Wednesday, April 12, 2017

The Mental Price of Melanoma

Given the many pleas and posts and requests for help that I've seen or have been sent directly regarding stress and worries and fears when peeps are given the diagnosis of melanoma....I thought the first article might demonstrate that you are not alone, though most folks diagnosed with melanoma have a "very good prognosis" (See?  I'm not the ONLY person saying that!!!) and the approach spelled out in the second might provide some useful information - 

Fear of new or recurrent melanoma after treatment for localised melanoma. Bell, Mehta, Turner, et al. Psychooncology. 2017 Jan 4.  

To estimate the amount of fear of new or recurrent melanoma among people treated for localized melanoma in an Australian specialist centre.  We randomly selected 400 potential participants from all those treated for localised melanoma at the Melanoma Institute Australia during 2014 (n = 902). They were asked to complete an adapted version of the Fear of Cancer Recurrence Inventory (FCRI). We calculated summary statistics for demographics, clinical variables and total FCRI and subscale scores.  215 people (54%) completed the FCRI questionnaire. The overall mean severity subscale score was was 15. A high proportion of participants had scores above a proposed threshold to screen for clinical fear of cancer recurrence (77% and 63% of participants with and without new or recurrent melanoma had severity subscale scores greater or = to 13). Most participants also had scores above a threshold found to have high specificity for clinical fear of cancer recurrence (65% and 48% of participants with and without new or recurrent melanoma had severity subscale scores greater or = to 6). The severity subscale appeared to discriminate well between groups with differing levels of risk of new or recurrent melanoma.  There is a substantial amount of fear of new or recurrent melanoma among this population, despite most having a very good prognosis.

Psychoeducational Intervention to Reduce Fear of Cancer Recurrence in People at High Risk of Developing Another Primary Melanoma: Results of a Randomized Controlled Trial. Dieng, Butow, Costa, et al. J Clin Oncol. 2016 Dec 20.   

People with a history of melanoma commonly report a fear of cancer recurrence (FCR), yet psychologic support is not routinely offered as part of ongoing melanoma care. This randomized controlled trial examined the efficacy of a psychoeducational intervention to reduce FCR and improve psychologic adjustment in this patient group compared with usual care. 
The intervention comprised a newly developed psychoeducational resource and three telephone-based psychotherapeutic sessions over a 1-month period timed in accordance with dermatologic appointments. Participants were randomly assigned to intervention (n = 80) or usual care (n = 84). Assessments were completed at baseline, 1 month, and 6 months after dermatologic appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviors, satisfaction with melanoma care, unmet needs, and health-related quality of life. 
At 6 months, the intervention group reported lower FCR severity, trigger, and distress scores than the control group in the baseline-adjusted models; the between-group mean difference was -1.9 for FCR severity, -2.0 for FCR triggers, and -0.7 for FCR distress. The decrease in FCR severity (but not triggers or distress) remained statistically significant after adjustment for other covariates. At 6 months, the intervention group also reported lower stress and improved melanoma-related knowledge compared with the control group. No differences were found between groups for other secondary outcomes.
This newly developed evidence-based psychoeducational intervention was effective in reducing FCR and stress and increasing melanoma-related knowledge in people at high risk for another melanoma.

If you as the patient or as a family member are having trouble dealing with the psychological burden of melanoma and its help.  Your doc may not offer it, but you can certainly ask for it!!!  And really helps to just - phone a friend!!! - c

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