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1.
Health Psychol ; 40(6): 408-417, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34323543

RESUMO

OBJECTIVE: Uveal melanoma, a rare eye cancer, presents potential vision loss and life threat. This prospective, longitudinal study interrogated the predictive utility of visual impairment, as moderated by optimism/pessimism, on depressive symptoms in 299 adults undergoing diagnostic evaluation. METHOD: Depressive symptoms (Center for Epidemiologic Studies Depression Scale), subjective (Measure of Outcome in Ocular Disease vision subscale) and objective (logarithm of the minimum angle of resolution) visual impairment, and optimism/pessimism (Life Orientation Test-Revised) were assessed before diagnostic evaluation and 1 week, 3 months, and 12 months after diagnosis. Multilevel modeling, with repeated measures (Level 1) nested within individuals (Level 2) and imputation of missing data (Blimp software), was performed. RESULTS: Depressive symptoms were significantly more elevated 1 week after diagnosis in cancer patients (n = 107) versus patients not diagnosed with cancer (n = 192). Higher subjective (but not objective) visual impairment predicted greater depressive symptoms (p < .001). Across the entire sample, the two-way (Optimism/Pessimism × Subjective Visual Impairment) interactions were statistically significant (ps < .05), but not the three-way interaction (with diagnosis). The positive association between subjective visual impairment and depressive symptoms was significant at low and moderate levels of optimism (ps < .001), but not at high optimism (p > .05). The association was significant at high and moderate levels (ps < .001), but not low (p > .05) levels of pessimism. CONCLUSIONS: Elevated depressive symptoms are evident in adults who do (vs. do not) receive a diagnosis of uveal melanoma but appear to remit within 3 months. Perceived impaired vision, especially coupled with low optimism or high pessimism, predicts depressive symptoms over time, with implications for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão , Melanoma , Otimismo , Pessimismo , Neoplasias Uveais , Transtornos da Visão , Adulto , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Melanoma/diagnóstico , Melanoma/psicologia , Otimismo/psicologia , Pessimismo/psicologia , Estudos Prospectivos , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/psicologia , Transtornos da Visão/psicologia
2.
Lancet Oncol ; 22(5): 655-664, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33857414

RESUMO

BACKGROUND: The European Organisation for Research and Treatment of Cancer (EORTC) 1325-MG/KEYNOTE-054 trial in patients with resected, high-risk stage III melanoma demonstrated improved recurrence-free survival with adjuvant pembrolizumab compared with placebo (hazard ratio 0·57 [98·4% CI 0·43-0·74]; p<0·0001). This study reports the results from the health-related quality-of-life (HRQOL) exploratory endpoint. METHODS: This double-blind, randomised, controlled, phase 3 trial was done at 123 academic centres and community hospitals across 23 countries. Patients aged 18 years or older with previously untreated histologically confirmed stage IIIA, IIIB, or IIIC resected cutaneous melanoma, and an Eastern Cooperative Oncology Group performance status score of 1 or 0 were eligible. Patients were randomly assigned (1:1) using a central interactive voice-response system on the basis of a minimisation technique stratified for stage and geographic region to receive intravenously 200 mg pembrolizumab or placebo. Treatment was administered every 3 weeks for 1 year, or until disease recurrence, unacceptable toxicity, or death. The primary endpoint of the trial was recurrence-free survival (reported elsewhere). HRQOL was a prespecified exploratory endpoint, with global health/quality of life (GHQ) over 2 years measured by the EORTC QLQ-C30 as the primary analysis. Analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02362594, and EudraCT, 2014-004944-37, and long-term follow-up is ongoing. FINDINGS: Between Aug 26, 2015, and Nov 14, 2016, 1019 patients were assigned to pembrolizumab (n=514) or placebo (n=505). Median follow-up was 15·1 months (IQR 12·8-16·9) at the time of this analysis. HRQOL compliance was greater than 90% at baseline, greater than 70% during the first year, and greater than 60% thereafter for both groups. Because of low absolute compliance numbers at later follow-up, the analysis was truncated to week 84. Baseline GHQ scores were similar between groups (77·55 [SD 18·20] in the pembrolizumab group and 76·54 [17·81] in the placebo group) and remained stable over time. The difference in average GHQ score between the two groups over the 2 years was -2·2 points (95% CI -4·3 to -0·2). The difference in average score during treatment was -1·1 points (95% CI -3·2 to 0·9) and the difference in average score after treatment was -2·2 points (-4·8 to 0·4). These differences are within the 5-point clinical relevance threshold for the QLQ-C30 and are therefore clinically non-significant. INTERPRETATION: Pembrolizumab does not result in a clinically significant decrease in HRQOL compared with placebo when given as adjuvant therapy for patients with resected, high-risk stage III melanoma. These results support the use of adjuvant pembrolizumab in this setting. FUNDING: Merck Sharp & Dohme.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Melanoma/tratamento farmacológico , Qualidade de Vida , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Melanoma/mortalidade , Melanoma/patologia , Melanoma/psicologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/psicologia
3.
Front Public Health ; 9: 630620, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33692982

