Psychological and behavioral symptoms in patients with melanoma: A systematic review and meta-analysis.

Publisher: Wiley Country of Publication: England NLM ID: 9214524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1099-1611 (Electronic) Linking ISSN: 10579249 NLM ISO Abbreviation: Psychooncology Subsets: MEDLINE

Original Publication: Chichester, W. Sussex, England : Wiley, c1992-

Melanoma*/epidemiology ; Skin Neoplasms*/epidemiology ; Sleep Wake Disorders*/epidemiology; Humans ; Quality of Life ; Depression/epidemiology ; Depression/therapy ; Fatigue/epidemiology ; Fatigue/therapy

Objective: Improved survival rates have made it increasingly important for clinicians to focus on cancer survivorship issues affecting the quality of life of melanoma patients. To provide a comprehensive overview of the disease and treatment-related issues affecting such patients, we conducted a systematic review and meta-analysis of the literature to estimate the prevalence of symptoms of depression, anxiety, fatigue, sleep disturbance, and cognitive problems among melanoma patients, both uveal and cutaneous, before, during and after treatment.
Methods: The review was preregistered with PROSPERO (#CRD42020189847) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of the literature published up until June 2022 was undertaken using PubMed, PsycInfo, the Cochrane Library, and CINAHL. Two independent reviewers screened 1418 records and quality-rated included studies. The reported prevalence rates of symptoms were pooled using a random-effects model.
Results: Sixty-six studies including a total of 12,400 melanoma patients published between 1992 and 2022 were included. Pooled prevalence rates ranged from 6% to 16% for depression and 7%-30% for anxiety across diagnoses (uveal and cutaneous melanoma) and assessment time points. One third of the patients (35%) reported clinically significant fatigue, 20%-44% had cognitive complaints, while prevalence of sleep disturbance was not reported. Quality assessment indicated that 80% of the studies were of good quality.
Conclusion: A large body of research shows that depression and anxiety symptoms are prevalent in melanoma patients before, during and after treatment. However, research examining other symptoms known to affect quality of life, such as fatigue, sleep disturbances, and cognitive problems, is still needed.
(© 2023 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Dang M, Zon L. Epigenetic regulation in melanoma. In: Fisher DE, Bastian BC, eds. Melanoma. Springer; 2019:83-98.
Sood S, Jayachandiran R, Pandey S. Current advancements and novel strategies in the treatment of metastatic melanoma. Integr Cancer Ther. 2021;20:1534735421990078. https://doi.org/10.1177/1534735421990078.
Curti BD, Faries MB. Recent advances in the treatment of melanoma. N Engl J Med. 2021;384(23):2229-2240. https://doi.org/10.1056/nejmra2034861.
Arnold M, Singh D, Laversanne M, et al. Global burden of cutaneous melanoma in 2020 and projections to 2040. JAMA Dermatol. 2022;158(5):495-503. https://doi.org/10.1001/jamadermatol.2022.0160.
Schadendorf D, van Akkooi ACJ, Berking C, et al. Melanoma. Lancet. 2018;392(10151):971-984. https://doi.org/10.1016/s0140-6736(18)31559-9.
Burns D, George J, Aucoin D, et al. The pathogenesis and clinical management of cutaneous melanoma: an evidence-based review. J Med Imaging Radiat Sci. 2019;50(3):460-469.e1. https://doi.org/10.1016/j.jmir.2019.05.001.
Davis LE, Shalin SC, Tackett AJ. Current state of melanoma diagnosis and treatment. Cancer Biol Ther. 2019;20(11):1366-1379. https://doi.org/10.1080/15384047.2019.1640032.
Raimonds K. Melanoma. In: Franca K, Lotti T, eds. Advances in Integrative Dermatology. Wiley; 2019:271-289.
Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Long-term outcomes with nivolumab plus ipilimumab or nivolumab alone versus ipilimumab in patients with advanced melanoma. J Clin Oncol. 2021;40(2):127-137. https://doi.org/10.1200/jco.21.02229.
