Assessment of quality of life (QOL) in melanoma patients: A systematic review of the literature

Abstract

8211 Background:Because of the increase in incidence and the early age of onset, melanoma has emerged as an important public health problem. Among all cancer patients, quality of life (QOL) has repeatedly been shown to be an independent predictor of survival and response to therapy. A systematic review was performed to examine QOL instruments utilized in melanoma patients. Methods:A comprehensive literature search was performed in Medline (1966–2003), Current Contents, Cancerlit, and Cochrane Library using search terms related to QOL and melanoma. The results were supplemented by hand searching and cross-referencing. Selection criteria included: publications in English language journals, study population with a majority of melanoma patients; and measures of QOL as a primary or secondary objective. Raw data were extracted and categorized by study design. Study populations, instruments utilized, domains evaluated, and QOL results were summarized. Results:52 published reports were identified; 26 met inclusion criteria. Study designs included 6 prospective cohort studies, 7 clinical trials, and 13 cross-sectional studies. QOL endpoints were the primary objective in 19 studies. Eight instruments were used to measure overall QOL; 35 instruments were used to measure individual domains. Anxiety, depression, stress, and distress, which are prevalent among all cancer patients, were identified. Additionally, patients with early stage melanoma noted distress with regard to visible surgical scarring. With late stage melanoma, there was a notable deterioration in physical well-being (fatigue) and psychological adjustment (isolation and lack of independence). Treatment related differences were identified in overall QOL for patients receiving high-dose interferon and biochemotherapy. Heterogeneity of the studies' precluded a comprehensive statistical analysis. Conclusions:Given the lack of consistency, it is difficult to interpret published QOL results in melanoma patients. This analysis indicates that there is an overwhelming need for a melanoma-specific instrument to reliably assess QOL in future melanoma treatment trials. No significant financial relationships to disclose.