Illness-Related Distress in Women with Clinically Localized Cutaneous Melanoma
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ORIGINAL ARTICLE – MELANOMAS
Illness-Related Distress in Women with Clinically Localized Cutaneous Melanoma Thomas M. Atkinson, PhD1, Nikki S. Noce2, Jennifer Hay, PhD1, Brian T. Rafferty, MS3, and Mary S. Brady, MD3 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY; 2New York University School of Medicine, New York, NY; 3Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY 1
ABSTRACT Background. 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 crosssectional survey to describe the experiences of women treated for clinically localized melanoma. Methods. 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). Results. 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 posttreatment; 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. Conclusions. 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.
Cutaneous melanoma is a rapidly growing health burden.1,2 This is especially true in women, where cutaneous melanoma has been identified as the second most common cancer and the most prevalent cause of cancer death in women aged 25–39 years.3 Between 1980 and 2004, the incidence of cutaneous melanoma increased by 50 % in women aged 15–39 years, whereas no significant change was observed for males in this age group over the same time period.4 The psychosocial impact of a diagnosis of cutaneous melanoma may disproportionately affect female patients. Several studies have shown that women experience more distress associated with the diagnosis and treatment of melanoma than men.5,6 For example, one study drawn from an outpatient pigmented lesion clinic showed that 27 % of women had clinically significant high stress, compared with 10 % of men.5 Additionally, research has demonstrated that melanoma has a more detrimental impact on quality of life in women than men.7 Further, women are more likely than men to report dissati
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