RESUMO

The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , COVID-19/economia , COVID-19/psicologia , Melanoma/economia , Melanoma/psicologia , Qualidade de Vida/psicologia , Desemprego/psicologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , COVID-19/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Melanoma/epidemiologia , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Inquéritos e Questionários , Desemprego/estatística & dados numéricos
5.
Support Care Cancer ; 29(2): 1005-1014, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32556624

RESUMO

PURPOSE: The aim of this study is to examine the factor structure and psychometric properties of the Skin Cancer Index (SCI) in a sample of patients with melanoma. METHODS: This study uses data from an observational study with longitudinal follow-up examining predictors of skin self-examination in melanoma patients from Montréal, Canada. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of the 15-item SCI scale. Correlations with other psychosocial measures of anxiety and depression, fear of cancer recurrence, quality of life, and emotional well-being were computed to examine construct validity. RESULTS: EFA results with 241 participants revealed a two-factor structure with acceptable fit and no significant cross-loadings. CFA results with a subsample of 173 participants examining the two-factor structure and second-order structure found equivalent fit for the two solutions. Cronbach's alpha for the total scale score and both subscales was high. Both factors showed positive associations with measures of anxiety and depression and fear of cancer and negative associations with quality of life and emotional well-being. CONCLUSION: Our study suggests that the SCI functions as a reliable two-factor scale assessing emotional and social distress in patients with melanoma, with the total SCI score assessing overall psychosocial distress.


Assuntos
Melanoma/psicologia , Angústia Psicológica , Psicometria/métodos , Neoplasias Cutâneas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
J Immunol Res ; 2020: 2192480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32775464

RESUMO

Purpose: To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI). Methods: Melanoma survivors were identified within two study populations (N = 104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up. Results: Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence (N = 8), existential problems (N = 2), survivor guilt (N = 2), and posttraumatic stress disorder (N = 6). The mean EORTC QLQ-C30 Global Score was not significantly different from the European mean of the healthy population. Nine survivors reported anxiety and/or depression (Hospitalization Depression Scale) during the survey. Seven survivors (41%) reported fatigue (Fatigue Severity Scale). Seven patients (41%) had impairment in NCF; only three out of seven survivors had impairment in subjective cognition (Cognitive Failure Questionnaire). Anxiety, depression, fatigue, and neurocognitive symptoms remained stable at the 1-year follow-up. All cases of skin toxicity (N = 8), hepatitis (N = 1), colitis (N = 3), and sarcoidosis (N = 1) resolved without impact on HRQoL. Three survivors experienced hypophysitis; all suffered from persistent fatigue and cognitive complaints 5 years after onset. One survivor who experienced a Guillain-Barré-like syndrome suffered from persisting depression, fatigue, and impairment in NCF. Conclusion: A majority of melanoma survivors treated with IPI continue to suffer from emotional distress and impairment in NCF. Timely detection in order to offer tailored care is imperative, with special attention for survivors with a history of neuroendocrine or neurological irAE. The trial is registered with B.U.N. 143201421920.


