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Anxiety and depression after diagnosis of high-risk primary cutaneous melanoma: a 4-year longitudinal study

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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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Authors and Affiliations

  1. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    Vanessa L. Beesley, Maria Celia B. Hughes, Maryrose K. Malt, Lena A. von Schuckmann & Adèle C. Green

  2. Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia

    B. Mark Smithers

  3. The University of Queensland, UQ Centre for Clinical Research & The University of Queensland Diamantina Institute, Experimental Dermatology Group, QLD, Brisbane, Australia

    Kiarash Khosrotehrani

  4. Cancer Research UK Manchester Institute, and School of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Adèle C. Green

Authors
  1. Vanessa L. Beesley
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  2. Maria Celia B. Hughes
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  3. B. Mark Smithers
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  4. Kiarash Khosrotehrani
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  6. Lena A. von Schuckmann
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  7. Adèle C. Green
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Correspondence to Vanessa L. Beesley.

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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

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