Ascierto PA, Dummer R, Gogas HJ, et al. Update on tolerability and overall survival in COLUMBUS: landmark analysis of a randomised phase 3 trial of encorafenib plus binimetinib vs vemurafenib or encorafenib in patients with BRAF V600-mutant melanoma. Eur J Cancer. 2020;126:33-44. https://doi.org/10.1016/j.ejca.2019.11.016.
Topalian SL, Drake CG, Pardoll DM. Immune checkpoint blockade: a common denominator approach to cancer therapy. Cancer Cell. 2015;27(4):450-461. https://doi.org/10.1016/j.ccell.2015.03.001.
Prieto PA, Yang JC, Sherry RM, et al. CTLA-4 blockade with ipilimumab: long-term follow-up of 177 patients with metastatic melanoma. Clin Cancer Res. 2012;18(7):2039-2047. https://doi.org/10.1158/1078-0432.ccr-11-1823.
Wolchok JD, Neyns B, Linette G, et al. Ipilimumab monotherapy in patients with pretreated advanced melanoma: a randomised, double-blind, multicentre, phase 2, dose-ranging study. Lancet Oncol. 2010;11(2):155-164. https://doi.org/10.1016/s1470-2045(09)70334-1.
Queirolo P, Boutros A, Tanda E, Spagnolo F, Quaglino P. Immune-checkpoint inhibitors for the treatment of metastatic melanoma: a model of cancer immunotherapy. Semin Cancer Biol. 2019;59:290-297. https://doi.org/10.1016/j.semcancer.2019.08.001.
Lee N, Zakka LR, Mihm MC, Jr, Schatton T. Tumour-infiltrating lymphocytes in melanoma prognosis and cancer immunotherapy. Pathology. 2016;48(2):177-187. https://doi.org/10.1016/j.pathol.2015.12.006.
Weber J. Immunotherapy for melanoma. Curr Opin Oncol. 2011;23(2):163-169. https://doi.org/10.1097/cco.0b013e3283436e79.
Holland JC. Psycho-oncology: overview, obstacles and opportunities. Psycho-Oncology. 2018;27(5):1364-1376. https://doi.org/10.1002/pon.4692.
Miaskowski C, Dodd M, Lee K. Symptom clusters: the new frontier in symptom management research. J Natl Cancer Inst Monogr. 2004;2004(32):17-21. https://doi.org/10.1093/jncimonographs/lgh023.
Barsevick AM, Whitmer K, Nail LM, Beck SL, Dudley WN. Symptom cluster research: conceptual, design, measurement, and analysis issues. J Pain Symptom Manag. 2006;31(1):85-95. https://doi.org/10.1016/j.jpainsymman.2005.05.015.
Xu S, Thompson W, Ancoli-Israel S, Liu L, Palmer B, Natarajan L. Cognition, quality-of-life, and symptom clusters in breast cancer: using Bayesian networks to elucidate complex relationships. Psycho-Oncology. 2017;27(3):802-809. https://doi.org/10.1002/pon.4571.
Bickel EA, Auener AM, Ranchor AV, Fleer J, Schroevers MJ. Understanding care needs of cancer patients with depressive symptoms: the importance of patients' recognition of depressive symptoms. Psycho-Oncology. 2022;31(1):62-69. https://doi.org/10.1002/pon.5779.
Treanor CJ, Donnelly M. The late effects of cancer and cancer treatment: a rapid review. J Community Support Oncol. 2014;12(4):137-148. https://doi.org/10.12788/jcso.0035.
Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349-5361. https://doi.org/10.1002/cncr.24561.
Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol. 2011;29(4):413-420. https://doi.org/10.1200/jco.2010.28.4455.
Prasad SM, Eggener SE, Lipsitz SR, Irwin MR, Ganz PA, Hu JC. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. J Clin Oncol. 2014;32(23):2471-2478. https://doi.org/10.1200/jco.2013.51.1048.
Strom L, Danielsen JT, Amidi A, Cardenas Egusquiza AL, Wu LM, Zachariae R. Sleep during oncological treatment - a systematic review and meta-analysis of associations with treatment response, time to progression and survival. Front Neurosci. 2022;16:817837. https://doi.org/10.3389/fnins.2022.817837.
Kasparian NA, McLoone KJ, Butow NP. Psychological responses and coping strategies among patients with malignant melanoma - a systematic review of the literature. Arch Dermatol. 2009;145(12):1415-1427. https://doi.org/10.1001/archdermatol.2009.308.
Anchouche S, Liu J, Zaguia F, Nassrallah G, Deschenes J. Quality of life considerations in uveal melanoma patients: a systematic review. Can J Ophthalmol. 2020;55(5):413-423. https://doi.org/10.1016/j.jcjo.2020.05.010.