Assuntos
Cognição/fisiologia , Melanoma/fisiopatologia , Melanoma/psicologia , Qualidade de Vida/psicologia , Sobreviventes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/fisiopatologia , Ansiedade/psicologia , Depressão/fisiopatologia , Depressão/psicologia , Fadiga/fisiopatologia , Fadiga/psicologia , Feminino , Humanos , Ipilimumab/uso terapêutico , Masculino , Melanoma/tratamento farmacológico , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/fisiopatologia , Recidiva Local de Neoplasia/psicologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
7.
Psychooncology ; 29(11): 1864-1873, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779313

RESUMO

OBJECTIVE: Cancer survivors commonly experience long-term anxiety and depression. Anxiety and depression might result from problems emerging during survivorship rather than illness and treatment. This study tested three potential causal paths: (a) concerns about physical symptoms and functional problems and fear of cancer recurrence (FCR) arising during survivorship directly cause anxiety and depression, (b) an indirect path whereby FCR mediates effects of concerns about physical symptoms and functional problems on anxiety and depression, and (c) a reciprocal path whereby anxiety and depression cause concerns about physical symptoms and functional problems and FCR, which exacerbate later anxiety and depression. METHODS: Sample of 453 uveal melanoma survivors who completed observations 6-, 12-, 24-, 36-, 48- and 60-months post-diagnosis and did not miss two consecutive observations. Cross-lagged analyses were conducted to predict Hospital Anxiety and Depression Scale subscale scores. Symptoms and functional problems were measured using the EORTC OPT 30 scale, and FCR operationalised by the EORTC OPT 30 worry about recurrence scale. Covariates were age, gender, treatment modality, and visual acuity of the fellow eye and chromosome-3 status (which accurately predicts 10-year survival), worry and anxiety or depression. RESULTS: All paths received some support, although the indirect path emerged only for anxiety in females. Concerns about physical symptoms, functional problems, and FCR originated in survivorship and appeared to both influence and be influenced by anxiety and depression. CONCLUSIONS: Findings emphasise the importance of actively monitoring survivors to prevent, detect, and intervene in the development of anxiety and depression during survivorship.


Assuntos
Ansiedade/psicologia , Sobreviventes de Câncer/psicologia , Depressão/psicologia , Medo/psicologia , Melanoma/psicologia , Neoplasias Uveais/psicologia , Adulto , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Melanoma/complicações , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/psicologia , Transtornos Fóbicos , Sobrevivência , Neoplasias Uveais/complicações
8.
Environ Health Prev Med ; 25(1): 35, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738889

RESUMO

BACKGROUND: Raising awareness and educating people regarding practices for skin cancer or melanoma prevention are critical in the context of the adversely increasing effects of global climate change. This study aimed to explore the knowledge, attitudes, and practices regarding skin cancer prevention and to determine the associated factors to knowledge, attitudes, and practices among dermatological patients in Vietnam. METHODS: This cross-sectional study included 590 dermatological patients between 18 and 82 years of age, who received an examination or treatment from the National Hospital of Dermatology in Hanoi, Vietnam, from September to December 2018. The respondents' attitudes on skin cancer and cancer prevention were assessed via face-to-face interviews with a structured questionnaire conducted by trained interviewers. RESULTS: Of the 590 respondents, the majority of people had correct responses to the question regarding skin cancer knowledge. Among the total participants, 39.8% thought that they were at risk of skin cancer, and 13.8% believed their occupation increased their skin cancer risk. The majority of respondents used hats (94.9%) and sunscreen skin coats (89.5%) and went into the shade (86.3%) when exposed to the sun. Women were less likely to be aware of their skin cancer risk but were more likely to practice prevention behaviors. CONCLUSION: Our results show that dermatological patients have acceptable knowledge towards skin cancer prevention, but still need to change their behavior to prevent the risk of skin cancer. This study highlights the importance of education to raise awareness regarding skin cancer in order to promote practice prevention strategies for skin cancer in Vietnam.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , Melanoma/prevenção & controle , Melanoma/psicologia , Pessoa de Meia-Idade , Dermatopatias/etiologia , Vietnã , Adulto Jovem
9.
Cancer Med ; 9(17): 6132-6140, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32649807

