The authors concluded that there were no differences in quality of life associated with different drug treatments for patients with metastatic melanoma. The authors’ conclusions appeared to reflect review findings, but the small number of studies with high drop-out rates suggested that a more cautious conclusion may have been more appropriate.

To evaluate the effects of treatment on quality of life in patients with advanced cutaneous malignant melanoma (metastatic melanoma).

The review also assessed baseline quality of life in patients with metastatic melanoma and economic analyses of the effect of screening and treatment. This abstract focused on the effects of treatments on quality of life.

MEDLINE, EMBASE, CINAHL, The Cochrane Library and DARE were searched from inception to 2006 for studies published in peer-reviewed journals. Search terms were reported. No language restrictions were applied. Reference lists of identified studies and reviews and the author’s personal files were screened.

Randomised controlled trials (RCTs) that evaluated quality of life associated with non-surgical treatments in adults with metastatic malignant melanoma including stage III or VI (according to the American Joint Committee on Cancer Staging) were eligible for inclusion. Studies were excluded if they evaluated patients with resectable disease or evaluated radiotherapy or if data about patients with metastatic melanoma could not be separated from patients with other types of cancer.

The included RCTs compared a variety of different drug regimens (details reported under Results). Studies assessed quality of life using different measures including European Organisation for Research and Treatment of Cancer (EORT), Quality of Life Questionnaire (QLQ C30), Quality of Well-Being Scale (QWB-SA), GQL-8, self-assessment and the Rotterdam Checklist Symptom questionnaire,

Two reviewers independently selected studies and resolved disagreements on inclusions through consensus or with the aid of another reviewer .

The authors did not state that they assessed the validity of efficacy studies.

It appeared that three reviewers independently extracted data. For each study, quality of life scores were presented for each treatment group with the level of statistical significance.

The studies were combined in a narrative synthesis.

Six RCTs (n=1,151 at baseline) were included in the quality of life assessments.

RCTs: There were no statistically significant differences in quality of life between dacarbazine (DTIC) versus fotemustine (one RCT, n=156, follow-up until end of induction), histamine dihydrochloride plus interleukin-2 (IL-2) versus IL-2 alone (one RCT, n=301, follow-up to four months), DTIC versus DTIC plus interferon (IFN)-alpha2a (one RCT, n=152, duration of follow-up not reported), temozolomide (TEM) versus DTIC (one RCT, n=305, follow-up to 24 weeks), cisplatin (CIS) plus DTIC with and without IL-2 and iIFN-alpha-2b (one RCT, n=176, median follow-up 18 months) and DTIC alone versus DTIC plus IFN-alpha (one RCT, n=61, follow-up up to 52 months).

Studies generally had high drop-out rates.

Studies found no strong evidence of cost-effectiveness for interferon (one study) or temozolomide. Melanoma screening was found to be neither cost-effective (one study) nor have survival benefit (one study)

There were no differences in quality of life associated with different drug treatments for patients with metastatic melanoma.

The review question was stated and inclusion criteria defined for intervention, participants, study design and outcome. Several relevant sources were searched and no language restrictions were applied. No attempts were made to minimise publication bias. Appropriate methods were used to minimise reviewer error and bias during the review process. Study validity was not assessed, but the authors stated that most studies had high drop-out rates and this limited the evidence. In view of the diversity among studies, a narrative synthesis was appropriate. The authors’ conclusions appeared to reflect review findings, but the small number of studies with high drop-out rates suggested that a more cautious conclusion may have been more appropriate.

Practice: The authors did not state any implications for practice.

Research: The authors stated that there was a need to identify effective treatments that improve survival and quality of life in patients with metastatic melanoma and a need to prevent metastatic melanoma. Studies should be of higher quality and ensure that all treated patients completed quality of life assessments. Future economic analysis should calculate the cost per quality of life year (QALY) gained.

Bristol-Myers-Squibb, Brussels, Belgium.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.