Longitudinal health-related quality of life after electrochemotherapy in elderly patients with cutaneous melanoma

Abstract

The incidence of cutaneous melanoma (CM) is increasing among elderly patients, who often present with advanced disease, including cutaneous metastases. Electrochemotherapy (ECT) is a local ablative treatment that enhances chemotherapy uptake via electric pulses. Management in patients aged ≥ 65 years is challenging because of frailty, comorbidities, and reduced tolerance to systemic therapy. Health-related quality of life (HRQoL) is an important treatment outcome, and shared decision-making (SDM) may help align treatment choices with patients’ preferences, values, and expectations. We aimed to evaluate longitudinal changes in EQ-5D utility scores in elderly patients with CM skin metastases treated with ECT and to identify clinical and patient-related factors associated with HRQoL. Methods HRQoL was assessed using the EQ-5D at baseline and during follow-up after ECT. Utility scores were analyzed over time, and associations with demographic and clinical variableswere examined. Predicted trajectory curves were developed to visualize the predicted trajectories of utility scores. Significant time interactions were observed for age (p = 0.009), baseline utility (p < 0.001), largest nodule diameter (p = 0.017), lesion site (p = 0.003), and sex (p = 0.012), indicating heterogeneous HRQoL trajectories. Lower baseline utility was associated with greater improvement (p < 0.001), whereas higher baseline utility, particularly in older patients, showed minimal change or slight early decline. Larger nodules and certain lesion sites were linked to poorer outcomes. Sex differences were modest, with females showing slightly less favorable early but more favorable later changes. Predicted trajectory curves enabled stratification of expected HRQoL trajectories. Longitudinal HRQoL trajectories following ECT in elderly patients with CM varied according to baseline HRQoL and patient characteristics. These findings identify candidate predictors for future individualized prediction models but should be considered hypothesis-generating. Prospective studies with external validation are needed to confirm their clinical utility and potential role in patient-centered treatment planning.