RESUMO

BACKGROUND: In recent years, monoclonal antibodies such as ipilimumab, nivolumab, and pembrolizumab have made a significant impact on the treatment of advanced melanoma. Combination of immune checkpoint inhibitors leads to improved survival and response rates of 58%-61% as compared to monotherapy (36%-44%). However, the price for the better response rates is also a higher frequency of severe adverse events (59%) as compared to monotherapy (17%-21%). This study examines attitudes towards melanoma therapy options of physicians, healthy individuals, melanoma patients, and physicians with oncological disease, their willingness to pay, and preference of quality versus length of life. METHODS: After obtaining ethical approval and informed consent surveys were conducted in 111 participants divided into four groups: melanoma patients (n = 30), healthy individuals as controls (n = 30), physicians (n = 27), and physicians with oncological disease (n = 24). Statistical analyses were conducted using SPSS statistics (version 25, IBM), applying the Pearson´s chi-squared test, Spearman correlation coefficient, Wilcoxon-Mann-Whitney test, and Kruskal-Wallis test. RESULTS: Life prolongation is more valued by melanoma patients and physicians with oncological disease compared to healthy controls and healthy physicians. In total, 30% of melanoma patients opt for a life prolonging therapy in all cases, even if this life prolongation is only marginal. Physicians are the strongest proponents of combination immunotherapy.    CONCLUSION: The valuation of the different treatment options differs in the four study groups with affected people valuing life prolongation much more. The individual value of cancer therapies is high, but differs from the societal standpoint.


Assuntos
Custos de Medicamentos , Longevidade , Melanoma/psicologia , Preferência do Paciente/psicologia , Médicos/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/economia , Antineoplásicos Imunológicos/uso terapêutico , Atitude do Pessoal de Saúde , Estudos de Casos e Controles , Tomada de Decisões , Características da Família , Feminino , Alemanha , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/economia , Inibidores de Checkpoint Imunológico/uso terapêutico , Ipilimumab/uso terapêutico , Masculino , Melanoma/tratamento farmacológico , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Cuidados Paliativos/psicologia , Fatores Socioeconômicos , Estatísticas não Paramétricas , Inquéritos e Questionários , Adulto Jovem
10.
Trials ; 21(1): 594, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605576

RESUMO

BACKGROUND: The Melanoma Genomics Managing Your Risk Study is a randomised controlled trial that aims to evaluate the efficacy of providing information on personal genomic risk of melanoma in reducing ultraviolet radiation (UV) exposure, stratified by traditional risk group (low or high phenotypic risk) in the general population. The primary outcome is objectively measured total daily Standard Erythemal Doses at 12 months. Secondary outcomes include UV exposure at specific time periods, self-reported sun protection and skin-examination behaviours, psychosocial outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the cost-effectiveness of the intervention. OBJECTIVE: To publish the pre-determined statistical analysis plan (SAP) before database lock and the start of analysis. METHODS: This SAP describes the data synthesis, analysis principles and statistical procedures for analysing the outcomes from this trial. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid potential analysis bias that may arise from knowledge of the outcome data. RESULTS: This SAP is consistent with best practice and should enable transparent reporting. CONCLUSION: This SAP has been developed for the Melanoma Genomics Managing Your Risk Study and will be followed to ensure high-quality standards of internal validity and to minimise analysis bias. TRIAL REGISTRATION: Prospectively registered with the Australian New Zealand Clinical Trials Registry, ID: ACTR N12617000691347 . Registered on 15 May 2017.


