Psychosocial outcome and health-related quality of life (HRQoL) in advanced melanoma survivors.

Abstract

162 Background: An increasing proportion of advanced melanoma patients (pts), treated with immune checkpoint inhibitors and/or BRAF/MEK-inhibitors, achieve long-term survival. The traumatic experience of melanoma progression, which often involves the brain, puts them at high risk for emotional and neurocognitive function (NCF) disturbances that may negatively impact their HRQoL. Methods: Pts with advanced melanoma (AJCC stages IIIC or IV) who were in remission for at least 1 year after treatment initiation were included in this ongoing single-center therapeutically non-interventional clinical trial. Data on psychosocial outcome and HRQoL were collected using 6 validated questionnaires, a semi-structured psychiatric examination (SSPE) and a computer based neuro-cognitive function (NCF) test. Results: Test results from the first 24 pts (9M/15F; median age 58y (29-87) were analysed. Mean EORTC Global Health Score was significant lower than the European Mean (t[23]=2.713, p= 0.006). The SSPE revealed that all pts reported fear of recurrence; 19 pts (79%) suffered from feelings of insecurity with daily worrying about the disease, associated with a fear of dying. Irritability was a prominent complaint in 18 pts [75%]). Twelve pts (50%) received a message of no hope at diagnosis of metastatic disease which had a persistent major psychological impact. Suicidal ideation occurred in 3 pts (13%), 1 pt (4%) made a suicide attempt (in the absence of depression). Nine pts (38%) reported worrying about their family, 4 pts (17%) had relational problems and 7 pts (29%) had financial problems related to the disease. Despite frequent fatigue complaints, only 4 pts (17%) had mild excessive sleepiness on the Epworth Sleepiness Scale and 9 pts (38%) on the Fatigue Severity Scale. The HADS results indicated a greater occurrence of anxiety compared to depression (NA=10, ND=6). Twenty pts (83%) reported memory complaints, but only 7 pts (29%) had elevated scores on the Cognitive Failure Questionnaire (CFQ). Conclusions: Advanced melanoma survivors are at risk of emotional and neurocognitive disturbances impacting on their HRQoL. Timely detection of psychosocial and neurocognitive problems and adapted care are indicated.