Women may experience distress or changes in their quality of life following treatment for early-stage melanoma. In order to plan future interventions and identify areas of primary concern, we conducted a cross-sectional survey to describe the experiences of women treated for clinically localized melanoma.
We examined quality of life, levels of distress, appearance perceptions, body image, fear of recurrence, and reproductive concerns in 100 patients (age 21-90 years, M = 54.34 years). Most (61 %) had melanoma of the extremity, with a median depth of 1.1 mm (range, 0-10.5 mm).
Significant depressive symptomatology occurred in 10 % of patients, and 12 % reported a clinically established high level of intrusive thoughts related to melanoma. Quality-of-life scores indicated more disruption on psychological, compared with social and physical functioning. Also, 64 % of women rated their appearance as worse post-treatment; 23 % were unsatisfied with the appearance of the surgical site. Recurrence concerns indicated significant worry about health and death. Most patients (>85 %) were not concerned about fertility, but 52 % worried that future children would have an increased risk of cancer.
Some women treated for clinically localized melanoma reported high levels of distress associated with their altered body image and fear of recurrence. Improvements in patient education prior to surgical intervention may reduce the distress associated with the diagnosis and treatment of melanoma.
[Show abstract][Hide abstract] ABSTRACT: Despite the increasing incidence of melanoma little is known about patients' emotional distress associated with this disease. Supplemented by the problem list (PL), the distress thermometer (DT) is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables.
Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease.
Out of 734 patients recruited into the study, 520 patients (71%) completed both the DT and the PL. Forty-seven percent met the ≥5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ≥5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner), and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data.
The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of life in melanoma patients, further research is needed.
PLoS ONE 07/2013; 8(7):e66800. DOI:10.1371/journal.pone.0066800 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
Little is known about melanoma survivors’ long-term symptoms, sun protection practices, and support needs from health providers.
Melanoma survivors treated at Stanford Cancer Center from 1995 through 2011 were invited to complete a heath needs survey. We compared responses of survivors by sex, education, time since diagnosis (long-term vs. short-term survivors), and extent of treatment received (wide local excision (WLE) alone versus WLE plus additional surgical or medical treatment (WLE+)).
One hundred sixty melanoma survivors (51 % male; 61 % long-term; 73 % WLE+) provided evaluable data. On average, patients were 62 years of age (SD = 14), highly educated (75 % college degree), and Caucasian (94 %). Overall, participants rated anxiety as the most prevalent symptom (34 %). Seventy percent reported that their health provider did not address their symptoms, and 53 % requested education about melanoma-specific issues. Following treatment, women spent significantly less time seeking a tan compared with men (p = 0.01), had more extremity swelling (p = 0.014), and expressed higher need for additional services (p = 0.03). Long-term survivors decreased their use of tanning beds (p = 0.03) and time spent seeking a tan (p = 0.002) and were less likely to receive skin screening every 3–6 months (p
Supportive Care Cancer 05/2014; 22(11). DOI:10.1007/s00520-014-2286-0 · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
For young women who were diagnosed with cancer prior to having children, reproductive potential might affect the quality of life (QoL). This systematic review looks at fertility issues in young female cancer patients, focusing on their influence on psychological well-being, specific fertility-related interventions and reproductive decisions.
Thirteen medical and social science databases were searched for relevant articles up to December 2012, according to PRISMA guidelines. Twenty-six articles meeting the eligibility criteria were included in the review, along with 5 additional papers that missed the inclusion criteria narrowly. Narrative synthesis was used to analyse the studies.
Depression, anxiety and quality of life (QoL) seemed to be related to the perceptions of reproductive issues rather than to the fertility status based on the type of treatment received. Fertility-related interventions improved patients' QoL, decisional regret, and decisional conflict. Finally, cancer influenced women's reproductive decisions. Pursuing pregnancy was affected mainly by worries about child's and mother's health. Decisions about treatment were influenced by the wish to preserve fertility. The generalisability of these results might be undermined by small sample sizes and homogeneity of participants within and across the studies. Inferences about causality of associations are problematic due to predominantly cross-sectional design.
Implications for cancer survivors:
The existing literature gives preliminary insight into the importance of fertility for young women diagnosed with cancer. However, more research is needed in order to offer patients comprehensive care.
Journal of Cancer Survivorship 08/2014; 8(4). DOI:10.1007/s11764-014-0388-9 · 3.30 Impact Factor
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