Assuntos
Interpretação Estatística de Dados , Predisposição Genética para Doença , Testes Genéticos/economia , Genômica/economia , Melanoma/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Austrália , Análise Custo-Benefício , Exposição Ambiental/prevenção & controle , Comportamentos Relacionados com a Saúde , Humanos , Melanoma/economia , Melanoma/genética , Melanoma/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/psicologia , Raios Ultravioleta/efeitos adversos
11.
J Cancer Surviv ; 14(5): 739-756, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32506221

RESUMO

PURPOSE: Cancer patients are encouraged to do more physical activity (PA). Exercising in outdoor settings, however, may expose people to UV radiation, which is the main risk factor of melanoma. This study aimed to understand how melanoma diagnoses affect people's perception of the outdoor environment for PA. METHOD: In-depth interviews were conducted among 19 individuals (20-85 years) with a history of melanoma at a skin cancer clinic in the Denver metropolitan area. Transcribed interviews were coded for emergent themes. The coding framework included topics related to PA behavior, sun protection, and perceptions of outdoor environment. RESULTS: Respondents reported no change in their level of outdoor activity after the melanoma diagnosis; they tried to reduce the risk of sun exposure by using sunscreen and sun-protective clothing. They also reported seeking shade, trees, and groundcover along urban corridors, in order to avoid sun exposure, reflective surfaces, and heat while being active outdoors. CONCLUSION: Given the public health significance of UV exposure and extreme heat, further investments should be made to craft streetscape design guidelines and implement sun-proof spaces across public facilities, including parks, schools, and sport fields in order to ameliorate environmental risks for skin cancer survivors, to prevent future cancers among those that are vulnerable to the hazards of excessive UV exposure and extreme heat, and to promote outdoor PA. IMPLICATIONS FOR CANCER SURVIVORS: Skin cancer survivors and other vulnerable population subgroups will benefit from discussions around neighborhood-based design interventions that promote PA while accounting for sun safety.


Assuntos
Ambiente Construído , Sobreviventes de Câncer/psicologia , Meio Ambiente , Exercício Físico , Conhecimentos, Atitudes e Prática em Saúde , Melanoma/prevenção & controle , Roupa de Proteção/estatística & dados numéricos , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/psicologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/psicologia , Adulto Jovem
12.
J Cancer Surviv ; 14(5): 712-719, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32519121

RESUMO

PURPOSE: To quantify the prevalence of anxiety or depression (overall; melanoma-related) among people with high-risk primary melanoma, their related use of mental health services and medications, and factors associated with persistent new-onset symptoms across 4 years post-diagnosis. METHODS: A longitudinal study of 675 patients newly diagnosed with tumor-stage 1b-4b melanoma. Participants completed the Hospital Anxiety and Depression Scale and answered questions about fear of cancer recurrence, use of medication, and support, serially over 4 years. We identified anxiety and depression trajectories with group-based trajectories models and factors associated with persistent symptoms with logistic regression. RESULTS: At diagnosis, 93 participants (14%) had melanoma-related anxiety or depression, and 136 (20%) were affected by anxiety and/or depression unrelated to melanoma. After 6 months, no more than 27 (5%) reported melanoma-related anxiety or depression at any time, while the point prevalence of anxiety and depression unrelated to melanoma was unchanged (16-21%) among the disease-free. Of 272 participants reporting clinical symptoms of any cause, 34% were taking medication and/or seeing a psychologist or psychiatrist. Of the participants, 11% (n = 59) had new-onset symptoms that persisted; these participants were more likely aged < 70. CONCLUSIONS: Melanoma-related anxiety or depression quickly resolves in high-risk primary melanoma patients after melanoma excision, while prevalence of anxiety or depression from other sources remains constant among the disease-free. However, one-in-ten develop new anxiety or depression symptoms (one-in-twenty melanoma-related) that persist. IMPLICATIONS FOR CANCER SURVIVORS: Chronic stress has been linked to melanoma progression. Survivors with anxiety and depression should be treated early to improve patient and, potentially, disease outcomes.


