Beesley Vanessa L, Smithers B Mark, O'Rourke Peter, Janda Monika, Khosrotehrani Kiarash, Green Adèle C
Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, QLD, 4029, Australia.
Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia.
Support Care Cancer. 2017 Jan;25(1):93-102. doi: 10.1007/s00520-016-3378-9. Epub 2016 Aug 25.
We aimed to describe variations in unmet supportive care needs of patients diagnosed with localised melanoma at high risk of recurrence and factors associated with initial and persisting moderate-to-high needs.
We ascertained 386 patients diagnosed with clinical stage IB-II melanoma and administered surveys every 6 months for 2 years. The proportion experiencing at least one moderate-to-high need was assessed among salient subgroups: 306 patients with no previous melanoma and 80 with previous melanoma at enrolment, 30 who experienced disease recurrence during follow-up and 31 who developed another primary. Baseline factors associated with (a) needs at enrolment and (b) persistent needs over 2 years (or as long as disease-free) were identified by logistic regression analyses.
The proportion of patients with needs substantially declined over the first 6 months (if no previous melanoma, from 48 to 22 %, p < 0.001; previous melanoma, 35 to 17 %, p = 0.007), and in those remaining disease-free, needs declined further by 24 months (to 14 and 6 % respectively). By contrast, 50 % of those experiencing recurrence, and 39 % of those who developed another primary, reported needs. Stressful life events and anxiety were associated with needs at enrolment. At least one need, mainly fear of recurrence, persisted in 22 % of disease-free participants. Persistent needs were predicted by age, depression, anxiety and other stressful life events.
Melanoma patients' needs peak when first diagnosed and if disease recurs. Younger people or those experiencing additional stressful events, anxiety or depression are more likely to experience persistent needs and may benefit from tailored support.
我们旨在描述诊断为局部复发性高危黑色素瘤患者未满足的支持性护理需求的变化，以及与初始和持续存在的中度至高度需求相关的因素。
我们确定了386例诊断为临床I B-II期黑色素瘤的患者，并在2年内每6个月进行一次调查。在显著亚组中评估至少有一项中度至高度需求的比例：306例既往无黑色素瘤患者和80例入组时曾患黑色素瘤患者，30例在随访期间疾病复发患者和31例发生另一种原发性疾病患者。通过逻辑回归分析确定与（a）入组时的需求和（b）2年（或只要无病）期间持续需求相关的基线因素。
需求患者的比例在最初6个月内大幅下降（如果既往无黑色素瘤，从48%降至22%，p<0.001；既往有黑色素瘤，从35%降至17%，p = 0.007），在那些仍无病的患者中，需求在24个月时进一步下降（分别降至14%和6%）。相比之下，50%的复发患者和39%发生另一种原发性疾病的患者报告有需求。紧张的生活事件和焦虑与入组时的需求相关。在22%的无病参与者中，至少有一种需求（主要是对复发的恐惧）持续存在。持续需求可通过年龄、抑郁、焦虑和其他紧张生活事件预测。
黑色素瘤患者的需求在首次诊断时以及疾病复发时达到峰值。年轻人或经历额外紧张事件、焦虑或抑郁的人更有可能有持续需求，可能受益于量身定制的支持。