Miniati M, Fabrini MG, Genovesi Ebert F, et al. Quality of life, depression, and anxiety in patients with uveal melanoma: a review. J Oncol. 2018;2018:5253109. https://doi.org/10.1155/2018/5253109.
Kasparian NA. Psychological stress and melanoma: are we meeting our patients' psychological needs? Clin Dermatol. 2013;31(1):41-46. https://doi.org/10.1016/j.clindermatol.2011.11.005.
Lindqvist Bagge AS, Wesslau H, Cizek R, et al. Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: a systematic review. Eur J Surg Oncol. 2022;48(2):312-319. https://doi.org/10.1016/j.ejso.2021.09.013.
Lynch Kelly D, Dickinson K, Hsiao CP, et al. Biological basis for the clustering of symptoms. Semin Oncol Nurs. 2016;32(4):351-360. https://doi.org/10.1016/j.soncn.2016.08.002.
Kwekkeboom KL. Cancer symptom cluster management. Semin Oncol Nurs. 2016;32(4):373-382. https://doi.org/10.1016/j.soncn.2016.08.004.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-2012. https://doi.org/10.1001/jama.283.15.2008.
Booth A, Clarke M, Dooley G, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2. https://doi.org/10.1186/2046-4053-1-2.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.
Sackett DL, Rosenberg W, et al. Evidence-based Medicine: How to Practice and Teach. Churchill Livingstone; 1997.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22(3):276-282. https://doi.org/10.11613/bm.2012.031.
Lung NH. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. National Institutes of Health; 2014. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration; 2011.
Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634. https://doi.org/10.1136/bmj.315.7109.629.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455-463. https://doi.org/10.1111/j.0006-341x.2000.00455.x.
von Hippel PT. The heterogeneity statistic I2 can be biased in small meta-analyses. BMC Med Res Methodol. 2015;15(1):35. https://doi.org/10.1186/s12874-015-0024-z.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to Meta-Analysis. John Wiley & Sons; 2011.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive Meta-Analysis Version 3. Biostat; 2013.
Caraceni A, Martini F, Belli L, et al. Neuropsychological and neurophysiological assessment of the central effects of interleukin-2 administration. Eur J Cancer. 1993;29A(9):1266-1269. https://doi.org/10.1016/0959-8049(93)90070-v.
Damato B, Hope-Stone L, Cooper B, et al. Patient-reported outcomes and quality of life after treatment of choroidal melanoma: a comparison of enucleation versus radiotherapy in 1596 patients. Am J Ophthalmol. 2018;193:230-251. https://doi.org/10.1016/j.ajo.2018.03.015.
Brown SL, Fisher PL, Hope-Stone L, et al. Predictors of long-term anxiety and depression in uveal melanoma survivors: a cross-lagged five-year analysis. Psycho-Oncology. 2020;29(11):1864-1873. https://doi.org/10.1002/pon.5514.
Bøhn S-KH, Thorsen L, Kiserud CE, et al. Chronic fatigue and associated factors among long-term survivors of cancers in young adulthood. Acta Oncol. 2019;58(5):753-762. https://doi.org/10.1080/0284186x.2018.1557344.
Fu MR, Anderson CM, McDaniel R, Armer J. Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study. Oncol Nurs Forum. 2002;29(6):961-966. https://doi.org/10.1188/02.onf.961-966.
Rogiers A, Leys C, Lauwyck J, et al. Neurocognitive function, psychosocial outcome, and health-related quality of life of the first-generation metastatic melanoma survivors treated with ipilimumab. J Immunol Res. 2020;2020:2192480. https://doi.org/10.1155/2020/2192480.
Rogiers A, Leys C, De Cremer J, et al. Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study. Support Care Cancer. 2020;28(7):3267-3278. https://doi.org/10.1007/s00520-019-05168-3.
Boekhout AH, Rogiers A, Jozwiak K, et al. Health-related quality of life of long-term advanced melanoma survivors treated with anti-CTLA-4 immune checkpoint inhibition compared to matched controls. Acta Oncol. 2021;60(1):69-77. https://doi.org/10.1080/0284186x.2020.1818823.