Assuntos
Ansiedade/epidemiologia , Sobreviventes de Câncer/psicologia , Depressão/epidemiologia , Melanoma/diagnóstico , Melanoma/psicologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/psicologia , Idoso , Ansiedade/psicologia , Austrália/epidemiologia , Depressão/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
13.
Qual Life Res ; 29(10): 2651-2660, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32405921

RESUMO

BACKGROUND: Pembrolizumab (PEMBRO) and ipilimumab + nivolumab (IPI + NIVO) are approved advanced melanoma (AM) immunotherapies. To address limited health-related quality of life (QoL) real-world evidence with immunotherapies in AM, we compared QoL in AM patients receiving either treatment in clinical practice. METHODS: A prospective US observational study enrolled adult AM patients initiating first-line PEMBRO or IPI + NIVO between June 2017 and March 2018. Endpoints included the QLQ-C30 global health score (GHS) and EuroQol visual analog scale (EQ-VAS) scores. Mean changes were compared using repeated measures mixed-effects models and are presented covariate adjusted. RESULTS: 225 PEMBRO and 187 IPI + NIVO patients were enrolled. From baseline through week 24, PEMBRO was associated with 3.2 mean GHS score increase (95% CI 0.5, 5.9; p = .02), while no change was observed with IPI + NIVO; 0.2 (95% CI - 2.6, 3.0; p = 0.87). Among objective treatment-responders, GHS scores associated with PEMBRO increased 6.0 (95% CI 3.1, 8.8; p < .0001); IPI + NIVO patients increased 3.8 (95% CI 0.8, 6.9; p = .01). In treatment non-responders, IPI + NIVO was associated with GHS/QoL deterioration of - 3.7 (95% CI - 6.8, - 0.6; p = .02), PEMBRO non-responders demonstrated no change; 0.7 (95% CI - 2.3, 3.7; p = 0.6). Between treatments, PEMBRO patients increased 2.6 greater in EQ-VAS (95% CI 0.6, 4.5; p = .01) vs IPI + NIVO at 24 weeks. CONCLUSIONS: PEMBRO was associated with better 24-week QoL compared to IPI + NIVO in actual clinical practice settings. Real-world data has known limitations, but with further confirmation these results may have implications for treatment selection.


Assuntos
Imunoterapia/métodos , Melanoma/psicologia , Qualidade de Vida/psicologia , Feminino , Humanos , Masculino , Melanoma/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Prospectivos
14.
J Am Acad Dermatol ; 83(4): 1098-1103, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32380221

RESUMO

BACKGROUND: Hispanics are among the fastest growing population in the United States and are predicted to account for one third of the nation by 2060. Although melanoma is more common among white patients, Hispanic individuals are at greater risk of late-stage diagnosis, increased tumor thickness, and poorer survival. OBJECTIVE: To better understand public awareness of melanoma and evaluate change over the last 21 years, particularly among high-risk minority populations. METHODS: A cross-sectional survey collecting information on knowledge and awareness of melanoma was conducted on 285 participants from May through November 2017. RESULTS: Approximately 39% of participants were unaware of melanoma. Sixty-five percent successfully identified early signs of disease. Approximately 86% of Fitzpatrick skin types (FST) I and II identified melanoma as a cancer, compared to 46.3% of FST III and IV and 57.6% of FST V and VI. Hispanic particiapnts were less likely to know what melanoma was compared to white participants (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.65-0.11; P = .0037). US natives (OR, 2.38; 95% CI, 5.56-1.04; P = .0403) and patients with any college education (OR, 2.86; 95% CI, 5.26-1.54; P = .0007) were more likely to know the meaning of melanoma. CONCLUSION: White participants and those with any college education were more likely to know the meaning of melanoma. Individuals of racial and ethnic minorities would benefit from educational programs geared toward early detection.


Assuntos
Grupos de Populações Continentais/psicologia , Grupos Étnicos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Disparidades nos Níveis de Saúde , Melanoma/psicologia , Neoplasias Cutâneas/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston/epidemiologia , Compreensão , Estudos Transversais , Escolaridade , Emigrantes e Imigrantes/psicologia , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Melanoma/etnologia , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Cutâneas/etnologia , Classe Social , Inquéritos e Questionários , Adulto Jovem
15.
Support Care Cancer ; 28(8): 3489-3501, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32342223

