questionnaires were sent nationwide to about 2,000 dermatologists, once yearly addressing the actual patients, screenings and treatments, the personal experiences and the dermatologists' attitudes towards rSCS. Descriptive data analysis from 2009, 2010 and 2011 was performed. RESULTS: The average dermatologist -performed 1,380/1,364/1,348 screenings annually (2009/ 2010/2011), with a mean remuneration of EUR 21.50/22.10/ 21.93. 32.9/46.6/53.3% of the dermatologists were rather or very satisfied with rSCS, and a rising number of dermatologists (69.4/80.0/83.1%) perceived a better quality of health care for skin cancer since 2008. CONCLUSION: rSCS is widely accepted by German dermatologists and is conducted with increasing frequency.