Beesley Vanessa L, Smithers B Mark, Khosrotehrani Kiarash, Khatun Mohsina, O'Rourke Peter, Hughes Maria Celia B, Malt Maryrose K, Zonta Mark J, Bayley Gerard J, Barbour Andrew P, Brown Lee J, D'Arcy Justin, Allan Christopher P, Green Adèle C
Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia.
Psychooncology. 2015 Jul;24(7):763-70. doi: 10.1002/pon.3718. Epub 2014 Oct 29.
The aim of this paper is to determine levels of supportive care needs, anxiety, depression and symptoms amongst patients newly diagnosed with localised invasive primary melanoma and if these varied amongst patients who had a sentinel lymph node biopsy (SLNB). We also considered quality of life compared with general population norms.
Patients newly diagnosed with clinical stage IB-II invasive melanoma were ascertained through Queensland hospitals, specialist clinics and pathology laboratories. Validated surveys measured 46 need items (Supportive Care Needs Survey-Short Form + melanoma subscale), anxiety and depression (Hospital Anxiety and Depression Scale) and quality of life and symptoms (Functional Assessment of Cancer Therapy-Melanoma). Regression models compared outcomes according to whether or not participants had a SLNB.
We surveyed 386 patients, 155 before and 231 after wide local excision, of whom 46% reported ≥1 moderate-level or high-level unmet need. The three highest needs were for help with fears about cancer spreading (17%), information about risk of recurrence (17%) and outcomes when spread occurred (16%). Those who had a SLNB were more likely to report a moderate or high unmet need for help with uncertainty about the future or with lymphoedema (p < 0.05). Overall, 32% of participants had anxiety and 15% had depression regardless of performance of SLNB. Melanoma-specific symptoms were worse in SLNB patients (p = 0.03). Compared with the general population, emotional well-being was lower amongst melanoma patients.
A substantial proportion of newly diagnosed patients with localised invasive melanoma need further melanoma-specific information and support with psychological concerns. Patients who have a SLNB clear of disease may need help with symptoms after surgery.
本文旨在确定新诊断为局限性侵袭性原发性黑色素瘤患者的支持性护理需求、焦虑、抑郁及症状水平，以及这些情况在接受前哨淋巴结活检（SLNB）的患者中是否存在差异。我们还将患者的生活质量与一般人群标准进行了比较。
通过昆士兰医院、专科诊所和病理实验室确定新诊断为临床分期IB-II期侵袭性黑色素瘤的患者。使用经过验证的调查问卷来测量46项需求项目（支持性护理需求调查问卷简表+黑色素瘤子量表）、焦虑和抑郁（医院焦虑抑郁量表）以及生活质量和症状（癌症治疗功能评估-黑色素瘤）。回归模型根据参与者是否接受SLNB对结果进行比较。
我们调查了386例患者，其中155例在广泛局部切除术前，231例在术后，46%的患者报告有≥1项中度或高度未满足的需求。需求最高的三项分别是关于癌症扩散恐惧的帮助（17%）、复发风险信息（17%）以及扩散发生时的结果（16%）。接受SLNB的患者更有可能报告在应对未来不确定性或淋巴水肿方面有中度或高度未满足的需求（p<0.05）。总体而言，无论是否进行SLNB，32%的参与者有焦虑，15%的参与者有抑郁。SLNB患者的黑色素瘤特异性症状更严重（p=0.03）。与一般人群相比，黑色素瘤患者的情绪幸福感较低。
相当一部分新诊断的局限性侵袭性黑色素瘤患者需要进一步的黑色素瘤特异性信息以及心理问题方面的支持。前哨淋巴结活检结果为无疾病的患者术后可能需要症状方面的帮助。