RESUMO

PURPOSE: Understanding the supportive care and unmet care needs of patients with melanoma is essential for informing the development or evaluation of supportive care services and interventions for patients with melanoma. METHODS: Three electronic databases (CINAHL, Medline and PsycINFO) were searched from 2000 to November 2019 to identify eligible quantitative and qualitative studies. The quality of evidence was assessed using the Mixed Methods Appraisal Tool. RESULTS: Fourteen studies (10 quantitative, three qualitative and one mixed-methods) were included. Informational care and unmet needs were the most commonly reported in patients with melanoma, followed by psychological, then social and physical. Findings were consistent between quantitative and qualitative studies; however, findings from qualitative data complimented those from quantitative data by providing more depth and insight into the prevalence, effects and associations of the different care needs. Patients' care and unmet needs were found to also be present all throughout their cancer journey and vary according to the stage throughout. CONCLUSION: Melanoma-specific care and unmet care needs were identified most commonly in the informational domain, followed by psychological, social and physical domains. Oncology practitioners should consider enhancing their supportive care interventions throughout the journey of patient with melanoma to reduce or address their unmet needs. The results of this mixed-methods systematic review warrant further research using robust study designs, melanoma-specific validated outcome measures and complete reporting of data in terms of disease stage.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Melanoma/terapia , Humanos , Melanoma/psicologia , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Prevalência , Apoio Social
17.
World J Surg Oncol ; 18(1): 53, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32156303

RESUMO

BACKGROUND: Sentinel lymph node excision (SLNE) can be performed in tumescent local anesthesia (TLA) or general anesthesia (GA). Perioperative cortisol level changes and anxiety are common in surgical interventions and might be influenced by the type of anesthesia. In this study, we intended to determine whether the type of anesthesia impacts the patients' perioperative levels of salivary cortisol (primary outcome) and the feeling of anxiety evaluated by psychological questionnaires (secondary outcome). METHODS: All melanoma patients of age undergoing SLNE at the University Hospital Essen, Germany, could be included in the study. Exclusion criteria were patients' intake of glucocorticoids or psychotropic medication during the former 6 months, pregnancy, age under 18 years, and BMI ≥ 30 as salivary cortisol levels were reported to be significantly impacted by obesity and might confound results. RESULTS: In total, 111 melanoma patients undergoing SLNE were included in our prospective study between May 2011 and April 2017 and could choose between TLA or GA. Salivary cortisol levels were measured three times intraoperatively, twice on the third and second preoperative day and twice on the second postoperative day. To assess anxiety, patients completed questionnaires (Hospital Anxiety and Depression Scale (HADS), State-Trait Anxiety Inventory (STAI)) perioperatively. Patients of both groups exhibited comparable baseline levels of cortisol and perioperative anxiety levels. Independent of the type of anesthesia, all patients showed significantly increasing salivary cortisol level from baseline to 30 min before surgery (T3) (TLA: t = 5.07, p < 0.001; GA: t = 3.09, p = 0.006). Post hoc independent t tests showed that the TLA group exhibited significantly higher cortisol concentrations at the beginning of surgery (T4; t = 3.29, p = 0.002) as well as 20 min after incision (T5; t = 277, p = 0.008) compared to the GA group. CONCLUSIONS: The type of anesthesia chosen for SLNE surgery significantly affects intraoperative cortisol levels in melanoma patients. Further studies are mandatory to evaluate the relevance of endogenous perioperative cortisol levels on the postoperative clinical course. TRIAL REGISTRATION: German Clinical Trials Register DRKS00003076, registered 1 May 2011.


Assuntos
Anestesia Geral , Anestesia Local , Ansiedade/etiologia , Hidrocortisona/análise , Excisão de Linfonodo/métodos , Melanoma/cirurgia , Saliva/química , Linfonodo Sentinela/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/psicologia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
18.
J Immunother Cancer ; 8(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32152222

