Abstract
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.
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Acknowledgments
We acknowledge the valuable contributions of our study staff Angela Carroll and Valerie Logan and clinical collaborators Doctors Mark Zonta (The Townsville Hospital and North Queensland Minimally Invasive Surgery), Gerard Bayley (Princess Alexandra Hospital and Phoenix Plastic Surgery, Greenslopes), Andrew Barbour (Princess Alexandra Hospital and Gastrointestinal & Soft Tissue Clinic, Greenslopes), Christopher Allan (Princess Alexandra Hospital and Mater Public & Private Hospital), Ivan Robertson (Royal Brisbane and Women’s Hospital), Lee Brown (Coastal Plastic Surgery, Sunshine Coast), Justin D’Arcy (Nambour Hospital & Sunshine Coast Private Hospital Medical Centre), David Weedon (Sullivan Nicolaides Pathology), Dominic Wood (IQ Pathology), and Richard Williamson (Zenith Specialist Pathology). We also thank Dr. Gunter Hartel for his help with formatting the trajectory figures. Finally, we thank all study participants.
Funding
This study and VL Beesley were funded by the Australian National Health and Medical Research Council Program (grant nos. 552429, 1073898). K Khosrotehrani was funded by a National Health and Medical Research Council fellowship (No. 1023371).
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Beesley, V.L., Hughes, M.C.B., Smithers, B.M. et al. Anxiety and depression after diagnosis of high-risk primary cutaneous melanoma: a 4-year longitudinal study. J Cancer Surviv 14, 712–719 (2020). https://doi.org/10.1007/s11764-020-00885-9
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DOI: https://doi.org/10.1007/s11764-020-00885-9