Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment

Dermatol Surg. 2007 Jan;33(1):11-6. doi: 10.1111/j.1524-4725.2007.33001.x.


Background: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers<or=10% improvement in relapse-free survival and overall survival with significant toxicity.

Objective: The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy.

Methods: Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a >/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN.

Results: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05).

Conclusions: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / adverse effects
  • Chemotherapy, Adjuvant
  • Decision Making
  • Female
  • Health Care Surveys
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / administration & dosage*
  • Interferon-alpha / adverse effects
  • Male
  • Melanoma / psychology*
  • Melanoma / secondary
  • Melanoma / therapy*
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Recombinant Proteins
  • Sentinel Lymph Node Biopsy
  • Skin Neoplasms / pathology
  • Skin Neoplasms / psychology*
  • Skin Neoplasms / therapy*


  • Antineoplastic Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins