QUALITY-OF-LIFE AND ETHICS - OPINIONS ABOUT CHEMOTHERAPY AMONG PATIENTS WITH ADVANCED MELANOMA, NEXT OF KIN AND CARE-PROVIDER

The treatment of generalized malignant melanoma is purely experimental and palliative. Despite rather pessimistic results from numerous clin ical trials with aggressive combination chemotherapy clinical trials a re still considered among the main options for making progress. During a period of three years, a longitudinal quality of life (QoL) study w as performed in connection with one such clinical trial, part of the S wedish Melanoma Programme. Parallel to the QoL measures, questions con cerning the value of treatment and communication about treatment toxic ity were consecutively put to patients with advanced disease, their ne xt-of-kin and nurses. During this period we followed professionals dea ling with everyday medical, psychological and ethical aspects of aggre ssive chemotherapy in the context of palliation. In connection with th e official closure of the QoL assessments, a questionnaire study addre ssing opinions on chemotherapy and ethical conflicts related to the cu rrent treatment was performed. All professional categories working at the Melanoma Unit of The Karolinska Hospital participated in this stud y. By combining these two sources of information, we have tried to giv e a broad picture of attitudes towards chemotherapy for palliation of metastatic melanoma. After 2-3 months of therapy half of the patients reported the treatment troublesome, 50% felt it had been helpful and v ery few had thought about stopping the treatment. The patients communi cated mainly with their family about treatment toxicity, leaving the n urses with insufficient information to assess effects on an individual level. The relatives therefore seem to be more appropriate proxy rate rs than the nurses in the present palliative situation, at least conce rning the value of treatment. The questionnaire study revealed fewer d ifferences between staff members than expected. The staff had an overw helmingly positive attitude to chemotherapy and found satisfaction in their work. They sought motivation in this meaningful work and the fee ling of being really needed by patients. The environment, a university clinic with an active treatment tradition, undoubtedly modifies the p ersonnel's attitudes and coping strategies. It seems reasonable to ass ume that the professional's view increases the patient's enthusiasm fo r chemotherapy.