Qualitative Investigation of Experience and Quality of Life in Patients Treated with Calcium Electroporation for Cutaneous Metastases

Abstract

(1) Background: Calcium electroporation is a novel cancer treatment. It includes injecting calcium-solution and applying electric pulses to tumour tissue. Data on quality of life for patients with cutaneous metastases treated with calcium electroporation is limited. We evaluated quality of life in patients with skin metastases treated with calcium electroporation using qualitative interviews. (2) Methods: This investigation featured a subgroup from a non-randomised phase II study (CaEP-R) at Zealand University Hospital, Denmark, studying response to calcium electroporation in cutaneous metastasis (ClinicalTrials no. NCT04225767). Participants were interviewed at baseline before calcium electroporation treatment and after two months. Data was analysed phenomenologically; (3) Results: Interviews were conducted February 2020-November 2021. Nine patients were included, of which seven participated in both interviews. All seven patients expected treated tumours to disappear, symptom relief and minimal side effects. Most patients requested peer accounts. All patients found the treatment uncomfortable but acceptable; all thought their fears of electric pulses exceeded their experience. All would repeat the treatment if effective. Successful treatment had a positive effect on pain, symptomatic wounds, sleep, vigour and social inclination; (4) Conclusions: Calcium electroporation enhanced health-related quality of life by reducing symptoms and increasing social inclination. Peer accounts provide patients with a shortcut to confidence in treatment on top of doctors' recommendations.

Keywords: calcium electroporation; cancer; electroporation; electroporation based treatments; patient experience; qualitative interviews; quality of life.

Figure 1

Themes and subthemes.

Figure 2

Example of affect in an endometrial cancer metastasis treated with calcium electroporation. (A) Digital clinical photograph at baseline before one calcium electroporation treatment in local anaesthesia. (B) One month after calcium electroporation treatment.

Figure 3

Patient-reported symptoms related to cutaneous metastases that affect quality of life before and two months after calcium electroporation. Bubble size is diameter relative to number of reporting patients from qualitative interview data, with the smallest bubble representing one report (n = 1) and largest seven reports (all, n = 7). Intense colour depicts direct symptoms from cutaneous metastasis, and low intensity depicts indirect symptoms. Green indicates improved symptoms. Note one patient reported no improvement in fear of death, and one patient reported unimproved oozing after two months (pink bubbles). The reporting patients of all other data points are the same before and after. One patient experienced transient improvement of fatigue, and one experienced transient improved vigour; These reports were not counted as improved or unchanged after two months. Apart from the two reports of unchanged symptoms and two reports of transient effects, there was unanimous improvement of direct and indirect symptoms related to cutaneous metastases.