Paterson AG, Trask PC, Wagner LI, Esper P, Redman B. Validation of the FACT-BRM with interferon-α treated melanoma patients. Qual Life Res. 2005;14(1):133-139. https://doi.org/10.1007/s11136-004-1694-x.
Tibubos AN, Ernst M, Brahler E, et al. Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study. Support Care Cancer. 2019;27(8):2809-2818. https://doi.org/10.1007/s00520-018-4587-1.
Hyatt A, Drosdowsky A, Williams N, et al. Exercise behaviors and fatigue in patients receiving immunotherapy for advanced melanoma: a cross-sectional survey via social media. Integr Cancer Ther. 2019;18:1534735419864431. https://doi.org/10.1177/1534735419864431.
Bartels F, Stronisch T, Farmer K, Rentzsch K, Kiecker F, Finke C. Neuronal autoantibodies associated with cognitive impairment in melanoma patients. Ann Oncol. 2019;30(5):823-829. https://doi.org/10.1093/annonc/mdz083.
Caraceni A, Martini C, Belli F, et al. Neuropsychological and neurophysiological assessment of the central effects of interleukin-2 administration. Eur J Cancer. 1993;29a(9):1266-1269. https://doi.org/10.1016/0959-8049(93)90070-v.
Trivedi R, Man H, Madut A, et al. Irregular sleep/wake patterns are associated with reduced quality of life in post-treatment cancer patients: a study across three cancer cohorts. Front Neurosci. 2021;15:700923. https://doi.org/10.3389/fnins.2021.700923.
World_Health_Organization. Depressive Disorder (Depression). World_Health_Organization; 2023. https://www.who.int/news-room/fact-sheets/detail/depression.
Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897-910. https://doi.org/10.1017/s003329171200147x.
Bol KF, Ellebaek E, Hoejberg L, et al. Real-world impact of immune checkpoint inhibitors in metastatic uveal melanoma. Cancers. 2019;11(10):1489. https://doi.org/10.3390/cancers11101489.
Rietschel P, Panageas KS, Hanlon C, Patel A, Abramson DH, Chapman PB. Variates of survival in metastatic uveal melanoma. J Clin Oncol. 2005;23(31):8076-8080. https://doi.org/10.1200/jco.2005.02.6534.
Hashemi SM, Rafiemanesh H, Aghamohammadi T, et al. Prevalence of anxiety among breast cancer patients: a systematic review and meta-analysis. Breast Cancer. 2020;27(2):166-178. https://doi.org/10.1007/s12282-019-01031-9.
Syrowatka A, Motulsky A, Kurteva S, et al. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat. 2017;165(2):229-245. https://doi.org/10.1007/s10549-017-4290-9.
Moreira A, Heinzerling L, Bhardwaj N, Friedlander P. Current melanoma treatments: where do we stand? Cancers. 2021;13(2):221. https://doi.org/10.3390/cancers13020221.
McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027-1035. https://doi.org/10.1016/j.jpsychires.2011.03.006.
Kessler CR, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States - results from the National Comorbidity Survey. Arch Gen Psychiatr. 1994;51(1):8-19. https://doi.org/10.1001/archpsyc.1994.03950010008002.
Kuehner C. Why is depression more common among women than among men? Lancet Psychiatr. 2017;4(2):146-158. https://doi.org/10.1016/s2215-0366(16)30263-2.
Altemus M, Sarvaiya N, Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35(3):320-330. https://doi.org/10.1016/j.yfrne.2014.05.004.
Howell DaO K, Olsen K. Distress-the 6th vital sign. Curr Oncol. 2011;18(5):208-210. https://doi.org/10.3747/co.v18i5.790.
Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev. 2012;11(1):CD007064. https://doi.org/10.1002/14651858.cd007064.pub2.
Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2019;381(16):1535-1546. https://doi.org/10.1056/nejmoa1910836.
Luigjes-Huizer YL, Tauber NM, Humphris G, et al. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psycho-Oncology. 2022;31(6):879-892. https://doi.org/10.1002/pon.5921.

Keywords: cancer; cancer survivorship; late effects; melanoma; meta-analysis; oncology; prevalence; psycho-oncology; side effects

Date Created: 20230627 Date Completed: 20230809 Latest Revision: 20230809

20250114

10.1002/pon.6184

37370196