RESUMO

BACKGROUND: Immune checkpoint inhibitors (CIs) have revolutionized treatment of advanced melanoma, leading to an emerging population of long-term survivors. Survivors' quality of life (QOL) and symptom burden are poorly understood. We set out to evaluate symptom burden and QOL in patients with advanced melanoma alive more than 1 year after initiating CI therapy. METHODS: Cross-sectional surveys, accompanied by chart review of patients with advanced melanoma treated with CIs at Memorial Sloan Kettering Cancer Center, completed therapy, and were alive >1 year after treatment initiation. Surveys were administered between February and August 2018. Surveys included: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, EuroQOL, items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events and Fatigue Severity Scale. RESULTS: We included 90 patients. The most common CI regimens were ipilimumab plus nivolumab (53%) and pembrolizumab (41%); most patients (71%) were not treated in clinical trials. Median time from CI therapy initiation was 40 months and from last dose was 28 months. Fatigue was reported by 28%, with higher fatigue scores in women than men; 12% reported difficulty sleeping. Aching joints (17%) and muscles (12%) were fairly common. Level of functioning was generally high. Overall QOL was excellent though 40% reported 'some or moderate' problems with anxiety/depression and 31% with pain/discomfort. CONCLUSIONS: After CI therapy, long-surviving advanced melanoma patients commonly report fatigue but otherwise have moderate symptom burden and good QOL. Ensuring appropriate symptom management will optimize clinical outcomes for these patients.


Assuntos
Fadiga/epidemiologia , Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/tratamento farmacológico , Qualidade de Vida , Sobreviventes/psicologia , Idoso , Estudos Transversais , Fadiga/psicologia , Feminino , Seguimentos , Humanos , Masculino , Melanoma/imunologia , Melanoma/patologia , Melanoma/psicologia , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Estados Unidos/epidemiologia
19.
Medicina (Kaunas) ; 56(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32050413

RESUMO

Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Ceratose Actínica/cirurgia , Melanoma/cirurgia , Qualidade de Vida , Neoplasias Cutâneas/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/psicologia , Carcinoma de Células Escamosas/psicologia , Feminino , Nível de Saúde , Humanos , Ceratose Actínica/psicologia , Masculino , Melanoma/psicologia , Pessoa de Meia-Idade , Dor Pós-Operatória/psicologia , Estudos Prospectivos , Autocuidado , Neoplasias Cutâneas/psicologia
20.
BMC Psychol ; 8(1): 8, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005293

RESUMO

BACKGROUND: The risk of metastases in uveal melanoma can accurately be estimated through genetic analysis of the tumor. A growing number of patients decide to receive information on their prognosis, although this can be extremely burdensome. Studies on the psychosocial impact of testing are sparse. The objective of this study was to examine traits of patients opting for prognostication, to investigate its psychosocial impact and the use of psycho-oncological services over time. We further examined characteristics of patients utilizing these services and risk factors of prolonged psychological distress. DESIGN AND METHODS: This study is a non-randomized controlled prospective clinical observational trial. Patients availing for prognostication formed the test group, while those who opted out constituted the observational group. The psychosocial impact of genetic testing was assessed with the following variables: resilience, social support, fear of tumor progression, depression, general distress, health-related quality of life, estimation of the perceived risk, and the utilization of psycho-oncological interventions. Data were assessed at five different time points over a period of 12 months. We applied binary logistic regression analysis, multiple linear regressions and a mixed model. RESULTS: Of 175 patients, 63 decided to obtain prognostic information. Treatment method (enucleation > brachytherapy), lower social support and higher general distress could significantly predict patient's choice for prognostic testing. After result announcement, perceived risk of metastases was significantly increased in patients with poor prognosis, while it decreased in those with good prognosis. Overall, a significant decrease over time appeared concerning fear of progression, general distress, depression and anxiety. Mental quality of life increased over time. The utilization of psycho-oncological interventions increased significantly after prognostication; however, this was equivalent in the test and observational groups. Female sex, higher general distress and higher anxiety predicted greater use of psycho-oncological interventions. DISCUSSION: Availing of prognostic testing is not associated with poorer subsequent psychological well-being. It rather may help to alleviate distress and promote a more realistic risk perception. However, psychological support should be available to all patients, independent of prognosis and treatment, especially considering that patients with low social support and high distress increasingly opt for prognostication.


Assuntos
Testes Genéticos , Melanoma/psicologia , Neoplasias Uveais/psicologia , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Melanoma/genética , Serviços de Saúde Mental , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Qualidade de Vida , Apoio Social , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/genética
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