'Living beneath the sword of damocles': perceptions of risk and fears of cancer recurrence amongst Australian melanoma survivors at high or moderate risk of developing new primary disease

Background: Despite continued progress in the clinical management of melanoma, patients continue to live at increased risk of developing new primary disease. This study examined risk perceptions, fears of cancer recurrence, melanoma-related behaviours, and satisfaction with clinical care amongst melanoma survivors at high or moderate risk of new primary disease.
Methods: Participants were recruited via the High Risk Clinic at the Sydney
Melanoma Diagnostic Centre (high risk group) or the Melanoma Institute
Australia (moderate risk group). Individuals at high risk (i.e. multiple melanoma diagnoses, or one primary melanoma and dysplastic naevus syndrome, DNS), or moderate risk (one melanoma and no DNS) completed a questionnaire assessing: psychological factors (e.g. fear of melanoma recurrence, risk perceptions, anxiety, depression); sun protection and skin cancer screening behaviours; satisfaction with clinical care; and demographic and clinical characteristics.
Results: 310 participants completed the survey (high risk n = 165; moderate
risk n = 145; response rate: 79%; 56% male; mean age: 59.5 years; SD = 12.8). Clinically-relevant levels of anxiety and depression, as measured by the HADS, were reported by 25% and 9% of participants, respectively. Seventy-three percent of participants reported clinically-relevant levels of fear of cancer recurrence, with mean scores similar between groups (t = −1.2, p = 0.2). Participants reported high levels of satisfaction with melanoma care. Path analysis is currently underway and will be presented at the meeting.
Conclusion: Melanoma patients experience a range of practical, emotional,
physical, and social challenges as a result of their diagnosis and treatment. For some people, these challenges may continue to have an impact long after initial diagnosis. Although many patients exhibit healthy psychological adjustment, this study found that 73% of moderate- to high-risk patients report levels of fear of cancer recurrence indicative of the need for clinical intervention. To be efficacious, psychological support must be offered to patients in a timely manner, and should be tailored to the individual’s needs and resources.