Understanding the Psychological Impact of Melanoma

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Cancer is a leading cause of morbidity and mortality worldwide, with an increasing number of cases due to rising incidence and improved survival rates.¹ However, alongside the physical toll of cancer, patients often experience significant psychological distress, affecting their overall quality of life. It is estimated that approximately 50% of patients with cancer report emotional distress, with one-third suffering from anxiety, depression, or adjustment disorders. Such distress can negatively influence treatment adherence and outcomes.² Therefore, assessing and managing psycho-oncological distress is a crucial component of comprehensive cancer care.

Methods

A recent retrospective study evaluated the psycho-oncological burden in 820 patients with melanoma treated in an outpatient setting.³ Patients were screened using the Distress Thermometer (DT) and the National Comprehensive Cancer Network (NCCN) Problem List to identify emotional, physical, and practical challenges affecting their well-being. DT scores of ≥ 5 were considered above the threshold for significant distress. Statistical analysis was conducted to determine factors associated with elevated DT scores, utilizing binary logistic regression.

Results

Patient Demographics

Among the 820 participants, there was an even gender distribution (49.5% men, 50.5% women) with a median age of 63 years. The majority had cutaneous melanoma (79.4%), and 44% had advanced melanoma (Stage III or IV). Only 14.6% received systemic treatment for metastases.

Psychological Distress and Associated Factors

More than 40% of patients had DT values over the threshold, necessitating psycho-oncological support. Physical concerns, including pain (36.2%), fatigue (35.7%), and sleep disturbances (31.9%), were commonly reported. Additionally, 30.3% of patients expressed significant worry, and nearly 30% reported fears or nervousness. Logistic regression identified several significant risk factors for elevated distress levels, including:

• Gender – Women (OR=1.420, p=0.016)
• Advanced melanoma stage (OR=1.567 for Stage III, OR=2.602 for Stage IV)
• Younger age (OR=0.985, p=0.002)
• Work-related concerns (OR=3.958, p=0.003)
• Emotional concerns such as fears (OR=2.677, p=0.004)
• Physical symptoms like tingling in hands/feet (OR=2.383, p=0.011) and sleep issues (OR=2.207, p=0.006)
• Spiritual concerns, including loss of faith (OR=12.717, p=0.042)

Discussion

The study found psycho-oncological distress significantly impacts patients with melanoma, necessitating targeted interventions. While clinicians primarily focus on medical treatment, psychosocial support is often overlooked due to time constraints. Studies indicate that brief consultations limit the opportunity to address patients' emotional and social concerns, highlighting the need for systematic screening tools like the DT and NCCN Problem List.

The findings align with previous studies showing that practical and family-related concerns, as well as physical symptoms, contribute to distress. Younger patients, particularly those balancing work or academic responsibilities, may require additional psychosocial support. Additionally, the study identified spiritual distress as a noteworthy concern, underscoring the need for holistic patient care.

Clinical Implications

To improve psycho-oncological care, researchers suggested oncology departments should integrate standardized distress screening into routine practice. Particular attention should be given to at-risk groups, including young adults, women, and those with advanced-stage disease. Evidence-based interventions such as psychoeducation, cognitive-behavioral therapy, and support groups can enhance quality of life and potentially improve treatment adherence and outcomes.

Conclusion

This study underscores the necessity of recognizing and addressing psycho-oncological distress in patients with melanoma. While over 40% of patients experienced significant distress, certain factors—including disease stage, gender, and specific concerns—heightened vulnerability. As psycho-oncological distress can fluctuate over time, continuous assessment and targeted interventions are essential to enhance patient well-being. Researchers suggested future research should focus on refining psychosocial care strategies, particularly for younger patients and those experiencing spiritual distress, to provide a more personalized approach to oncology care.

References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
2. Grassi L. Psychiatric and psychosocial implications in cancer care: the agenda of psycho-oncology. Epidemiol Psychiatr Sci. 2020;29:e89. Published 2020 Jan 9. doi:10.1017/S2045796019000829
3. Reitmajer M, Riedel P, Garbe C, Schäffeler N, Eigentler TK, Forschner A. Distress and its determinants in 820 consecutive melanoma patients. Cancer Med. 2025;14(6):e70820. doi:10.1002/cam4.70820