Psychological distress and unmet supportive care needs in melanoma survivors and patients at high risk of developing melanoma: a Swiss cross-sectional study

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◆ 논문 초록 (Abstract)

BACKGROUND: Many patients with melanoma experience worry, anxiety and distress. Screening for psychological distress can facilitate early identification and management. However, little is known about such distress in melanoma survivors and patients at high risk of developing melanoma. OBJECTIVES: The primary outcome was to assess the melanoma-related worry in melanoma survivors and patients at high risk of melanoma. Additionally, a secondary outcome was to determine the optimal Distress Thermometer (DT) cutoff for identifying those needing psycho-oncological support. METHODS: We prospectively collected the distress-related patient-reported outcomes at the Department of Dermatology of the University Hospital in Basel, Switzerland between January 2021 and January 2024. Validated questionnaires including the DT, Melanoma Worry Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder were used to assess the primary outcome. For the secondary outcome, receiver operating characteristic (ROC) analysis was used to estimate the optimal DT cutoff. RESULTS: The study population comprised 430 individuals, including 175 (41%) melanoma survivors and 255 (59%) patients at high risk for melanoma. Worry about getting a primary or subsequent melanoma was more prominent in melanoma survivors (26%) compared with patients at high risk for melanoma (16%). Patients at high risk for melanoma had less melanoma worry compared with melanoma survivors, with an odds ratio (OR) of 0.56 [95% confidence interval (CI) 0.34-0.93]. Melanoma worry predictors included being divorced (OR 3.08, 95% CI 1.28-7.38) and younger age (OR 0.97, 95% CI 0.95-0.99). Patients at high risk of melanoma showed significant higher distress [median DT 4, interquartile range (IQR) 2-6] compared with melanoma survivors (DT 2, IQR 1-5) (P < 0.001). ROC analysis estimated a DT score of 3 as the optimal cutoff for melanoma survivors, whereas a DT score of 6 was optimal in patients at high risk of melanoma. CONCLUSIONS: This study found that melanoma survivors exhibit greater disease-specific worry, whereas patients at high risk for melanoma show increased general distress, underscoring their distinct psycho-oncological needs. Adopting tailored DT cutoffs (≥ 3 for melanoma survivors, ≥ 6 for patients at high risk for melanoma) may improve the detection of clinically relevant distress. Importantly, interest in psychological support was observed across all DT scores, indicating the need for flexible, patient-centred approaches. These findings highlight the unmet need for psychosocial care in both melanoma survivors and patients at high risk of melanoma, and could aid dermatologists in screening patients for psychological distress. Melanoma is one of the most common cancers globally. The number of new cases reached 331 722 in 2022. Melanoma survivors experience fear of recurrence during follow-up visits. They also report high levels of worry, anxiety and other psychological health conditions. However, knowledge about the emotional burden of patients at high risk of developing melanoma is limited. These patients also experience anxiety about developing the disease. Therefore, both of these groups may need psychological and social support. This study investigated the psychological burden of 175 melanoma survivors and 255 patients at high risk of melanoma. The impact of the condition was assessed using validated questionnaires. One of these was the Distress Thermometer (DT) score (a single question rated from 0 to 10). We found that worry about a primary or subsequent melanoma was present in 26% of the melanoma survivors. Overall, 16% of the patients at high risk of melanoma had the same worry. In contrast, levels of general distress were higher in patients at high risk of melanoma. We found that melanoma survivors may need support if their DT score is 3 or higher. Patients at high risk of melanoma may need support if their score is 6 or higher. Our findings suggest that melanoma survivors exhibited high levels of disease-specific worry. On the other hand, patients at high risk of developing melanoma show increased general distress. This highlights distinct psychological needs. Adopting the tailored DT cutoff values of 3 and 6 may improve the detection of clinically relevant distress in these subgroups. These results show an unmet need for psychological care in both melanoma survivors and patients at high risk of melanoma. We hope this study will inform dermatologists in screening during daily practice.

◆ 원문 정보
저자: Sieborg J, Zwahlen D, Maul JT, Hædersdal M, Kjeldsen EW et al.
저널: Br J Dermatol
연도: 2026
DOI: 10.1093/bjd/ljaf439

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