Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study



Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symptoms among melanoma survivors.


A register-based sample of 684 long-term survivors an average of 8.4 (SD = 1.72; range 5.67–12.17) years after diagnosis was compared to 2049 participants from a representative survey by the Multidimensional Fatigue Inventory. In a hierarchical linear regression, statistical predictors for fatigue were ascertained.


Overall fatigue was not increased in melanoma survivors except for younger melanoma survivors under 40 years. As in the general population, fatigue increased with age, and it was higher in women compared to men. Fatigue was associated with decreased quality of life, reduced functioning, and increased physical and mental symptoms. Substantial predictors (30% explained variance) were higher age, additional chronic illness, self-blame, detrimental interactions and lack of social support, and also fear of recurrence. There was neither an effect of medical parameters (clinical stage, time since diagnosis) nor of participation in follow-up care.


Fatigue needs to be taken seriously in the aftercare of melanoma survivors as it is associated with multiple functional and quality of life impairments and heightened distress. Reduction of fatigue in melanoma patients should address younger survivors (under 40 years) and older survivors (over 60 years) with additional chronic illness and focus on illness coping and social support.

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We gratefully acknowledge the support of the Deutsche Krebshilfe e. V. We greatly appreciate the generous support of the physicians participating (including the occupational union of dermatologists), and especially the former patients’ willingness to participate.

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Corresponding author

Correspondence to Ana Nanette Tibubos.

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The protocol was approved by the Ethics Committee of the Statutory Physician Board of the State of Rhineland Palatinate (Reference number 837.161.11.7703).

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The authors declare that they have no conflict of interest.

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Tibubos, A.N., Ernst, M., Brähler, E. et al. Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study. Support Care Cancer 27, 2809–2818 (2019). https://doi.org/10.1007/s00520-018-4587-1

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  • Cancer
  • Fatigue
  • Malignant melanoma
  • Mental health